Interprofessional, simulation-based technology-enhanced learning to improve physical healthcare in psychiatry: The RAMPPS course.

PubMed

Akroyd, Mike; Jordan, Gary; Rowlands, Paul

2016-06-01

People with serious mental illness have reduced life expectancy compared with a control population, much of which is accounted for by significant physical comorbidity. Frontline clinical staff in mental health often lack confidence in recognition, assessment and management of such 'medical' problems. Simulation provides one way for staff to practise these skills in a safe setting. We produced a multidisciplinary simulation course around recognition and assessment of medical problems in psychiatric settings. We describe an audit of strategic and design aspects of the recognition and assessment of medical problems in psychiatric settings, using the Department of Health's 'Framework for Technology Enhanced Learning' as our audit standards. At the same time, as highlighting areas where recognition and assessment of medical problems in psychiatric settings adheres to these identified principles, such as the strategic underpinning of the approach, and the means by which information is collected, reviewed and shared, it also helps us to identify areas where we can improve. © The Author(s) 2014.

Student and Teacher Reflections on Indirectness as a Pragmatic Feature of Pharmacist-Patient Simulations

ERIC Educational Resources Information Center

Hussin, Virginia

2013-01-01

This article reports on a research process where focussed reflection on pharmacist-patient simulations led to meta-pragmatic awareness and directions for pedagogical practice. The research participants were third-year EAL pharmacy students, who were practising being pharmacists, and pharmacy staff members, who played the part of patients. Analysis…

DTkid: Interactive Simulation Software for Training Tutors of Children with Autism

ERIC Educational Resources Information Center

Randell, Tom; Hall, Martin; Bizo, Lewis; Remington, Bob

2007-01-01

Discrete-trial training (DTT) relies critically on implementation by trained tutors. We report three experiments carried out in the development of "DTkid"--interactive computer simulation software that presents "SIMon", a realistic virtual child with whom novice tutors can learn and practise DTT techniques. Experiments 1 and 2 exposed groups of…

Practising What We Preach: Justice and Ethical Instruction in Management Education

ERIC Educational Resources Information Center

Robbins, Tina L.; Jeffords, Ben C.

2009-01-01

Building on organizational justice research, we extended the study of classroom justice to management education. In the first study, we identified the criteria that business students use to define distributive, procedural, and interactional fairness. In a second study, we found that management students' perceptions of both procedural and…

Postgraduate Programmes on Environmental Water Resources Engineering and Management in Greek Universities

ERIC Educational Resources Information Center

Latinopoulos, Pericles; Angelidis, Panagiotis

2014-01-01

The management of complex water problems is nowadays being practised through new ways and approaches. Therefore, water engineers, planners and managers should be appropriately educated through modern undergraduate curricula and by well-designed postgraduate specialisation programmes. Within this framework, a study of the specific characteristics…

Feasibility and fidelity of practising surgical fixation on a virtual ulna bone

PubMed Central

LeBlanc, Justin; Hutchison, Carol; Hu, Yaoping; Donnon, Tyrone

2013-01-01

Background Surgical simulators provide a safe environment to learn and practise psychomotor skills. A goal for these simulators is to achieve high levels of fidelity. The purpose of this study was to develop a reliable surgical simulator fidelity questionnaire and to assess whether a newly developed virtual haptic simulator for fixation of an ulna has comparable levels of fidelity as Sawbones. Methods Simulator fidelity questionnaires were developed. We performed a stratified randomized study with surgical trainees. They performed fixation of the ulna using a virtual simulator and Sawbones. They completed the fidelity questionnaires after each procedure. Results Twenty-two trainees participated in the study. The reliability of the fidelity questionnaire for each separate domain (environment, equipment, psychological) was Cronbach α greater than 0.70, except for virtual environment. The Sawbones had significantly higher levels of fidelity than the virtual simulator (p < 0.001) with a large effect size difference (Cohen d < 1.3). Conclusion The newly developed fidelity questionnaire is a reliable tool that can potentially be used to determine the fidelity of other surgical simulators. Increasing the fidelity of this virtual simulator is required before its use as a training tool for surgical fixation. The virtual simulator brings with it the added benefits of repeated, independent safe use with immediate, objective feedback and the potential to alter the complexity of the skill. PMID:23883510

Teacher Self-Efficacy and Classroom Management Styles in Jordanian Schools

ERIC Educational Resources Information Center

Abu-Tineh, Abdullah M.; Khasawneh, Samar A.; Khalaileh, Huda A.

2011-01-01

Two main purposes guided this study. The first was to identify the degree to which Jordanian teachers practise classroom management styles in their classrooms and their level of teacher self-efficacy. The second purpose was to explore the relationships between classroom management styles and teacher self-efficacy. This study is quantitative in…

Effectiveness of a Brief Intervention Using Process-Based Mental Simulations in Promoting Muscular Strength in Physical Education

ERIC Educational Resources Information Center

Koka, Andre

2017-01-01

This study examined the effectiveness of a brief theory-based intervention on muscular strength among adolescents in a physical education setting. The intervention adopted a process-based mental simulation technique. The self-reported frequency of practising for and actual levels of abdominal muscular strength/endurance as one component of…

Relative Importance of Professional Practice and Engineering Management Competencies

ERIC Educational Resources Information Center

Pons, Dirk

2016-01-01

Problem: The professional practice of engineering always involves engineering management, but it is difficult to know what specifically to include in the undergraduate curriculum. Approach: The population of New Zealand practising engineers was surveyed to determine the importance they placed on specific professional practice and engineering…

Near-peer medical student simulation training.

PubMed

Cash, Thomas; Brand, Eleanor; Wong, Emma; Richardson, Jay; Athorn, Sam; Chowdhury, Faiza

2017-06-01

There is growing concern that medical students are inadequately prepared for life as a junior doctor. A lack of confidence managing acutely unwell patients is often cited as a barrier to good clinical care. With medical schools investing heavily in simulation equipment, we set out to explore if near-peer simulation training is an effective teaching format. Medical students in their third year of study and above were invited to attend a 90-minute simulation teaching session. The sessions were designed and delivered by final-year medical students using clinical scenarios mapped to the Sheffield MBChB curriculum. Candidates were required to assess, investigate and manage an acutely unwell simulated patient. Pre- and post-simulation training Likert scale questionnaires were completed relating to self-reported confidence levels. There is growing concern that medical students are inadequately prepared for life as a junior doctor RESULTS: Questionnaires were completed by 25 students (100% response rate); 52 per cent of students had no prior simulation experience. There were statistically significant improvements in self-reported confidence levels in each of the six areas assessed (p < 0.005). Thematic analysis of free-text comments indicated that candidates enjoyed the practical format of the sessions and found the experience useful. Our results suggest that near-peer medical student simulation training benefits both teacher and learner and that this simplistic model could easily be replicated at other medical schools. As the most junior members of the team, medical students are often confined to observer status. Simulation empowers students to practise independently in a safe and protected environment. Furthermore, it may help to alleviate anxiety about starting work as a junior doctor and improve future patient care. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Effect of different agronomic practises on greenhouse gas emissions, especially N2O and nutrient cycling

NASA Astrophysics Data System (ADS)

Koal, Philipp; Schilling, Rolf; Gerl, Georg; Pritsch, Karin; Munch, Jean Charles

2014-05-01

In order to achieve a reduction of greenhouse gas emissions, management practises need to be adapted by implementing sustainable land use. At first, reliable field data are required to assess the effect of different farming practises on greenhouse gas budgets. The conducted field experiment covers and compares two main aspects of agricultural management, namely an organic farming system and an integrated farming system, implementing additionally the effects of diverse tillage systems and fertilisation practises. Furthermore, the analysis of the alterable biological, physical and chemical soil properties enables a link between the impact of different management systems on greenhouse gas emissions and the monitored cycle of matter, especially the nitrogen cycle. Measurements were carried out on long-term field trials at the Research Farm Scheyern located in a Tertiary hilly landscape approximately 40 km north of Munich (South Germany). The long-term field trials of the organic and integrated farming system were started in 1992. Since then, parcels in a field (each around 0,2-0,4 ha) with a particular interior plot set-up have been conducted. So the 20 years impacts of different tillage and fertilisation practises on soil properties including trace gases were examined. Fluxes of CH4, N2O and CO2 are monitored since 2007 for the integrated farming system trial and since 2012 for the organic farming system trial using an automated system which consists of chambers (per point: 4 chambers, each covering 0,4 m2 area) with a motor-driven lid, an automated gas sampling unit, an on-line gas chromatographic analysis system, and a control and data logging unit (Flessa et al. 2002). Each chamber is sampled 3-4 times in 24 hours. The main outcomes are the analysis of temporal and spatial dynamics of greenhouse gas fluxes as influenced by management practice events (fertilisation and tillage) and weather effects (drying-rewetting, freezing-thawing, intense rainfall and dry periods) in both established systems and the creation of an impact study comparing the minimum tillage system with the conventional tillage system. Physical, chemical and biological soil properties (i.a. texture, mineral nitrogen and soil organic carbon) were monitored to aggregate the parameters and processes influencing the greenhouse gas fluxes. Moreover, to understand processes leading the greenhouse gas emissions, additional experiments under laboratory conditions (e.g. soil potential for trace gas formation) are included. Furthermore, with the comparison of the similar long-term field experiments (organic vs. integrated) more relevant data are ascertained to assess and calculate the global warming potential of different management and tillage systems.

Management of Neurogenic Bladder.

PubMed

Sripathi, Venkataramani; Mitra, Aparajita

2017-07-01

This article provides a comprehensive summary of the clinical approach, investigative modalities and management of a child with neurogenic bladder disease due to myelodysplasia. It is aimed at pediatric physicians and surgeons working in developing nations. The methodologies suggested are simple and can be practised even in resource poor regions. The goal of management is avoidance of Chronic kidney disease and for this, meticulous bladder management is the key.

Quality nursing care in the words of nurses.

PubMed

Burhans, Linda Maas; Alligood, Martha Raile

2010-08-01

This paper is a report of a study of the meaning of quality nursing care for practising nurses. Healthcare quality continues to be a subject of intense criticism and debate. Although quality nursing care is vital to patient outcomes and safety, meaningful improvements have been disturbingly slow. Analysis of quality care literature reveals that practising nurses are rarely involved in developing or defining improvement programs for quality nursing care. Therefore, two major study premises were that quality nursing care must be meaningful and relevant to nurses and that uncovering their meaning of quality nursing care could facilitate more effective improvement approaches. Using van Manen's hermeneutic phenomenology, meaning was revealed through analysis of interviews to answer the research question 'What is the lived meaning of quality nursing care for practising nurses?' Twelve nurses practising on medical or surgical adult units at general or intermediate levels of care within acute care hospitals in the United States of America were interviewed. Emerging themes were discovered through empirical and reflective analysis of audiotapes and transcripts. The data were collected in 2008. The revealed lived meaning of quality nursing care for practising nurses was meeting human needs through caring, empathetic, respectful interactions within which responsibility, intentionality and advocacy form an essential, integral foundation. Nurse managers could develop strategies that support nurses better in identifying and delivering quality nursing care reflective of responsibility, caring, intentionality, empathy, respect and advocacy. Nurse educators could modify education curricula to model and teach students the intrinsic qualities identified within these meanings of quality nursing care.

Interprofessional, simulation-based technology-enhanced learning to improve physical health care in psychiatry: The recognition and assessment of medical problems in psychiatric settings course.

PubMed

Akroyd, Mike; Jordan, Gary; Rowlands, Paul

2016-06-01

People with serious mental illness have reduced life expectancy compared with a control population, much of which is accounted for by significant physical comorbidity. Frontline clinical staff in mental health often lack confidence in recognition, assessment and management of such 'medical' problems. Simulation provides one way for staff to practise these skills in a safe setting. We produced a multidisciplinary simulation course around recognition and assessment of medical problems in psychiatric settings. We describe an audit of strategic and design aspects of the recognition and assessment of medical problems in psychiatric settings course, using the Department of Health's 'Framework for Technology Enhanced Learning' as our audit standards. At the same time as highlighting areas where recognition and assessment of medical problems in psychiatric settings adheres to these identified principles, such as the strategic underpinning of the approach, and the means by which information is collected, reviewed and shared, it also helps us to identify areas where we can improve. © The Author(s) 2014.

'Practising under your own Pin'- a description of the transition experiences of newly qualified midwives.

PubMed

Avis, Mark; Mallik, Maggie; Fraser, Diane M

2013-11-01

Transition experiences of newly qualified midwives were examined in depth during the third phase of a UK evaluation study of midwifery education. The fitness to practise and the retention of newly qualified nursing and midwifery graduates are pressing concerns for health care managers. The advantages of preceptorship are reported in the literature but the content and timing of schemes remain unclear. A semi-structured diary was kept for up to 6 months by 35 newly qualified midwives in 18 work sites covering all countries in the UK. The preceptor and supervisor of midwives for each newly qualified midwife completed short questionnaires about their preceptee's performance, and a further sub-sample of newly qualified midwives and preceptors participated in a semi-structured interview. Data were analysed to elicit aspects of newly qualified midwives transition experiences. Findings confirm that structured preceptorship schemes are not widely available. Newly qualified midwives primarily obtained transition support from members of the midwifery team. Although perceived as competent, there is no demarcation point in becoming confident to practise as a registered practitioner. Implications for managers include the importance of a supportive culture within clinical teams for successful transition and the introduction of structured preceptorship schemes facilitated by appropriate rotation patterns. © 2012 John Wiley & Sons Ltd.

Relative importance of professional practice and engineering management competencies

NASA Astrophysics Data System (ADS)

Pons, Dirk

2016-09-01

Problem: The professional practice of engineering always involves engineering management, but it is difficult to know what specifically to include in the undergraduate curriculum. Approach: The population of New Zealand practising engineers was surveyed to determine the importance they placed on specific professional practice and engineering management competencies. Findings: Results show that communication and project planning were the two most important topics, followed by others as identified. The context in which practitioners use communication skills was found to be primarily with project management, with secondary contexts identified. The necessity for engineers to develop the ability to use multiple soft skills in an integrative manner is strongly supported by the data. Originality: This paper is one of only a few large-scale surveys of practising engineers to have explored the soft skill attributes. It makes a didactic contribution of providing a ranked list of topics which can be used for designing the curriculum and prioritising teaching effort, which has not previously been achieved. It yields the new insight that combinations of topics are sometimes more important than individual topics.

The GP tests of competence assessment: which part best predicts fitness to practise decisions?

PubMed

Jayaweera, Hirosha Keshani; Potts, Henry W W; Keshwani, Karim; Valerio, Chris; Baker, Magdalen; Mehdizadeh, Leila; Sturrock, Alison

2018-01-02

The General Medical Council (GMC) conducts Tests of Competence (ToC) for doctors referred for Fitness to Practise (FtP) issues. GPs take a single best answer knowledge test, an Objective Structured Clinical Examination (OSCE), and a Simulated Surgery (SimSurg) assessment which is a simulated GP consultation. The aim of this study was to examine the similarities between OSCEs and SimSurg to determine whether each assessment contributed something unique to GP ToCs. A mixed methods approach was used. Data were collated on 153 GPs who were required to undertake a ToC as a part of being investigated for FtP issues between February 2010 and October 2016. Using correlation analysis, we examined to what degree performance on the knowledge test, OSCE, and SimSurg related to case examiner recommendations and FtP outcomes, including the unique predictive power of these three assessments. The outcome measures were case examiner recommendations (i) not fit to practise; ii) fit to practise on a limited basis; or iii) fit to practise) as well as FtP outcomes (i) erased/removed from the register; ii) having restrictions/conditions; or iii) be in good standing). For the qualitative component, 45 GP assessors were asked to rate whether they assess the same competencies and which assessment provides better feedback about candidates. There was significant overlap between OSCEs and SimSurg, p < 0.001. SimSurg had additional predictive power in the presence of OSCEs and the knowledge test (p = 0.030) in distinguishing doctors from different FtP categories, while OSCEs did not (p = 0.080). Both the OSCEs (p = 0.004) and SimSurg (p < 0.001) had significant negative correlations with case examiner recommendations when accounting for the effects of the other two assessments. Inductive thematic analysis of the responses to the questionnaire showed that assessors perceived OSCEs to be better suited to target specific knowledge and skills. SimSurg was thought to produce a more global picture as the scenarios more accurately portray a patient consultation. While all three assessments are strong predictors of both case examiner recommendations and FtP outcomes, our findings suggest that the efficiency of GP ToCs can be improved by removing some of this overlapping content.

Individualised patient care: a framework for guidelines.

PubMed

Redfern, S

It is assumed that individualised patient care (IPC) benefits both patients and nurses. This study set out to clarify what IPC means to nurses and how they practise it, as well as how it is experienced by patients. With some exceptions, IPC was not practised widely in the seven wards used as case studies. Even in the wards where it was more common, there were some examples of bad practice. Factors that facilitated IPC were: the personal qualities of the nurses; a shared understanding among the ward team of the goals of nursing care and what constitutes good practice; levels of staffing and skill mix; effective leadership and management of nursing work.

Preparation, Clinical Support, and Confidence of Speech-Language Therapists Managing Clients with a Tracheostomy in the UK

ERIC Educational Resources Information Center

Ward, Elizabeth; Morgan, Tessa; McGowan, Sue; Spurgin, Ann-Louise; Solley, Maura

2012-01-01

Background: Literature regarding the education, training, clinical support and confidence of speech-language therapists (SLTs) working with patients with a tracheostomy is limited; however, it suggests that many clinicians have reduced clinical confidence when managing this complex population, many face role and team challenges practising in this…

Learning through simulated independent practice leads to better future performance in a simulated crisis than learning through simulated supervised practice.

PubMed

Goldberg, A; Silverman, E; Samuelson, S; Katz, D; Lin, H M; Levine, A; DeMaria, S

2015-05-01

Anaesthetists may fail to recognize and manage certain rare intraoperative events. Simulation has been shown to be an effective educational adjunct to typical operating room-based education to train for these events. It is yet unclear, however, why simulation has any benefit. We hypothesize that learners who are allowed to manage a scenario independently and allowed to fail, thus causing simulated morbidity, will consequently perform better when re-exposed to a similar scenario. Using a randomized, controlled, observer-blinded design, 24 first-year residents were exposed to an oxygen pipeline contamination scenario, either where patient harm occurred (independent group, n=12) or where a simulated attending anaesthetist intervened to prevent harm (supervised group, n=12). Residents were brought back 6 months later and exposed to a different scenario (pipeline contamination) with the same end point. Participants' proper treatment, time to diagnosis, and non-technical skills (measured using the Anaesthetists' Non-Technical Skills Checklist, ANTS) were measured. No participants provided proper treatment in the initial exposure. In the repeat encounter 6 months later, 67% in the independent group vs 17% in the supervised group resumed adequate oxygen delivery (P=0.013). The independent group also had better ANTS scores [median (interquartile range): 42.3 (31.5-53.1) vs 31.3 (21.6-41), P=0.015]. There was no difference in time to treatment if proper management was provided [602 (490-820) vs 610 (420-800) s, P=0.79]. Allowing residents to practise independently in the simulation laboratory, and subsequently, allowing them to fail, can be an important part of simulation-based learning. This is not feasible in real clinical practice but appears to have improved resident performance in this study. The purposeful use of independent practice and its potentially negative outcomes thus sets simulation-based learning apart from traditional operating room learning. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Multi-year assessment of soil-vegetation-atmosphere transfer (SVAT) modeling uncertainties over a Mediterranean agricultural site

NASA Astrophysics Data System (ADS)

Garrigues, S.; Olioso, A.; Calvet, J.-C.; Lafont, S.; Martin, E.; Chanzy, A.; Marloie, O.; Bertrand, N.; Desfonds, V.; Renard, D.

2012-04-01

Vegetation productivity and water balance of Mediterranean regions will be particularly affected by climate and land-use changes. In order to analyze and predict these changes through land surface models, a critical step is to quantify the uncertainties associated with these models (processes, parameters) and their implementation over a long period of time. Besides, uncertainties attached to the data used to force these models (atmospheric forcing, vegetation and soil characteristics, crop management practices...) which are generally available at coarse spatial resolution (>1-10 km) and for a limited number of plant functional types, need to be evaluated. This paper aims at assessing the uncertainties in water (evapotranspiration) and energy fluxes estimated from a Soil Vegetation Atmosphere Transfer (SVAT) model over a Mediterranean agricultural site. While similar past studies focused on particular crop types and limited period of time, the originality of this paper consists in implementing the SVAT model and assessing its uncertainties over a long period of time (10 years), encompassing several cycles of distinct crops (wheat, sorghum, sunflower, peas). The impacts on the SVAT simulations of the following sources of uncertainties are characterized: - Uncertainties in atmospheric forcing are assessed comparing simulations forced with local meteorological measurements and simulations forced with re-analysis atmospheric dataset (SAFRAN database). - Uncertainties in key surface characteristics (soil, vegetation, crop management practises) are tested comparing simulations feeded with standard values from global database (e.g. ECOCLIMAP) and simulations based on in situ or site-calibrated values. - Uncertainties dues to the implementation of the SVAT model over a long period of time are analyzed with regards to crop rotation. The SVAT model being analyzed in this paper is ISBA in its a-gs version which simulates the photosynthesis and its coupling with the stomata conductance, as well as the time course of the plant biomass and the Leaf Area Index (LAI). The experiment was conducted at the INRA-Avignon (France) crop site (ICOS associated site), for which 10 years of energy and water eddy fluxes, soil moisture profiles, vegetation measurements, agricultural practises are available for distinct crop types. The uncertainties in evapotranspiration and energy flux estimates are quantified from both 10-year trend analysis and selected daily cycles spanning a range of atmospheric conditions and phenological stages. While the net radiation flux is correctly simulated, the cumulated latent heat flux is under-estimated. Daily plots indicate i) an overestimation of evapotranspiration over bare soil probably due to an overestimation of the soil water reservoir available for evaporation and ii) an under-estimation of transpiration for developed canopy. Uncertainties attached to the re-analysis atmospheric data show little influence on the cumulated values of evapotranspiration. Better performances are reached using in situ soil depths and site-calibrated photosynthesis parameters compared to the simulations based on the ECOCLIMAP standard values. Finally, this paper highlights the impact of the temporal succession of vegetation cover and bare soil on the simulation of soil moisture and evapotranspiration over a long period of time. Thus, solutions to account for crop rotation in the implementation of SVAT models are discussed.

Barriers and Facilitators in Pain Management in Long-Term Care Institutions: A Qualitative Study

ERIC Educational Resources Information Center

Fox, Patricia; Solomon, Patricia; Raina, Parminder; Jadad, Alejandro R.

2004-01-01

The purpose of this study was to identify barriers to the management of pain in long-term care institutions. Formal caregivers practising in four long-term care institutions in Hamilton, Ontario participated in eight focus groups. Participants included 6 physicians, 19 registered nurses, 8 registered practical nurses, 13 health care aides and 8…

Rootstock and vineyard floor management influence on 'Cabernet Sauvignon' grape yeast assimilable nitrogen (YAN).

PubMed

Lee, Jungmin; Steenwerth, Kerri L

2011-08-01

This is a study on the influence that two rootstocks (110R, high vigour; 420A, low vigour) and three vineyard floor management regimes (tilled resident vegetation - usual practise in California, and barley cover crops that were either mowed or tilled) had upon grape nitrogen-containing compounds (mainly ammonia and free amino acids recalculated as YAN), sugars, and organic acids in 'Cabernet Sauvignon' clone 8. A significant difference was observed for some of the free amino acids between rootstocks. In both sample preparation methods (juiced or chemically extracted), 110R rootstock grapes were significantly higher in SER, GLN, THR, ARG, VAL, ILE, LEU, and YAN than were 420A rootstock grapes. Differences in individual free amino acid profiles and concentrations were observed between the two sample preparations, which indicate that care should be taken when comparing values from dissimilar methods. No significant differences among vineyard floor treatments were detected, which suggests that mowing offers vineyard managers a sustainable practise, alternative to tilling, without negatively affecting grape nitrogen compounds, sugars, or organic acids. Published by Elsevier Ltd.

Is High Fidelity Simulation the Most Effective Method for the Development of Non-Technical Skills in Nursing? A Review of the Current Evidence

PubMed Central

Lewis, Robin; Strachan, Alasdair; Smith, Michelle McKenzie

2012-01-01

Aim: To review the literature on the use of simulation in the development of non-technical skills in nursing Background: The potential risks to patients associated with learning 'at the bedside' are becoming increasingly unacceptable, and the search for innovative education and training methods that do not expose the patient to preventable errors continues. All the evidence shows that a significant proportion of adverse events in health care is caused by problems relating to the application of the 'non-technical' skills of communication, teamwork, leadership and decision-making. Results: Simulation is positively associated with significantly improved interpersonal communication skills at patient handover, and it has also been clearly shown to improve team behaviours in a wide variety of clinical contexts and clinical personnel, associated with improved team performance in the management of crisis situations. It also enables the effective development of transferable, transformational leadership skills, and has also been demonstrated to improve students' critical thinking and clinical reasoning in complex care situations, and to aid in the development of students' self-efficacy and confidence in their own clinical abilities. Conclusion: High fidelity simulation is able to provide participants with a learning environment in which to develop non-technical skills, that is safe and controlled so that the participants are able to make mistakes, correct those mistakes in real time and learn from them, without fear of compromising patient safety. Participants in simulation are also able to rehearse the clinical management of rare, complex or crisis situations in a valid representation of clinical practice, before practising on patients. PMID:22893783

Achilles tenotomy as an office procedure and current practising trends among New Zealand orthopaedic surgeons.

PubMed

Agius, Lewis; Wickham, Angus; Walker, Cameron; Knudsen, Joshua

2018-05-18

Percutaneous Achilles tenotomy (PAT) is performed during the final phase of casting with Ponseti method. Several settings have been proposed as venues for this procedure, however it is increasingly being performed in theatre under a general anaesthetic (GA). General anaesthesia, however, is expensive and not without risks. The purpose of the present study was to compare results of outpatient releases to theatre releases, and assess current practising trends among orthopaedic surgeons. Retrospective comparison of patients with idiopathic clubfoot managed by Ponseti method who had Achilles tenotomy performed in outpatient clinic and in theatre. Surveys were sent to all POSNZ members to determine current practising trends in New Zealand. Parental satisfaction surveys were performed. Comparative cost analysis was performed using hospital billing information. The current study includes 64 idiopathic congenital clubfeet (19 bilateral cases). PAT was performed on 26 clubfeet under local anaesthetic in an outpatient setting, and 33 clubfeet under GA in a theatre setting. There was no significant difference for post-operative complications, or recurrence (p=0.67). Those in theatre group were exposed to a greater number of general anaesthetics before the age of four. Among practising New Zealand paediatric orthopaedic surgeons, 77.78% perform this in theatre under general anaesthesia, while only 22.22% perform PAT in outpatient clinic. The main barriers included concerns regarding pain control, concerns regarding incomplete release, concerns regarding distress to family and concerns regarding sterility. Parental satisfaction surveys found pain management to be excellent. Financial data was analysed and indicative costs were $6,061 NZD per procedure in theatre, compared to $378 NZD per procedure in clinic. PAT performed in a clinic setting is both safe and efficacious with results comparative to that performed in theatre. There was no difference in post-operative complications or recurrence. Parental satisfaction to this procedure is excellent. There are significant financial advantages. Based on this data, our institution now performs all releases in an outpatient setting.

Major Events Coordinated Security Solutions: The Application of the Project Management Body of Knowledge for Managing a Science and Technology Project

DTIC Science & Technology

2011-02-01

subject matter experts, to analysis of laboratory samples during V2010. Significance: The MECSS project produced more than 195 scientific reports...represents the sum of knowledge related to project management and includes best practises and techniques generally accepted by the project...2011-03 2.2.1 Science Town Science Town is the moniker for a multi-agency, mobile laboratory capability that brings together world

Perceived quality of chronic illness care is associated with self-management: Results of a nationwide study in the Netherlands.

PubMed

van Houtum, L; Heijmans, M; Rijken, M; Groenewegen, P

2016-04-01

Healthcare providers are increasingly expected to help chronically ill patients understand their own central role in managing their illness. The aim of this study was to determine whether experiencing high-quality chronic illness care and having a nurse involved in their care relate to chronically ill people's self-management. Survey data from 699 people diagnosed with chronic diseases who participated in a nationwide Dutch panel-study were analysed using linear regression analysis, to estimate the association between chronic illness care and various aspects of patients' self-management, while controlling for their socio-demographic and illness characteristics. Chronically ill patients reported that the care they received was of high quality to some extent. Patients who had contact with a practise nurse or specialised nurse perceived the quality of the care they received as better than patients who only had contact with a GP or medical specialist. Patients' perceptions of the quality of care were positively related to all aspects of their self-management, whereas contact with a practise nurse or specialised nurse in itself was not. Chronically ill patients who have the experience to receive high-quality chronic illness care that focusses on patient activation, decision support, goal setting, problem solving, and coordination of care are better self-managers. Having a nurse involved in their care seems to be positively valued by chronically ill patients, but does not automatically imply better self-management. Copyright © 2016. Published by Elsevier Ireland Ltd.

Imperfect practice makes perfect: error management training improves transfer of learning.

PubMed

Dyre, Liv; Tabor, Ann; Ringsted, Charlotte; Tolsgaard, Martin G

2017-02-01

Traditionally, trainees are instructed to practise with as few errors as possible during simulation-based training. However, transfer of learning may improve if trainees are encouraged to commit errors. The aim of this study was to assess the effects of error management instructions compared with error avoidance instructions during simulation-based ultrasound training. Medical students (n = 60) with no prior ultrasound experience were randomised to error management training (EMT) (n = 32) or error avoidance training (EAT) (n = 28). The EMT group was instructed to deliberately make errors during training. The EAT group was instructed to follow the simulator instructions and to commit as few errors as possible. Training consisted of 3 hours of simulation-based ultrasound training focusing on fetal weight estimation. Simulation-based tests were administered before and after training. Transfer tests were performed on real patients 7-10 days after the completion of training. Primary outcomes were transfer test performance scores and diagnostic accuracy. Secondary outcomes included performance scores and diagnostic accuracy during the simulation-based pre- and post-tests. A total of 56 participants completed the study. On the transfer test, EMT group participants attained higher performance scores (mean score: 67.7%, 95% confidence interval [CI]: 62.4-72.9%) than EAT group members (mean score: 51.7%, 95% CI: 45.8-57.6%) (p < 0.001; Cohen's d = 1.1, 95% CI: 0.5-1.7). There was a moderate improvement in diagnostic accuracy in the EMT group compared with the EAT group (16.7%, 95% CI: 10.2-23.3% weight deviation versus 26.6%, 95% CI: 16.5-36.7% weight deviation [p = 0.082; Cohen's d = 0.46, 95% CI: -0.06 to 1.0]). No significant interaction effects between group and performance improvements between the pre- and post-tests were found in either performance scores (p = 0.25) or diagnostic accuracy (p = 0.09). The provision of error management instructions during simulation-based training improves the transfer of learning to the clinical setting compared with error avoidance instructions. Rather than teaching to avoid errors, the use of errors for learning should be explored further in medical education theory and practice. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Planning and Designing Effective Defence and Related Information Services: Conference Proceedings of the Technical Information Panel Specialists’ Meeting Held in Ankara, Turkey on 10-11 September 1986.

DTIC Science & Technology

1987-04-01

managerial talent and management style and behaviour on the basis of fixed and practised managerial principles. However, the material aspect, that is...motivation is encouraged by - immaterial incentives extrinsic motivation - material incentives on the one hand and by - management style and bihaviour...Logistics Management & Information Programs 26 Bid Victor Division 75996 Pans Armees NASA Headquarters (Code NIT) France Washington DC 20546 USA

These terrifying three words: A qualitative, mixed methods study of students' and mentors' understandings of 'fitness to practise'.

PubMed

Haycock-Stuart, Elaine; MacLaren, Jessica; McLachlan, Alison; James, Christine

2016-08-01

There is little empirical published research pertaining to fitness to practise and pre-registration nursing students. Much of the existing fitness to practise literature focuses on medical students and there is a preponderance of literature reviews and descriptive or discursive papers. The multicentre study aimed to explore students' and mentor's understandings of fitness to practise processes in pre-registration nursing programmes. A qualitative study in the interpretive paradigm with interpretive analysis involving 6 focus groups and 4 face-to-face interviews with nursing students and mentors. Eleven Higher Education Institutions providing pre-registration nursing education in the UK. Data were collected January 2014-March 2015 following ethical approval. Purposive sampling was used to recruit mentors and nursing (but not midwifery) students from pre-registration nursing programmes at different stages of educational preparation. Qualitatively driven semi-structured focus groups (n=6) and interviews (n=4) were conducted with a total of 35 participants (17 pre-registration nursing students and 18 nursing mentors). Three themes identified from the student and mentor data are considered: Conceptualising Fitness to Practise; Good Health and Character; and Fear and Anxiety Surrounding Fitness to Practise Processes. Uncertainty about understandings of fitness to practise contributed to a pervasive fear among students and reluctance among mentors to raise concerns about a student's fitness to practise. Both students and mentors expressed considerable anxiety and engaged in catastrophic thinking about fitness to practise processes. Higher Education Institutes should reinforce to students that they are fit to practise the majority of the time and reduce the negative emotional loading of fitness to practise processes and highlight learning opportunities. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Entrepreneur-Managers in Higher Education: (How) Do They Exist?

ERIC Educational Resources Information Center

Birds, Rachel

2014-01-01

Policy-makers in the United Kingdom increasingly emphasise the contribution of innovation and entrepreneurialism to the economy. Drawing on a recent ethnographic study of a university commercial enterprise, this article examines the notion of entrepreneurialism in a higher education institution as understood and practised by its employees. The…

Practising Knowing: Emergence(y) Teleologies

ERIC Educational Resources Information Center

Manidis, Marie; Scheeres, Hermine

2013-01-01

This article presents a meta-disciplinary and institutional framework of practices used by nurses and doctors to manage the indeterminacy of knowing in emergency departments (EDs) in Australia. We draw on Schatzkian perspectives of how practices prevail and reflect particular site ontologies. We posit that nurses and doctors draw on a repertoire…

Facing and Managing Dilemmas as a Clinical Educator

ERIC Educational Resources Information Center

McAllister, Lindy; Higgs, Joy; Smith, David

2008-01-01

Although clinical educators make an important and irreplaceable contribution to the education of students undertaking qualifications that will enable them to practise as health professionals, little is known about the day-to-day experiences of clinical educators and the complexities of clinical education that may contribute to the problems or to…

[Local anesthesia in dentistry. Additional techniques].

PubMed

Makkes, P C; Bouvy-Berends, E C; Rupreht, J

1996-05-01

Patients with insufficient coping abilities can yet be dentally treated by practising several additional techniques. Behaviour management should always be the starting point of all dental treatment strategies. In the end the administration of well selected drugs should lead, via anxiolysis, sedation or general anaesthesia, to a painfree and optimal treatable patient.

The effects of individual differences, prior experience and cognitive load on the transfer of dynamic decision-making performance.

PubMed

Nicholson, Brad; O'Hare, David

2014-01-01

Situational awareness is recognised as an important factor in the performance of individuals and teams in dynamic decision-making (DDM) environments (Salmon et al. 2014 ). The present study was designed to investigate whether the scores on the WOMBAT™ Situational Awareness and Stress Tolerance Test (Roscoe and North 1980 ) would predict the transfer of DDM performance from training under different levels of cognitive load to a novel situation. Participants practised a simulated firefighting task under either low or high conditions of cognitive load and then performed a (transfer) test in an alternative firefighting environment under an intermediate level of cognitive load. WOMBAT™ test scores were a better predictor of DDM performance than scores on the Raven Matrices. Participants with high WOMBAT™ scores performed better regardless of their training condition. Participants with recent gaming experience who practised under low cognitive load showed better practice phase performance but worse transfer performance than those who practised under high cognitive load. The relationship between task experience, situational awareness ability, cognitive load and the transfer of dynamic decision-making (DDM) performance was investigated. Results showed that the WOMBAT™ test predicted transfer of DDM performance regardless of task cognitive load. The effects of cognitive load on performance varied according to previous task-relevant experience.

[Claude Perrault, famous architect, unknown physician, untiring researcher].

PubMed

Hazard, Jean

2007-01-01

As a famous architect Charles Perrault persuaded Colbert to appoint a committee of the "Bâtiments du Roi" made up of three persons: Le Vau, Le Brun and one of his brothers Claude whose Louis XIV chose the plan. While Le Vau was busy in Versailles Perrault's influence became dominating. Although he was an unknown medical practitioner he managed to be allowed to practise and to teach medicine and to be a member of theses' jury for twenty five years. He was highly regarded by his colleagues who did not hesitate to hold a consultation. His trip in Bordeaux was consecrated to look after his brother but because of his numerous occupations he gave up practising medicine and he only treated the members of his family, his friends and some poor. He was a tireless researcher and at the "Académie des Sciences" he looked after the "Histoire naturelle des animaux" (Natural History of the Animals). In "Les Essais de Physique" he tackled numerous problems of physiology such as elasticity and contractility of arteries, studied the sense organs and did some experiments about blood transfusion. As an exceptional man he could practise the three of the occupations.

Managing obesity in pharmacy: the Australian experience.

PubMed

Um, Irene S I; Armour, Carol; Krass, Ines; Gill, Timothy; Chaar, Betty B

2010-12-01

To explore pharmacists' opinions about the provision of weight management services in community pharmacy and their attitudes towards the establishment of an accredited training course in weight management in pharmacy. Interviews were conducted with practising pharmacists on site in various community pharmacies in metropolitan Sydney, Australia. In-depth, semi-structured interviews with twenty practising pharmacists were conducted. Of the twenty interviewed pharmacists, sixteen were involved in the provision of one or more pharmacy based weight management programs in their pharmacies. Interviews were audio-recorded, transcribed and analysed using the grounded theory approach. The data were thematically analysed to identify facilitators and perceived barriers to the provision of high quality services, and pharmacists' willingness to undertake training and accreditation. Participants clearly perceived a role for pharmacy in weight management. Key facilitators to provision of service were accessibility and the perception of pharmacists as trustworthy healthcare professionals. The pharmacists proposed collaboration with other healthcare professionals in order to provide a service incorporating diet, exercise and behavioural therapy. A program that was not-product-centred, and supported by ethical marketing was favoured. Appropriate training and accreditation were considered essential to assuring the quality of such services. Barriers to the provision of high quality services identified were: remuneration, pharmacy infrastructure, client demand and the current marketing of product-centred programs. Australian pharmacists believe there is a role for pharmacy in weight management, provided training in accredited programs is made available. A holistic, evidence-based, multi-disciplinary service model has been identified as ideal.

Current management strategies for patellofemoral pain: an online survey of 99 practising UK physiotherapists.

PubMed

Smith, Benjamin E; Hendrick, Paul; Bateman, Marcus; Moffatt, Fiona; Rathleff, Michael Skovdal; Selfe, James; Smith, Toby O; Logan, Pip

2017-05-08

Patellofemoral pain (PFP) is considered one of the commonest forms of knee pain. This study aimed to identify how physiotherapists in the United Kingdom (UK) currently manage patellofemoral pain (PFP), particularly in relation to exercise prescription, and response to pain. An anonymous survey was designed with reference to previous surveys and recent systematic reviews. Practising UK physiotherapists who treat patients with PFP were invited to take part via an invitation email sent through professional networks, the 'interactive Chartered Society of Physiotherapy (iCSP)' message board, and social media (Twitter). Descriptive statistics were used to analyse the data. A total of 99 surveys were completed. Responders reported a wide range of management strategies, including a broad selection of type and dose of exercise prescription. The five most common management strategies chosen were: closed chain strengthening exercises (98%); education and advice (96%); open chain strengthening exercises (76%); taping (70%) and stretches (65%). Physiotherapists with a special interest in treating PFP were statistically more likely to manage patients with orthotics (P = 0.02) and bracing (P = 0.01) compared to physiotherapists without a special interest. Approximately 55% would not prescribe an exercise if it was painful. Thirty-one percent of physiotherapists would advise patients not to continue with leisure and/or sporting activity if they experienced any pain. Current UK practice in the management strategies of PFP is variable. Further high quality research on which to inform physiotherapy practice is warranted for this troublesome musculoskeletal condition.

CAD/CAM silicone simulator for teaching cheiloplasty: description of the technique.

PubMed

Zheng, Y; Lu, B; Zhang, J; Wu, G

2015-02-01

Techniques of virtual simulation have been used to teach junior surgeons how to do a cheiloplasty, but still do not meet the trainees' demands. We describe a CAD/CAM silicone simulator, which we made using several maxillofacial prosthetic techniques. An optical scanning system was used to collect the data about the cleft lip. Reverse engineering software was then used to build the virtual model, and this was processed in wax by machine. The definitive simulator was made with prosthetic silicone and extrinsic colourants. The surgical trainees practised the basic skills of cheiloplasty on the simulator, and proved its worth. Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Doctor performance assessment in daily practise: does it help doctors or not? A systematic review.

PubMed

Overeem, Karlijn; Faber, Marjan J; Arah, Onyebuchi A; Elwyn, Glyn; Lombarts, Kiki M J M H; Wollersheim, Hub C; Grol, Richard P T M

2007-11-01

Continuous assessment of individual performance of doctors is crucial for life-long learning and quality of care. Policy-makers and health educators should have good insights into the strengths and weaknesses of the methods available. The aim of this study was to systematically evaluate the feasibility of methods, the psychometric properties of instruments that are especially important for summative assessments, and the effectiveness of methods serving formative assessments used in routine practise to assess the performance of individual doctors. We searched the MEDLINE (1966-January 2006), PsychINFO (1972-January 2006), CINAHL (1982-January 2006), EMBASE (1980-January 2006) and Cochrane (1966-2006) databases for English language articles, and supplemented this with a hand-search of reference lists of relevant studies and bibliographies of review articles. Studies that aimed to assess the performance of individual doctors in routine practise were included. Two reviewers independently abstracted data regarding study design, setting and findings related to reliability, validity, feasibility and effectiveness using a standard data abstraction form. A total of 64 articles met our inclusion criteria. We observed 6 different methods of evaluating performance: simulated patients; video observation; direct observation; peer assessment; audit of medical records, and portfolio or appraisal. Peer assessment is the most feasible method in terms of costs and time. Little psychometric assessment of the instruments has been undertaken so far. Effectiveness of formative assessments is poorly studied. All systems but 2 rely on a single method to assess performance. There is substantial potential to assess performance of doctors in routine practise. The longterm impact and effectiveness of formative performance assessments on education and quality of care remains hardly known. Future research designs need to pay special attention to unmasking effectiveness in terms of performance improvement.

Interrelationships between lipid peroxidation and total antioxidant status in sedentary controls and unprofessional athletes.

PubMed

Caimi, Gregorio; Canino, Baldassare; Lo Presti, Rosalia

2010-01-01

We examined the thiobarbituric acid-reactive substances (TBARS) as an index of lipid peroxidation, and the total antioxidant status (TAS) in 81 unprofessional athletes subdivided into three subgroups. The first group included 28 subjects who practised endurance sports, the second included 30 subjects who practised mixed sports, the third included 23 subjects who practised power sports. We enrolled also a group of 61 sedentary controls (SC). TBARS were increased and TAS was decreased in the whole group of athletes in comparison with SC; an almost similar behaviour was present also subdividing athletes according to the practised sport. A significant negative correlation between these two parameters emerged in SC but not in the whole group of athletes. Unless for the athletes that practised endurance sports a similar trend was found in athletes that practised mixed and power sports. In conclusion, at rest the symmetrical behaviour between the lipid peroxidation increase and the TAS decrease, observed in sedentary controls, was not evident in unprofessional athletes who practised different sports.

Job characteristics, well-being and risky behaviour amongst pharmacists.

PubMed

Phipps, Denham L; Walshe, Kieran; Parker, Dianne; Noyce, Peter R; Ashcroft, Darren M

2016-12-01

Healthcare practitioners' fitness to practise has often been linked to their personal and demographic characteristics. It is possible that situational factors, such as the work environment and physical or psychological well-being, also have an influence on an individual's fitness to practise. However, it is unclear how these factors might be linked to behaviours that risk compromising fitness to practise. The aim of this study was to examine the association between job characteristics, well-being and behaviour reflecting risky practice amongst a sample of registered pharmacists in a region of the United Kingdom. Data were obtained from a cross-sectional self-report survey of 517 pharmacists. These data were subjected to principal component analysis and path analysis, with job characteristics (demand, autonomy and feedback) and well-being (distress and perceived competence) as the predictors and behaviour as the outcome variable. Two aspects of behaviour were found: Overloading (taking on more work than one can comfortably manage) and risk taking (working at or beyond boundaries of safe practice). Separate path models including either job characteristics or well-being as independent variables provided a good fit to the data-set. Of the job characteristics, demand had the strongest association with behaviour, while the association between well-being and risky behaviour differed according to the aspect of behaviour being assessed. The findings suggest that, in general terms, situational factors should be considered alongside personal factors when assessing, judging or remediating fitness to practise. They also suggest the presence of different facets to the relationship between job characteristics, well-being and risky behaviour amongst pharmacists.

How to Use Technology Effectively in Post-Compulsory Education

ERIC Educational Resources Information Center

Clarke, Alan

2011-01-01

The use of technology within the lifelong learning sector brings many benefits to learners, teachers and managers. Aimed at trainee and practising teachers, this book contains clear, practical guidance on how to use technology and e-learning effectively to enhance all aspects of teaching and learning in the post-compulsory sector. Alan Clarke…

On Practising in Physical Education: Outline for a Pedagogical Model

ERIC Educational Resources Information Center

Aggerholm, K.; Standal, O.; Barker, D. M.; Larsson, H.

2018-01-01

Background: Models-based approaches to physical education have in recent years developed as a way for teachers and students to concentrate on a manageable number of learning objectives, and align pedagogical approaches with learning subject matter and context. This paper draws on Hannah Arendt's account of "vita activa" to map existing…

Continuity and Change in Disaster Education in Japan

ERIC Educational Resources Information Center

Kitagawa, Kaori

2015-01-01

This article aims to describe post-war continuity and change in disaster education in Japan. Preparedness for natural disasters has been a continuous agenda in Japan for geographical and meteorological reasons, and disaster education has been practised in both formal and informal settings. Post-war disaster management and education have taken a…

The Accounting System and Resource Allocation Reform in a Public University

ERIC Educational Resources Information Center

Spathis, Charalambos; Ananiadis, John

2004-01-01

This paper studies the accounting system reform practised in Greek universities since January 2000, and more particularly at the Aristotle University of Thessaloniki (AUTH). It specifically examines the allocation of resources to faculties by university management based on certain criteria. The AUTH is the largest public university in Greece and…

Aggravated loss of tooth structure.

PubMed

Barsby, M J

1989-09-01

Self-inflicted tooth modification other than ritual mutilation practised in some countries is a rare occurrence. The author reports a case of aggravated loss of tooth structure where a patient has contributed to loss of tooth structure by the novel method of adjusting his natural teeth with a 'knife'. Subsequent management of the case is discussed.

Moving to evidence-based practice in long-term care: the role of a Best Practise Resource Centre in two long-term care settings.

PubMed

Brazil, Kevin; Royle, Joan A; Montemuro, Maureen; Blythe, Jennifer; Church, Anne

2004-03-01

In this article, the authors provide an overview on the development of a Long-Term Care Best Practise Resource Centre. The results of both a feasibility study and the outcomes of a 1-year demonstration project are presented. The demonstration project involved a hospital as the information service provider and two demonstration sites, a home care service agency and a nursing home that used the services of the Centre. The goals of the Centre were threefold: provide access to literature for staff in long-term care (LTC) settings; improve the information management skills of health care providers; and support research and the integration of best practices in LTC organizations. The results of the pilot study contributed to the development of a collaborative information access system for LTC clinicians and managers that provides timely, up-to-date information contributing to improving the quality of care for adults receiving LTC. Based on this demonstration project, strategies for successful innovation in LTC are identified.

International Expert Consensus Document on Takotsubo Syndrome (Part II): Diagnostic Workup, Outcome, and Management.

PubMed

Ghadri, Jelena-Rima; Wittstein, Ilan Shor; Prasad, Abhiram; Sharkey, Scott; Dote, Keigo; Akashi, Yoshihiro John; Cammann, Victoria Lucia; Crea, Filippo; Galiuto, Leonarda; Desmet, Walter; Yoshida, Tetsuro; Manfredini, Roberto; Eitel, Ingo; Kosuge, Masami; Nef, Holger M; Deshmukh, Abhishek; Lerman, Amir; Bossone, Eduardo; Citro, Rodolfo; Ueyama, Takashi; Corrado, Domenico; Kurisu, Satoshi; Ruschitzka, Frank; Winchester, David; Lyon, Alexander R; Omerovic, Elmir; Bax, Jeroen J; Meimoun, Patrick; Tarantini, Guiseppe; Rihal, Charanjit; Y-Hassan, Shams; Migliore, Federico; Horowitz, John D; Shimokawa, Hiroaki; Lüscher, Thomas Felix; Templin, Christian

2018-06-07

The clinical expert consensus statement on takotsubo syndrome (TTS) part II focuses on the diagnostic workup, outcome, and management. The recommendations are based on interpretation of the limited clinical trial data currently available and experience of international TTS experts. It summarizes the diagnostic approach, which may facilitate correct and timely diagnosis. Furthermore, the document covers areas where controversies still exist in risk stratification and management of TTS. Based on available data the document provides recommendations on optimal care of such patients for practising physicians.

International Expert Consensus Document on Takotsubo Syndrome (Part II): Diagnostic Workup, Outcome, and Management

PubMed Central

Ghadri, Jelena-Rima; Wittstein, Ilan Shor; Prasad, Abhiram; Sharkey, Scott; Dote, Keigo; Akashi, Yoshihiro John; Cammann, Victoria Lucia; Crea, Filippo; Galiuto, Leonarda; Desmet, Walter; Yoshida, Tetsuro; Manfredini, Roberto; Eitel, Ingo; Kosuge, Masami; Nef, Holger M; Deshmukh, Abhishek; Lerman, Amir; Bossone, Eduardo; Citro, Rodolfo; Ueyama, Takashi; Corrado, Domenico; Kurisu, Satoshi; Ruschitzka, Frank; Winchester, David; Lyon, Alexander R; Omerovic, Elmir; Bax, Jeroen J; Meimoun, Patrick; Tarantini, Guiseppe; Rihal, Charanjit; Y.-Hassan, Shams; Migliore, Federico; Horowitz, John D; Shimokawa, Hiroaki; Lüscher, Thomas Felix; Templin, Christian

2018-01-01

Abstract The clinical expert consensus statement on takotsubo syndrome (TTS) part II focuses on the diagnostic workup, outcome, and management. The recommendations are based on interpretation of the limited clinical trial data currently available and experience of international TTS experts. It summarizes the diagnostic approach, which may facilitate correct and timely diagnosis. Furthermore, the document covers areas where controversies still exist in risk stratification and management of TTS. Based on available data the document provides recommendations on optimal care of such patients for practising physicians. PMID:29850820

Best practise use in stroke rehabilitation: from trials and tribulations to solutions!

PubMed

Menon, Anita; Bitensky, Nicol Korner; Straus, Sharon

2010-01-01

This article explores the use of best practises among stroke rehabilitation professionals, salient barriers that influence their knowledge uptake/application and effective knowledge translation (KT) strategies that meet the needs of this clinician group. Relevant literature on evidence-based practise in stroke rehabilitation and the use of KT strategies among rehabilitation professionals is summarised and discussed. Although adherence to rehabilitation guidelines translates into improved patient outcomes, best practises are not routinely applied by clinicians when treating individuals with a stroke. Lack of protected work time to search and appraise the research literature is by far the largest organisational barrier to knowledge uptake/application. Personal barriers, such as the lack of confidence and skills to interpret, synthesise and apply research findings, also limit clinicians' uptake of best practises. Studies involving rehabilitation professionals found that active KT strategies were more effective than passive strategies to produce change in their evidence-based knowledge and practise behaviours. As such, interactive e-learning resources are likely to be a relevant KT solution to meet rehabilitation professionals' specific learning needs, guide their clinical decision-making and ultimately increase their best practise behaviours. We have the knowledge of best practises in stroke rehabilitation, a means to disseminate that knowledge internationally through interactive e-learning resources, and information about effective KT interventions. With these opportunities in place, rehabilitation professionals can expand their capacity by adopting stroke best practises and producing better outcomes for patients.

A simulated emergency department for medical students.

PubMed

Johnson, Patricia; Brazil, Victoria; Raymond-Dufresne, Éliane; Nielson, Tracy

2017-08-01

During their training, medical students often undertake a rotation in an emergency department (ED), where they are exposed to a wide variety of patient presentations. Simulation can be an effective teaching strategy to help prepare learners for the realities of the clinical environment. Simulating an ED shift can provide students with the opportunity to perform a range of clinical activities, within their scope of practice, in a supervised and supportive learning environment. Medical students often undertake a rotation in an emergency department CONTEXT: There is limited literature describing the structure, syllabus, feasibility and perceived usefulness of simulating a typical ED for medical student training. We developed a simulated ED (simED) teaching session for medical students at our university. Students were informed of the purpose and learning tasks of the session prior to attendance. At the start of their 2-hour simED shift students were allocated 'patients' by the Triage nurse. At the completion of their shift, students attended a debriefing discussion. Student feedback indicated that they felt that the simED: provided a good opportunity to practise skills and apply theory to practice; was realistic and challenging; highlighted the importance of teamwork; and enabled them to identify skills requiring further practise. Suggestions for improvements included a longer time spent in the simED and the opportunity to see more patients. The simED approach seemed to be well received and perceived by medical students as useful preparation for the ED. An overview of the structure, materials and resources used is provided to assist educators seeking to implement similar ED clinical scenarios in their curriculum. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Self-reported optometric practise patterns in age-related macular degeneration.

PubMed

Ly, Angelica; Nivison-Smith, Lisa; Zangerl, Barbara; Assaad, Nagi; Kalloniatis, Michael

2017-11-01

The use of advanced imaging in clinical practice is emerging and the use of this technology by optometrists in assessing patients with age-related macular degeneration is of interest. Therefore, this study explored contemporary, self-reported patterns of practice regarding age-related macular degeneration diagnosis and management using a cross-sectional survey of optometrists in Australia and New Zealand. Practising optometrists were surveyed on four key areas, namely, demographics, clinical skills and experience, assessment and management of age-related macular degeneration. Questions pertaining to self-rated competency, knowledge and attitudes used a five-point Likert scale. Completed responses were received from 127 and 87 practising optometrists in Australia and New Zealand, respectively. Advanced imaging showed greater variation in service delivery than traditional techniques (such as slitlamp funduscopy) and trended toward optical coherence tomography, which was routinely performed in age-related macular degeneration by 49 per cent of respondents. Optical coherence tomography was also associated with higher self-rated competency, knowledge and perceived relevance to practice than other modalities. Most respondents (93 per cent) indicated that they regularly applied patient symptoms, case history, visual function results and signs from traditional testing, when queried about their management of patients with age-related macular degeneration. Over half (63 per cent) also considered advanced imaging, while 31 per cent additionally considered all of these as well as the disease stage and clinical guidelines. Contrary to the evidence base, 68 and 34 per cent rated nutritional supplements as highly relevant or relevant in early age-related macular degeneration and normal aging changes, respectively. These results highlight the emergence of multimodal and advanced imaging (especially optical coherence tomography) in the assessment of age-related macular degeneration by optometrists. Clinically significant variations in self-rated test competency and the understanding regarding nutritional supplements for different stages of age-related macular degeneration suggest that further work to up-skill optometrists may be required. © 2017 Optometry Australia.

The Internet as a Tool to Learn a Second Language in a Technical Environment

ERIC Educational Resources Information Center

Pastor, M. Luisa Carrio

2007-01-01

Second language acquisition is a hard task for teachers, since to achieve the motivation from students to practice a language simulating a real context is very difficult. On the one hand, students are often influenced by their mother tongue and more when they are practising a second language with a partner from the same nationality. On the other,…

A Comparison between Flash and Second Life Programs as Aids in the Learning of Basic Laboratory Procedures

ERIC Educational Resources Information Center

Booth, Paula; Henderson-Begg, Stephanie

2011-01-01

Invited as a paper from E-Learn 2009 This study compared two programmes developed as a learning tool for students to practise basic laboratory procedures. One was a Flash simulation programme, the other a Second Life virtual reality programme. A cohort of 93 bioscience students participated in the between trial. A control group was used to…

An evaluation of a public health practitioner registration programme: lessons learned for workforce development.

PubMed

Rahman, Em; Wills, Jane

2014-09-01

This article explores the lessons learned for workforce development from an evaluation of a regional programme to support the assessment and registration of public health practitioners to the UK Public Health Register (UKPHR) in England. A summative and process evaluation of the public health practitioner programme in Wessex was adopted. Data collection was by an online survey of 32 public health practitioners in the Wessex area and semi-structured interviews with 53 practitioners, programme support, employers and system leaders. All survey respondents perceived regulation of the public health workforce as very important or important. Managers and system leaders saw a register of those fit to practise and able to define themselves as a public health practitioner as a necessary assurance of quality for the public. Yet, because registration is voluntary for practitioners, less value was currently placed on this than on completing a master's qualification. The local programme supports practitioners in the compilation of a retrospective portfolio of evidence that demonstrates fitness to practise; practitioners and managers stated that this does not support current and future learning needs or the needs of those working at a senior level. One of the main purposes of statutory regulation of professionals is to protect the public by an assurance of fitness to practise where there is a potential for harm. The widening role for public health practitioners without any regulation means that there is the risk of inappropriate interventions or erroneous advice. Regulators, policy makers and system leaders need to consider how they can support the development of the public health workforce to gain professional recognition at all levels of public health, including practitioners alongside specialists, and support a professional career framework for the public health system. © Royal Society for Public Health 2014.

How can surgical training benefit from theories of skilled motor development, musical skill acquisition and performance psychology?

PubMed

McCaskie, Andrew W; Kenny, Dianna T; Deshmukh, Sandeep

2011-05-02

Trainee surgeons must acquire expert status in the context of reduced hours, reduced operating room time and the need to learn complex skills involving screen-mediated techniques, computers and robotics. Ever more sophisticated surgical simulation strategies have been helpful in providing surgeons with the opportunity to practise, but not all of these strategies are widely available. Similarities in the motor skills required in skilled musical performance and surgery suggest that models of music learning, and particularly skilled motor development, may be applicable in training surgeons. More attention should be paid to factors associated with optimal arousal and optimal performance in surgical training - lessons learned from helping anxious musicians optimise performance and manage anxiety may also be transferable to trainee surgeons. The ways in which the trainee surgeon moves from novice to expert need to be better understood so that this process can be expedited using current knowledge in other disciplines requiring the performance of complex fine motor tasks with high cognitive load under pressure.

Expanding collaborative care: integrating the role of dietitians and nutrition interventions in services for people with mental illness.

PubMed

Teasdale, Scott B; Latimer, Geogina; Byron, Annette; Schuldt, Vanessa; Pizzinga, Josephine; Plain, Janice; Buttenshaw, Kerryn; Forsyth, Adrienne; Parker, Elizabeth; Soh, Nerissa

2018-02-01

This article aims to draw mental health clinicians' attention to the connections between nutrition and mental health, and the roles that Accredited Practising Dietitians play in improving mental and physical health through dietary change. Selective narrative review. Unhealthy dietary practices are common in high prevalence and severe mental illness. Epidemiological evidence demonstrates that nutrients and dietary patterns impact on mental health. In addition, poor physical health is well documented in people with mental illness and the greatest contributor to the mortality gap. Dietary intervention studies demonstrate improved mental and physical health outcomes. Accredited Practising Dietitians translate nutrition science into practical advice to improve the nutritional status of patients with mental illness, and prevent and manage comorbidities in a variety of care settings. Medical Nutrition Therapy offers opportunities to improve the physical and mental health of people living with mental illness.

The Development of Practising Strategies in Young People

ERIC Educational Resources Information Center

Hallam, Susan; Rinta, Tiija; Varvarigou, Maria; Creech, Andrea; Papageorgi, Ioulia; Gomes, Teresa; Lanipekun, Jennifer

2012-01-01

There has been considerable research considering how instrumental practice changes as expertise develops. Much of that research has been relatively small scale and restricted in the range of instrumentalists included. This paper aimed to explore the development of practising strategies and motivation to practise as expertise develops with a large…

Building an Online Library for Interpretation Training: Explorations into an Effective Blended-Learning Mode

ERIC Educational Resources Information Center

Chan, Clara Ho-yan

2014-01-01

This paper reports on a blended-learning project that aims to develop a web-based library of interpreting practice resources built on the course management system Blackboard for Hong Kong interpretation students to practise outside the classroom. It also evaluates the library's effectiveness for learning, based on a case study that uses it to…

Volunteer involvement in the support of self-managed computerised aphasia treatment: The volunteer perspective.

PubMed

Palmer, Rebecca; Enderby, Pam

2016-10-01

The speech-language pathology profession has explored a number of approaches to support efficient delivery of interventions for people with stroke-induced aphasia. This study aimed to explore the role of volunteers in supporting self-managed practice of computerised language exercises. A qualitative interview study of the volunteer support role was carried out alongside a pilot randomised controlled trial of computer aphasia therapy. Patients with aphasia practised computer exercises tailored for them by a speech-language pathologist at home regularly for 5 months. Eight of the volunteers who supported the intervention took part in semi-structured interviews. Interviews were audio recorded, transcribed verbatim and analysed thematically. Emergent themes included: training and support requirements; perception of the volunteer role; challenges facing the volunteer, in general and specifically related to supporting computer therapy exercises. The authors concluded that volunteers helped to motivate patients to practise their computer therapy exercises and also provided support to the carers. Training and ongoing structured support of therapy activity and conduct is required from a trained speech-language pathologist to ensure the successful involvement of volunteers supporting impairment-based computer exercises in patients' own homes.

Practising Leadership in Newly Multi-Ethnic Schools: Tensions in the Field?

ERIC Educational Resources Information Center

Devine, Dympna

2013-01-01

This paper explores the leadership practices of three principals following a period of intensive immigration in Ireland. Drawing on the work of Bourdieu, it conceptualises schools as structured social spaces and of their leadership work as a form of "practising". This practising is an outcome of the intersection between deeply embedded…

Student professional suitability: lessons from how the regulator handles fitness to practise cases.

PubMed

Unsworth, John

2011-07-01

A self regulating profession, such as nursing, has to have in place systems which deal with practitioners considered unfit to practise. In addition, students studying to enter the profession may also be subject to systems to address concerns about their professional suitability. While the NMC have left it up to each Higher Education Institution (HEI) to identify the systems which should be in place for students, there is a body of case law and statutory legislation which governs how the NMC deals with fitness to practise amongst qualified nurses and midwives. This paper examines the content of fitness to practise policies in place across HEIs and compares this with how the regulator handles fitness to practise cases. Data was collected using unobtrusive methods and was analysed using content analysis. The results suggest that many HEI's policies have significant gaps which may result in challenges to decision making. In addition, the power of some Vice Chancellors to overturn fitness to practise decisions on appeals calls into question the whole notion of professional self regulation. Copyright © 2010 Elsevier Ltd. All rights reserved.

Spanish adaptation of the Creative Potential and Practised Creativity scale (CPPC-17) in the workplace and inside the organization.

PubMed

Boada-Grau, Joan; Sánchez-García, José-Carlos; Prizmic-Kuzmica, Aldo-Javier; Vigil-Colet, Andreu

2014-01-01

This study follows the theoretical framework put forward by Hinton on creative potential and practised creativity. The objective was to adapt the 17-item Creative Potential and Practised Creativity scale into Spanish and examine its psychometric properties. The study sample was made up of 975 Spanish employees (48.5% men and 51.5% women). After performing a confirmatory factor analysis, the findings revealed a three-factor structure: Creative potential, Practised creativity and Perception of organizational support. Furthermore, appropriate reliability was found for all three factors as well as initial evidence of construct validity in relation to certain external correlates and a series of scales measuring workaholism, irritation, burnout and personality. The present scale may prove ideal for adequately identifying Creative potential, Practised creativity and Perceived organizational support.

Role of physical activity and sport in oncology: scientific commission of the National Federation Sport and Cancer CAMI.

PubMed

Bouillet, T; Bigard, X; Brami, C; Chouahnia, K; Copel, L; Dauchy, S; Delcambre, C; Descotes, J M; Joly, F; Lepeu, G; Marre, A; Scotte, F; Spano, J P; Vanlemmens, L; Zelek, L

2015-04-01

This overview reports published data about the interaction between physical activity and sport during and after cancer on one hand and improvement in psychological parameters, survival and biological mechanisms underlying this effect on the other hand. Practising physical activity and sport during cancer modifies parameters assessing fatigue and quality of life and reduces symptoms of depression. An association also exists between the practise of physical activity and sport and overall and cancer-specific survivals, especially after breast cancer, colon cancer and prostate cancer. These benefits seem to be mediated by a modification of circulating levels of estrogens, insulin, IGF-1 and by a decrease in insulin-resistance, by alterations in the secretion of adipokines, and by a reduction in chronic inflammation through decreased levels of cytokines. There exist some obstacles to the practise of physical activity. These obstacles are mainly related to a fear of pain induced by physical activity and to overweight. These programmes of physical activity and sport cannot be offered to all patients since there are several contra-indications, with some being present since the initial visit and others appearing during cancer management either due to disease progression or related to iatrogenic effects. Whereas benefits from physical activity and sport among cancer patients seem obvious, there are still several pending clinical and biological issues. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Infant feeding. 5. Managing baby related feeding challenges.

PubMed

Marshall, Joyce

2013-02-01

'Infant feeding' is the 12th series of 'Midwifery basics' targeted at practising midwives. The aim of these articles is to inform and encourage readers to seek further information through a series of activities relating to the topic. In this fifth article Joyce Marshall considers a range of baby related issues that pose challenges for both mothers and midwives in relation to infant feeding.

A SURVEY OF METHODS FOR SETTING MINIMUM INSTREAM FLOW STANDARDS IN THE CARIBBEAN BASIN.

Treesearch

F. N. SCATENA

2004-01-01

To evaluate the current status of instream flow practices in streams that drain into the Caribbean Basin, a voluntary survey of practising water resource managers was conducted. Responses were received from 70% of the potential continental countries, 100% of the islands in the Greater Antilles, and 56% of all the Caribbean island nations. Respondents identified ‘...

The effect of the publication of a major clinical trial in a high impact journal on clinical practise: the ORACLE Trial experience.

PubMed

Kenyon, Sara; Taylor, David J

2002-12-01

To estimate the short term effect of the publication of a major clinical trial on clinical practise. Questionnaire survey of clinical practise. UK. All maternity units in the UK. A self-administered questionnaire completed by lead consultants on delivery suite of maternity units. Changes in antibiotic prescription. Within six months of publication, approximately 50% of maternity units had changed their guidelines for the care of women with preterm prelabour rupture of the fetal membranes. Publication of a major clinical trial does impact on clinical practise but the impact is heterogeneous in terms of time and consistency.

Future practice of graduates of the New Zealand Diploma of Obstetrics and Gynaecology or Certificate in Women's Health.

PubMed

Miller, Dawn; Roberts, Helen; Wilson, Don

2008-09-22

To determine: why Diploma of Obstetrics (DipObs), Diploma of Obstetrics and Medical Gynaecology (DipOMG), or Certificate in Women's Health graduates enrolled; course usefulness; and subsequent practice. 588 University of Otago DipObs, DipOMG, and Certificate in Women's Health graduates (1992-2006) plus Auckland University graduates (1996-2006) were identified. All were doctors. Questionnaires were sent to the 477 with New Zealand medical registration and responses analysed. 334 of the 477 graduates returned completed questionnaires--70% response rate. 73% had worked as GPs, 10% at family planning clinics, 6% at sexual health clinics; and 13% specialised in OandG. 80% enrolled to further knowledge in women's health, 20% in children's health, and 43% to practise GP obstetrics. Most respondents who enrolled in the 1990s intended to practise GP obstetrics but by 2000 most did not. Of 137 New Zealand-based GP respondents who enrolled to practise GP obstetrics, only 5 (3.6%) currently practise intrapartum obstetric care. Twenty-three GPs still practise shared maternity care. Of 220 primary care practitioners, 90% provide early antenatal care. 93% described the course as useful-extremely useful. The DipObs, Dip OMG and Certificate in Women's Health have continued to provide useful postgraduate training in women's health during a changing time in New Zealand pregnancy care. While many graduates of the 1990s enrolled to practise GP obstetrics, most recent graduates did not, and few GPs still practise intrapartum obstetrics.

The Social-Psychological Outcomes of Martial Arts Practise Among Youth: A Review

PubMed Central

Vertonghen, Jikkemien; Theeboom, Marc

2010-01-01

Martial arts involvement among the youth has been described in controversial terms. Studies regarding the effects of martial arts practise on youth show contrasting images. While some refer to enhanced personal and social opportunities for those that participate, others warn against increased levels of aggressiveness and antisocial behavior among its participants. The aim of the present review is to provide, firstly, an overview of the major findings of studies concerning the social-psychological outcomes of martial arts practise. Secondly, the limitations of those studies are discussed. From more than 350 papers, collected during a two-year lasting literature study, 27 papers met all criteria to be included in this study. This review revealed that even though a considerable amount of research on social-psychological outcomes of martial arts practise has been conducted over the years, to date, it has not brought clarity in the existing duality regarding the possible effects of martial arts involvement. It is proposed that a better understanding can be provided if specific influential factors are taken into account in future research (i.e., participants' characteristics, type of guidance, social context and structural qualities of the sport). Key points Many common beliefs exist about the positive and negative outcomes of martial arts practise. Studies regarding the effects of martial arts practise on youth show contrasting images. Several influential factors have to be taken into account when examining the social-psychological outcomes of martial arts practise. PMID:24149778

The social-psychological outcomes of martial arts practise among youth: a review.

PubMed

Vertonghen, Jikkemien; Theeboom, Marc

2010-01-01

Martial arts involvement among the youth has been described in controversial terms. Studies regarding the effects of martial arts practise on youth show contrasting images. While some refer to enhanced personal and social opportunities for those that participate, others warn against increased levels of aggressiveness and antisocial behavior among its participants. The aim of the present review is to provide, firstly, an overview of the major findings of studies concerning the social-psychological outcomes of martial arts practise. Secondly, the limitations of those studies are discussed. From more than 350 papers, collected during a two-year lasting literature study, 27 papers met all criteria to be included in this study. This review revealed that even though a considerable amount of research on social-psychological outcomes of martial arts practise has been conducted over the years, to date, it has not brought clarity in the existing duality regarding the possible effects of martial arts involvement. It is proposed that a better understanding can be provided if specific influential factors are taken into account in future research (i.e., participants' characteristics, type of guidance, social context and structural qualities of the sport). Key pointsMany common beliefs exist about the positive and negative outcomes of martial arts practise.Studies regarding the effects of martial arts practise on youth show contrasting images.Several influential factors have to be taken into account when examining the social-psychological outcomes of martial arts practise.

Simulation in surgery: a review.

PubMed

Tan, Shaun Shi Yan; Sarker, Sudip K

2011-05-01

The ability to acquire surgical skills requires consistent practice, and evidence suggests that many of these technical skills can be learnt away from the operating theatre. The aim of this review article is to discuss the importance of surgical simulation today and its various types, exploring the effectiveness of simulation in the clinical setting and its challenges for the future. Surgical simulation offers the opportunity for trainees to practise their surgical skills prior to entering the operating theatre, allowing detailed feedback and objective assessment of their performance. This enables better patient safety and standards of care. Surgical simulators can be divided into organic or inorganic simulators. Organic simulators, consisting of live animal and fresh human cadaver models, are considered to be of high-fidelity. Inorganic simulators comprise virtual reality simulators and synthetic bench models. Current evidence suggests that skills acquired through training with simulators, positively transfers to the clinical setting and improves operative outcome. The major challenge for the future revolves around understanding the value of this new technology and developing an educational curriculum that can incorporate surgical simulators.

Current Australasian practice for diagnosis and management of idiopathic pulmonary fibrosis: Where are we now?

PubMed

Troy, Lauren K; Chapman, Sally A; Lake, Fiona; Wilsher, Margaret L; Honeysett, Liarna B; Macansh, Sacha; Corte, Tamera J

2015-05-01

Recent international consensus statements have refined evidence-based guidelines for the diagnosis and management of idiopathic pulmonary fibrosis (IPF). This study sought to investigate how closely these guidelines are adhered to and to compare current practices with those of a similar cohort 15 years ago. A questionnaire on IPF diagnosis and management was distributed to respiratory physicians practising in Australia and New Zealand, in 2012-2013, and results were compared with a similar survey conducted in 1999. A total of 172 and 144 questionnaires were completed in 1999 and 2012-2013, respectively. The most important investigations in both survey populations were high-resolution computed tomography scans, spirometry, diffusing capacity for carbon monoxide, chest X-ray, static lung volumes and autoimmune serology. In 1999, physicians were more likely to perform arterial blood gases, bronchoalveolar lavage and transbronchial lung biopsy. In the 2012-2013 cohort, 6-min walk tests and pulse oximetry were more widely utilized. Treatment choices differed considerably between the two survey populations. In 1999, the majority would offer a steroid-based regimen, whereas most would not use any specific treatment or would refer for trial participation in 2012-2013. Approach to IPF diagnosis and management is not uniform and has changed over 15 years. Surveyed respiratory physicians were generally practising in accordance with clinical guidelines, although significant variation in practice was identified in both cohorts. This study identifies the need to standardize care of IPF patients across Australia and New Zealand. © 2015 Asian Pacific Society of Respirology.

'Imagine if I gave up smoking ...': a qualitative exploration of Aboriginal participants' perspectives of a self-management pilot training intervention.

PubMed

Chapple, Kimberley; Kowanko, Inge; Harvey, Peter; Chong, Alwin; Battersby, Malcolm

2016-01-01

This paper reports on a pilot qualitative study investigating Aboriginal participants' perspectives of the Flinders Living Well Smoke Free (LWSF) 'training intervention'. Health workers nationally have been trained in this program, which offers a self-management approach to reducing smoking among Aboriginal clients. A component of the training involves Aboriginal clients volunteering their time in a mock care-planning session providing the health workers with an opportunity to practise their newly acquired skills. During this simulation, the volunteer clients receive one condensed session of the LWSF intervention imitating how the training will be implemented when the health workers have completed the training. For the purpose of this study, 10 Aboriginal clients who had been volunteers in the mock care-planning process, underwent a semi-structured interview at seven sites in Australia, including mainstream health services, Aboriginal community controlled health services and remote Aboriginal communities. The study aimed to gauge their perspectives of the training intervention they experienced. Early indications suggest that Aboriginal volunteer clients responded positively to the process, with many reporting substantial health behaviour change or plans to make changes since taking part in this mock care-planning exercise. Enablers of the intervention are discussed along with factors to be considered in the training program.

Why women go to medical college but fail to practise medicine: perspectives from the Islamic Republic of Pakistan.

PubMed

Moazam, Farhat; Shekhani, Sualeha

2018-07-01

Female medical students outnumber men in countries such as Saudi Arabia, India and Pakistan, yet many fail to practise medicine following graduation. In Pakistan, 70% of medical students are women, yet it is estimated that half of them will not pursue medicine following graduation. This is considered a major reason for physician shortages in the country. We conducted a qualitative study drawing upon the 'role strain' theory to explore the views of final-year medical students from four medical colleges in Karachi, Pakistan, on female graduates not entering the medical field. Data were obtained through 20 individual in-depth interviews and two focus group discussions. Themes were developed inductively from the data using the constant comparison method. Pakistani parents actively channel daughters into medical education, considering medicine to be the most 'respectable' field. However, in a patrilocal society with norms of early, arranged marriages for daughters, there is a significant influence of in-laws and a husband on a woman's professional future. Parents perceive the medical degree as a 'safety net' should something go wrong with the marriage, rather than a step toward a medical career. Female respondents experience significant role conflict between their socially rooted gender roles as homemakers and mothers and their careers in medicine. Postgraduate training systems that are unfriendly to women provide further deterrents for women wishing to work. Contrary to popular belief, women not practising medicine is not the sole contributor to physician shortages. A significant factor appears to be male graduates migrating abroad for better training and financial prospects. Acceptance of traditional cultural values, including entrenched gender roles in society, deters women from practising medicine. To enable greater participation of women in the medical field, steps are required that will allow women to better manage family and work conflicts. © 2018 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Software selection based on analysis and forecasting methods, practised in 1C

NASA Astrophysics Data System (ADS)

Vazhdaev, A. N.; Chernysheva, T. Y.; Lisacheva, E. I.

2015-09-01

The research focuses on the problem of a “1C: Enterprise 8” platform inboard mechanisms for data analysis and forecasting. It is important to evaluate and select proper software to develop effective strategies for customer relationship management in terms of sales, as well as implementation and further maintenance of software. Research data allows creating new forecast models to schedule further software distribution.

Leading nurses in dire straits: head nurses' navigation between nursing and leadership roles.

PubMed

Sørensen, Erik E; Delmar, Charlotte; Pedersen, Birthe D

2011-05-01

The present study reports selected findings from a doctoral study exploring the negotiation between nursing and leadership in hospital head nurses' leadership practice. The importance of bringing a nursing background into leadership is currently under debate. In spite of several studies of nursing and clinical leadership, it is still unclear how nurses' navigate between nursing and leadership roles. An 11-month-long ethnographic study of 12 head nurses' work: five worked at a first line level and seven at a department level. At the first line level, leadership practices were characterized by an inherent conflict between closeness and distance to clinical practice; at the department level practises were characterized by 'recognition games'. On both levels, three interactive roles were identified, that of clinician, manager and a hybrid role. Where clinician or manager roles were assumed, negotiation between roles was absent, leading to reactive, adaptive and isolated practices. The hybrid role was associated with dialectical negotiation of roles leading to stable and proactive practices. Nursing leadership practises depend on leaders' negotiation of the conflicting identities of nurse and leader. Successful nursing leaders navigate between nursing and leadership roles while nourishing a double identity. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.

Effect of domestic violence training

PubMed Central

Zaher, Eman; Keogh, Kelly; Ratnapalan, Savithiri

2014-01-01

Abstract Objective To describe and evaluate the effectiveness of domestic violence education in improving physicians’ knowledge, recognition, and management of abused women. Data sources The Cochrane Database of Systematic Reviews, MEDLINE, PubMed, PsycINFO, ERIC, and EMBASE were searched for articles published between January 1, 2000, and November 1, 2012. This search was supplemented by manual searches for relevant articles using a combined text-word and MeSH-heading search strategy. Study selection Randomized controlled trials were selected that used educational interventions among physicians and provided data on the effects of the interventions. Synthesis Nine randomized controlled trials were included that described different educational approaches with various outcome measures. Three studies examined the effects of educational interventions among postgraduate trainee physicians and found an increase in knowledge but no change in behaviour with regard to identifying victims of domestic violence. Six studies examined educational interventions for practising physicians. Three of these studies used multifaceted physician training that combined education with system support interventions to change physician behaviour, such as increasing general awareness of domestic violence with brochures and posters, providing aids to remind physicians how to identify victims, facilitating physician access to victim support services, and providing audits and feedback. Multifaceted educational interventions included interactive workshops, Web-based learning, and experiential training. Another study used focus-group discussions and training, and showed improved domestic violence reporting among physicians. The remaining 2 studies showed improved perceptions of practising physicians’ self-efficacy using problem-based online learning. Conclusion It was difficult to determine the most effective educational strategy, as the educational interventions and the outcome measures varied among the selected studies. Brief interventions for postgraduate trainee physicians improved knowledge but did not seem to affect behaviour. Online education using a problem-based learning format improved practising physicians’ perceptions, knowledge, and skills in managing domestic violence. Physician training combined with system support interventions seemed to benefit domestic violence victims and increase referrals to domestic violence support resources. PMID:25022633

Eco-pharmacovigilance of non-steroidal anti-inflammatory drugs: Necessity and opportunities.

PubMed

He, Bing-Shu; Wang, Jun; Liu, Juan; Hu, Xia-Min

2017-08-01

Eco-pharmacovigilance (EPV) is a practical and powerful approach to minimize the potential risks posed by pharmaceutical residues in environment. However, it is impracticable to practise rigorous and unitary EPV process for all the existing and new pharmaceuticals. Here, we focused on non-steroidal anti-inflammatory drugs (NSAIDs), and discussed the necessity and potential opportunities of practising EPV of NSAIDs. We found that the consumption of NSAIDs is huge and ubiquitous across the globe. NSAIDs were worldwidely reported as one of the most dominant and frequently detected groups in environmental matrices including wastewater, surface water, suspended solids, sediments, groundwater, even drinking water. Besides, there is definitive evidence for the adverse impacts of NSAID residues on scavenging birds and aquatic species. These data suggested the necessity of implementing EPV of NSAIDs. From the perspective of drug administration, we identified some things that can be done as management practice options for EPV implementation on NSAIDs. Copyright © 2017 Elsevier Ltd. All rights reserved.

Urinary stones in Malaysia--its incidence and management.

PubMed

Sreenevasan, G

1990-06-01

The life of Lord Moynihan is briefly reviewed. Incidence of stones in Peninsular Malaysia appears to show the same trend as in other industrialised countries. Management of urinary calculi both prior to and after the introduction of ESWL in a personal series is discussed. More than 90% of urinary stones are now treated by ESWL threatening the place of surgery in Urology. The pattern of incorporating renal transplantation into the urological training programme as practised in the Institute of Urology and Nephrology in Malaysia is suggested as a way to assure a place for surgery in Urology.

[Between individuality and "evidence-based medicine"--the role of the general practitioner within the scope of disease management programs].

PubMed

Szecsenyi, Joachim; Schneider, Antonius

2003-06-01

In Germany, the change from the "traditional", experience-based general practitioner (GP) to the evidence-based practising co-ordinator may be accelerated by the introduction of disease management programmes. Here, we will discuss some tools that can help to meet this challenge. Also, a set of requirements will be defined that the health care system will have to provide in support of GPs. Maintaining the relationship between doctor and patient and also allowing for individual care on the basis of evidence-based medicine will remain a challenge.

An Overview of Total Quality Management (TQM) practice in Construction Sector

NASA Astrophysics Data System (ADS)

Likita, A. J.; Zainun, N. Y.; Rahman, I. Abdul; Awal, A. S. M. Abdul; Alias, A. R.; Rahman, M. Q. Abdul; Ghazali, F. E. Mohamed

2018-04-01

In construction sector TQM can be termed as a philosophy which guides construction professionals on the proper execution of construction projects in terms of quality. The aim of this paper is to discuss on quality management practice in construction sector. This paper evaluated five previous researches and the findings were discussed to find a conclusion of TQM practise in construction sector. The study found that TQM had been successfully practice in construction sector at Saudi Arabia, India, US and South Africa. Application of Artificial Neural Network (ANN) help to improve the implementation of TQM in construction sector. In conclusion, quality management practices will give better control of processes in construction sector.

The effect of dyad versus individual simulation-based ultrasound training on skills transfer.

PubMed

Tolsgaard, Martin G; Madsen, Mette E; Ringsted, Charlotte; Oxlund, Birgitte S; Oldenburg, Anna; Sorensen, Jette L; Ottesen, Bent; Tabor, Ann

2015-03-01

Dyad practice may be as effective as individual practice during clinical skills training, improve students' confidence, and reduce costs of training. However, there is little evidence that dyad training is non-inferior to single-student practice in terms of skills transfer. This study was conducted to compare the effectiveness of simulation-based ultrasound training in pairs (dyad practice) with that of training alone (single-student practice) on skills transfer. In a non-inferiority trial, 30 ultrasound novices were randomised to dyad (n = 16) or single-student (n = 14) practice. All participants completed a 2-hour training programme on a transvaginal ultrasound simulator. Participants in the dyad group practised together and took turns as the active practitioner, whereas participants in the single group practised alone. Performance improvements were evaluated through pre-, post- and transfer tests. The transfer test involved the assessment of a transvaginal ultrasound scan by one of two clinicians using the Objective Structured Assessment of Ultrasound Skills (OSAUS). Thirty participants completed the simulation-based training and 24 of these completed the transfer test. Dyad training was found to be non-inferior to single-student training: transfer test OSAUS scores were significantly higher than the pre-specified non-inferiority margin (delta score 7.8%, 95% confidence interval -3.8-19.6%; p = 0.04). More dyad (71.4%) than single (30.0%) trainees achieved OSAUS scores above a pre-established pass/fail level in the transfer test (p = 0.05). There were significant differences in performance scores before and after training in both groups (pre- versus post-test, p < 0.01) with large effect sizes (Cohen's d = 3.85) and no significant interactions between training type and performance (p = 0.59). The dyad group demonstrated higher training efficiency in terms of simulator score per number of attempts compared with the single-student group (p = 0.03). Dyad practice improves the efficiency of simulation-based training and is non-inferior to individual practice in terms of skills transfer. © 2015 John Wiley & Sons Ltd.

Using of CBA Method for Evaluation of the Investments in the Link with Social Responsible Business

NASA Astrophysics Data System (ADS)

Mrvová, Ľubica; Vaňová, Jaromíra

2012-12-01

The paper presents knowledge from the area of economic efficiency assessment of the environmental investments, in the link with environmental management with context of social responsible business and their mutual connection, on the base of CBA method. CBA method creates basis for the software CBA1.1, which was created for the needs of business practise for the small and medium enterprises in the Slovak Republic.

Process-orientated simulation of tillage practices and land use change to optimize distributed flood control measures

NASA Astrophysics Data System (ADS)

Disse, M.; Rieger, W.

2009-04-01

Not only climate change affects hydrological systems but also land use change and agricultural tillage practises have an important impact on infiltration and runoff generation. In the last five to six decades monocropping, drainage and rectification of small rivers were carried out to optimize crop yields and economic benefits. However, in recent years more holistic and sustainable management concepts are required. The advantages of ecological management of land, soil and water resources are manifold: the biodiversity is higher, the buffer function of soils will be conserved and both low water and floods are positive affected. The target of the presented research project which is financed by the Bavarian environment agency, is to establish an optimal flood retention concept in a mesoscale catchment of 150 km² which emphasizes ecological flood measures like best tillage practices, small retention basins and renaturation of small rivers. To quantify the effects of these measures the water balance model WaSiM-ETH was used. The grid-based water flow and balance simulation model WaSiM-ETH is a well-established tool for investigating the spatial and temporal variability of hydrological processes in complex river basins. The model can be seen as a reasonable compromise between detailed physical basis and minimum data requirements (http://www.wasim.ch/en/index.html). WaSiM was coupled with a 2d-ground water model and an additional drainage tool. Different vegetation was parameterized with high spatial and temporal resolution. Additionally, future climate scenarios like the extension of vegetation periods were considered. The effectiveness of decentralized retention basins could be simulated by a new implemented see storage tool. The presentation will give quantitative results for different flood control measures. The pros and cons of physically based approaches in hydrological modelling will be discussed.

The development, implementation and evaluation of a cross organisational clinical guideline for the management and prevention of wound infection.

PubMed

Stubbs, Nikki; Sandoe, Jonathan; Mc Ginnis, Elizabeth; Edmunds, Heather

2012-11-01

The Tissue Viability services in acute and primary care in Leeds had concerns about the increasing inappropriate use of topical antiseptic dressings for wound management and were aware that the use was disproportionate to the evidence supporting their prescribing. A scoping exercise of the use of topical antiseptics and systemic antibiotic usage in Leeds led to the identification of heterogeneous prescribing of systemic antibiotics and an almost £500,000 spend on topical antiseptics across Leeds community. The project involved the following stages. 1- Local scoping of topical antiseptics and systemic antibiotic prescribing. 2- A cross organisational working group to develop and implement a clinical best practice guideline for the prevention, diagnosis and management of wound infection. 3- Development of a revised local dressings formulary. 4- The establishment of a new referral process to Tissue Viability for wounds requiring topical antiseptic treatments. 5- Evaluation of the new guideline through- monitoring prescribing- monitoring wound sampling- monitoring A & E admissions- collecting patient feedback through the ‘Tell Tissue Viability’ process. *Expenditure on topical antiseptic dressings for the period Oct 2009-Dec 2009 was £128,864 and this reduced to £65,604 for the period Nov 2011-Jan 2012. This demonstrates an overall saving of £63,260 with a projected annual saving of £237,584 within the community trust alone. *A reduction in the number of wound swabs sent to microbiology from inpatient locations by 1500/year comparing 2008/9 with 2010/11. *An increase in wound swabs sent from GPs by 100/year comparing 2008/9 with 2010/11. *A reduction in penicillin V and co-fluampicil prescriptions and an increase in flucloxacillin prescriptions in general practise suggesting greater concordance with local antibiotic prescribing recommendations. The implementation of a clinical guideline in association with support from the specialist team, for patients requiring topical antiseptics has resulted in a reduction in the inappropriate use of topical antiseptics in hospital and community. Wound sampling practises and prescribing practises have changed. No apparent increased risk for patients has been identified but it has not been easy to obtain details about admission to Accident and Emergency with cellulitis and optimising surveillance remains a challenge for the future. Copyright © 2012 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

Improving health service management education: the manager speaks.

PubMed

Harris, M G; Harris, R D; Tapsell, L

1993-01-01

This paper uses health service manager judgements to discuss educational approaches and environments suitable to the development of required competencies and reports barriers to and opportunities for competency development. Practising managers were found to recognise and value the educational contributions made by academic programs, health service organisations and professional associations to the development of professional competence. Academic programs are seen as the appropriate vehicle for developing conceptual, analytical, problem solving and communication competencies that require considerable maturation time. Health service organisations are seen to have a key role in promoting professional competence through maintaining a culture conductive to encouraging managers to undertake further education, supported by appropriate system strategies. Professional associations are regarded as appropriate sponsors for promoting knowledge and skill update in relation to current issues in management through short courses, conferences and timely educational meetings. Wherever possible, collaboration between professional and educational organisations was seen to be desirable.

Ethical budgets: a critical success factor in implementing new public management accountability in health care.

PubMed

Bosa, Iris M

2010-05-01

New public management accountability is increasingly being introduced into health-care systems throughout the world - albeit with mixed success. This paper examines the successful introduction of new management accounting systems among general practitioners (GPs) as an aspect of reform in the Italian health-care system. In particular, the study examines the critical role played by the novel concept of an 'ethical budget' in engaging the willing cooperation of the medical profession in implementing change. Utilizing a qualitative research design, with in-depth interviews with GPs, hospital doctors and managers, along with archival analysis, the present study finds that management accounting can be successfully implemented among medical professionals provided there is alignment between the management imperative and the ethical framework in which doctors practise their profession. The concept of an 'ethical budget' has been shown to be an innovative and effective tool in achieving this alignment.

Postmortem procedures in the emergency department: using the recently dead to practise and teach.

PubMed Central

Iserson, K V

1993-01-01

In generations past, it was common practice for doctors to learn lifesaving technical skills on patients who had recently died. But this practice has lately been criticised on religious, legal, and ethical grounds, and has fallen into disuse in many hospitals and emergency departments. This paper uses four questions to resolve whether doctors in emergency departments should practise and teach non-invasive and minimally invasive procedures on the newly dead: Is it ethically and legally permissible to practise and teach non-invasive and minimally invasive procedures on the newly dead emergency-department patient? What are the alternatives or possible consequences of not practising non-invasive and minimally invasive procedures on newly dead patients? Is consent from relatives required? Should doctors in emergency departments allow or even encourage this use of newly dead patients? PMID:8331644

Changes in prostitution and the AIDS epidemic in Thailand.

PubMed

Hanenberg, R; Rojanapithayakorn, W

1998-02-01

The HIV/AIDS epidemic which broke out in Thailand 1988 was mainly caused by the widespread patronage of prostitutes. The Thai authorities responded with programmes which encouraged the use of condoms in commercial sex. These programmes were highly successful. However, prostitution has changed since the beginning of the epidemic, partly for economic and demographic reasons, but mainly because of the fear of AIDS. Fewer women practise prostitution, men patronize it less, and the price of commercial sex has risen. Prostitution is less likely to be practised in brothels and more likely to be practised in establishments like restaurants and bars. Moreover, as fewer native Thai women are willing to practise prostitution, foreign women are taking their place. In order to continue to control the epidemic, the authorities will have to adapt their programmes to the changing structure of commercial sex.

Sequential effects after practice with the dominant and non-dominant hand on the acquisition of a sliding task in schoolchildren.

PubMed

Senff, Oliver; Weigelt, Matthias

2011-03-01

This study was designed to investigate sequential effects after practice with the dominant and non-dominant hand on the acquisition of a new motor task. A total of 64 middle school children were asked to practise a cent-slide task, which required them to slide coins from one side of a cardboard into a circular target on the opposite side. Four groups practised this task within different practice schedules: (1) participants practised only with their dominant hand (right-only group); (2) participants used only their non-dominant hand (left-only group); (3) participants started to practise the skill with their dominant hand and then switched to their non-dominant hand (right-to-left group); or (4) participants started to practise the skill with their non-dominant hand and then switched to their dominant hand (left-to-right group). The acquisition of the task was facilitated after initial practice with the non-dominant hand. This was reflected in a better retention of the task and a stronger performance under a modified testing situation of the left-to-right group when compared to all other groups. Also, the left-only group showed larger interlimb transfer effects to the untrained hand than the right-only group. It is concluded that the sequence in which the dominant and non-dominant hands are used to practise influences the acquisition of new motor tasks.

Generational attitudes of rural mental health nurses.

PubMed

Crowther, Andrew; Kemp, Michael

2009-04-01

To determine how attitudes of rural mental health nurses differ across generations. Survey. Mental health services in rural New South Wales. Practising mental health nurses. Survey responses. Survey response rate 44%. A total of 89 mental health nurses, clustered in inpatient units and community health centres, responded. Of these nurses, 4 were veterans, 52 baby boomers, 17 Generation X and 5 Generation Y. There are significant differences in how mental health nurses from different generations view their work, and in what is expected from managers. Managers need to modify traditional working styles, allowing greater flexibility of employment. They must also accept lower staff retention rates, and facilitate the development of younger staff.

Transformational leadership: a cascading chain reaction.

PubMed

Murphy, Lorraine

2005-03-01

Historical influences still permeate contemporary nursing practise. These are mirrored in organizational philosophies, transactional and autocratic leadership styles and disempowered staff. Whilst there is disparity amongst the theorists' definitions of leadership, there is consensus pertaining to the attributes necessary to realize effective leadership. Transformational leadership is heralded as new criterion for nurse managers, and can be achieved through training, education and professional development in key leadership competencies. To achieve a chain reaction, charismatic transformational leaders espouse intellectual stimulation and individual consideration to empower staff and enhance patient care. Nurse managers that develop and foster transformational leadership can surmount oppressive traditions and confidently navigate a complex and rapidly changing health care environment.

Parental groups during the child's first year: an interview study of parents' experiences.

PubMed

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

2014-10-01

To highlight what was important to parents with respect to consultation groups at well-child clinics. Parents managing of their role as parents affect the child's health and are therefore an important priority for public health. Well-child clinics in Norway practise consultations in groups to support parents and to facilitate social network; however, few studies explore parents' perspective of this kind of groups. Grounded theory. We used classical grounded theory with a generative and constant comparative approach. Data were collected through seven focus groups and two individual interviews with the parents of children aged 8-15 months. The parents were most concerned about how to achieve connection without accountability and how to obtain relevant health information. They managed this by 'multipositioning', encompassing the strategies of: (1) practising conditional openness, (2) seeking to belong, (3) awaiting initiative and (4) expecting balanced health information. The use of these strategies explains how they resolved their challenges. Parental groups seem to be popular and have great potential to establish a social network; however, underestimating the need for structure and continuity in the groups might cause this opportunity to be missed. Understanding parents' perspectives will be useful when planning strategies to strengthen parental groups at well-child clinics and that the engaged organisers will account for this need to ensure public health work of high quality and effectiveness for parents. © 2014 John Wiley & Sons Ltd.

Could simulated emergency procedures practised in a static environment improve the clinical performance of a Critical Care Air Support Team (CCAST)? A literature review.

PubMed

Lamb, Di

2007-02-01

The Royal Air Force Critical Care Air Support Teams (CCASTs) have a philosophy to undertake transfers of critically ill patients from anywhere in the world back to a UK medical facility in a stable or improved clinical condition. The training they receive is primarily taught by traditional didactic methods, with no standardisation of education between teams that are expected to deliver care to the same standard. Notwithstanding there being no current compromise to patient care during air transfer, it was important to consider the benefits of an alternative experiential teaching modality. Experiential learning utilised in the static environment could potentially improve the current CCAST training curriculum and, therefore, improve clinical performance during air transfer. In the absence of primary research evidence investigating beneficial teaching modalities for medical flight crews, a review of recent literature was undertaken to observe any potential relevance to the aeromedical specialty. This critical review examined recent quantitative research on various modalities of experiential learning and their influence on the critical thinking, higher cognitive and psychomotor skill acquisition by healthcare professionals in a static hospital environment. The main databases were interrogated using the following inclusion criteria: patient simulation, clinical competence, aeromedical, education, computer simulation, critical thinking and problem-based learning. The number of articles obtained was 13; these were coded on methodological strength to reduce the potential for inclusion bias. Nine studies were finally selected for review. Many small studies have been undertaken, primarily observing benefits of experiential learning to medical students and doctors. No studies show conclusively that simulated learning improves patient outcome, but the body of evidence suggests human patient simulators to be advantageous over other modalities because of their realistic recreation of critical events. They have proven to be at least as effective as traditional teaching by didactic methods. For CCASTs to have a standardised training curriculum, they should undertake real-time missions in a flight simulator, supported by a human patient simulator programmed to respond to the physiological changes associated with altitude. Real scenarios could then be practised, on demand, in a safe environment as an augmentation to the current training programme. Consequently, those acquired skills could then be carried out with improved proficiency during real missions with a concomitant potential for improvement in the standard of patient care.

Mandatory continuing professional education in pharmacy: the Singapore experience.

PubMed

Ang, Hui-Gek; Pua, Yong-Hao; Subari, Nur Azah

2013-08-01

Mandatory Continuing Professional Education (CPE) for the renewal of pharmacists' practising certificate was implemented in Singapore in 2008 OBJECTIVE: To study pharmacists' perceptions and attitudes about the impact of mandatory CPE in Singapore. Singapore. Internet-based questionnaire survey, conducted between May and June 2011. Pharmacists' perceptions and attitudes toward mandatory CPE and the perceived difficulty in fulfilling the CPE requirements. The overall survey response rate was 52 % (840/1,609). Of the respondents, 32 % were non-practising, 49 % were practising in patient care areas, and 19 % were practising in non-patient care areas. More than half the pharmacists agreed that mandatory CPE (1) enhanced or increased their knowledge base and skills (70 %; 95 % CI 67-73 %), (2) motivated them to continually learn (64 %; 95 % CI, 60-67 %), and (3) motivated them to reflect on their professional practice or work (58 %; 95 % CI, 54-61 %). Mandatory CPE was not perceived to enhance or increase employability. Non-practising pharmacists appeared to have the greatest difficulty meeting the CPE requirements. In general, pharmacists value mandatory CPE more for positive professional reasons than for employability reasons. The survey results may serve as useful baseline data for future studies of pharmacists' perceptions and attitudes toward CPE in Singapore.

Should I cancel my NMC registration?

PubMed

Cornock, Marc

2017-04-05

To practise as a nurse, you must be registered with the Nursing and Midwifery Council (NMC). Your entry on to the register shows you have met the competencies and standards required to practise as a nurse.

Practises to identify and prevent adverse aircraft-and-rotorcraft-pilot couplings-A ground simulator perspective

NASA Astrophysics Data System (ADS)

Pavel, Marilena D.; Jump, Michael; Masarati, Pierangelo; Zaichik, Larisa; Dang-Vu, Binh; Smaili, Hafid; Quaranta, Giuseppe; Stroosma, Olaf; Yilmaz, Deniz; Johnes, Michael; Gennaretti, Massimmo; Ionita, Achim

2015-08-01

The aviation community relies heavily on flight simulators as a fundamental tool for research, pilot training and development of any new aircraft design. The goal of the present paper is to provide a review on how effective ground simulation is as an assessment tool for unmasking adverse Aircraft-and-Rotorcraft Pilot Couplings (APC/RPC). Although it is generally believed that simulators are not reliable in revealing the existence of A/RPC tendencies, the paper demonstrates that a proper selection of high-gain tasks combined with appropriate motion and visual cueing can reveal negative features of a particular aircraft that may lead to A/RPC. The paper discusses new methods for real-time A/RPC detection that can be used as a tool for unmasking adverse A/RPC. Although flight simulators will not achieve the level of reality of in-flight testing, exposing A/RPC tendencies in the simulator may be the only convenient safe place to evaluate the wide range of conditions that could produce hazardous A/RPC events.

The GDC - lifting the lid. Part 4: fitness to practise.

PubMed

Mathewson, H; Rudkin, D

2008-07-26

As an organisation whose function is to protect the public, the General Dental Council's role in investigating complaints about dentists and dental care professionals dealing suitably with those who have been shown to practise in an unprofessional or dangerous manner is obviously of paramount importance. This article looks at the GDC's fitness to practise procedures - the system that looks into complaints and allegations of malpractice about dental practitioners. It outlines the different stages in the process and introduces some of the many people involved with the efficient running of this vital service.

What can transaction costs tell us about governance in the delivery of large scale HIV prevention programmes in southern India?

PubMed

Guinness, Lorna

2011-06-01

This paper aims to understand the transaction costs implications of two different governance modes for large scale contracting of HIV prevention services to non-governmental organisations (NGOs) in 2 states in India as part of the National AIDS Control Programme between 2001 and 2003. Interviews at purposively selected case study NGOs, contracting agencies and key informants as well as document review were used to compile qualitative data and make comparisons between the states on five themes theoretically proposed to shape transaction costs: institutional environment, informational problems, opportunism, scale of activity and asset specificity (the degree to which investments made specifically for the contract have value elsewhere). The State AIDS Control Society (SACS) in state Y used a management agency to manage the NGO contracts whereas the SACS in state X contracted directly with the NGOs. A high level of uncertainty, endemic corruption and weak information systems served to weaken the contractual relationships in both states. The management agency in state Y enabled the development of a strong NGO network, greater transparency and control over corrupt practises than the contract model in state X. State X's contractual process was further weakened by inadequate human resources. The application of the transaction cost framework to contracting out public services to NGOs identified the key costs associated with the governance of HIV prevention services through NGO contracts in India. A more successful form of relational contract evolved within the network of the contract management agency and the NGOs. This led to improved flows of information and perceived quality, and limited corrupt practises. It is unlikely that the SACS on its own, with broader responsibilities and limited autonomy can achieve the same ends. The management agency approach therefore appears to be both transaction cost reducing and better able to cope with the large scale of these contracting programmes. Copyright © 2011 Elsevier Ltd. All rights reserved.

What can transaction costs tell us about governance in the delivery of large scale HIV prevention programmes in southern India?

PubMed Central

Guinness, Lorna

2011-01-01

This paper aims to understand the transaction costs implications of two different governance modes for large scale contracting of HIV prevention services to non-governmental organisations (NGOs) in 2 states in India as part of the National AIDS Control Programme between 2001 and 2003. Interviews at purposively selected case study NGOs, contracting agencies and key informants as well as document review were used to compile qualitative data and make comparisons between the states on five themes theoretically proposed to shape transaction costs: institutional environment, informational problems, opportunism, scale of activity and asset specificity (the degree to which investments made specifically for the contract have value elsewhere). The State AIDS Control Society (SACS) in state Y used a management agency to manage the NGO contracts whereas the SACS in state X contracted directly with the NGOs. A high level of uncertainty, endemic corruption and weak information systems served to weaken the contractual relationships in both states. The management agency in state Y enabled the development of a strong NGO network, greater transparency and control over corrupt practises than the contract model in state X. State X’s contractual process was further weakened by inadequate human resources. The application of the transaction cost framework to contracting out public services to NGOs identified the key costs associated with the governance of HIV prevention services through NGO contracts in India. A more successful form of relational contract evolved within the network of the contract management agency and the NGOs. This led to improved flows of information and perceived quality, and limited corrupt practises. It is unlikely that the SACS on its own, with broader responsibilities and limited autonomy can achieve the same ends. The management agency approach therefore appears to be both transaction cost reducing and better able to cope with the large scale of these contracting programmes. PMID:21349622

Assessing the limitations of the existing physician directory for measuring electronic health record (EHR) adoption rates among physicians in Connecticut, USA: cross-sectional study.

PubMed

Tikoo, Minakshi

2012-01-01

To assess the limitations of the existing physician directory in measuring electronic health record adoption rates among a cohort of Connecticut physicians. A population-based mailing assessed the number of physicians practising in Connecticut. Information about practice site, practises pertaining to storing of patient information, sources of revenue and preferred method for receiving survey. Practice status in Connecticut, measured by yes and no. Demographic information was collected on gender, year of birth, race and ethnicity. The response rate for the postcard mailing was 19% (3105/16 462). Of the 16 462 unduplicated consumers, 233 (1%) were retired and 5828 (35%) did not practise in Connecticut. Of the 3105 valid postcard responses we received, 2159 were for physicians practising in Connecticut. Nine (0.4%) of these responses did not specify a preferred method for receiving the full physician survey; 91 physicians refused to participate in the survey; 2159 surveys were sent out using each physician's requested method for receiving the survey, that is, web-based, regular mail or telephone. As of August 2012, 898 physicians had returned surveys, resulting in a response rate of 42%. The postcard response rate based on the unduplicated lists adjusted for exclusions, such as death, retired and do not practise in Connecticut, is 30%, which is low. We may be missing physicians' population which could greatly affect the indicators being used to measure change in electronic health record adoption rates. It is difficult to obtain an accurate physician count of practising physicians in Connecticut from the existing lists. States that are participating in the projects funded under various Office of the National Coordinator for Health Information Technology (ONC) initiatives must focus on getting an accurate count of the physicians practising in their state, since their progress is being measured based on this key number.

A preliminary investigation into the moral reasoning abilities of UK veterinarians.

PubMed

Batchelor, C E M; Creed, A; McKeegan, D E F

2015-08-01

Veterinary medicine is an ethically challenging profession, but the ethical reasoning abilities of practising veterinarians in the UK have never been formally assessed. This study investigated moral reasoning ability in 65 qualified veterinarians (38 practising and 27 academic) and 33 members of the public in the UK using the Defining Issues Test. Academic veterinarians had higher scores than members of the public but practising veterinarians did not. There was large variation in moral reasoning abilities among qualified veterinarians. Moral reasoning score in veterinarians did not improve with years of experience. These results show that despite having a professional degree moral reasoning skills of practising veterinarians may be insufficient to deal with the demands of their profession. This could have implications for animal welfare, client services and veterinarian wellbeing. The results highlight the need for more training in this area. British Veterinary Association.

Employee perceptions of managers' leadership over time.

PubMed

Palm, Kristina; Ullström, Susanne; Sandahl, Christer; Bergman, David

2015-01-01

This paper aims to explore if and how employees in a healthcare organisation perceive changes in their managers' leadership behaviour over time. An interview study was conducted with employees whose managers had participated in a two-year leadership development programme offered by their employer, Healthcare Provision Stockholm County. Qualitative content analysis was applied, and the interview discussions focused on areas in which the majority of the informants perceived that a change had occurred over time and their answers were relatively consistent. The majority of employees did discern changes in their managers' leadership over time, and, with very few exceptions, these changes were described as improvements. The knowledge that employees perceived changes in their managers' leadership supports investments in leadership development through courses, programmes or other initiatives. The present findings contribute to a deeper empirical understanding of leadership as it is practised over time in everyday contexts among employees in healthcare organisations.

Positive implications from socially accountable, community-engaged medical education across two Philippines regions.

PubMed

Woolley, Torres; Cristobal, Fortunato; Siega-Sur, Jusie; Ross, Simone; Neusy, Andre-Jacques; Halili, Servando; Reeve, Carole

2018-02-01

Hundreds of millions of people worldwide lack access to quality health services, largely because of geographic and socioeconomic maldistribution of qualified practitioners. This study describes differences between the practice locations of Philippines medical graduates from two 'socially accountable, community-engaged' health professional education (SAHPE) schools and the practice locations of graduates from two 'conventionally trained' medical schools located in the same respective geographic regions. Licensed medical graduates were currently practising in the Philippines and had been practising for at least 6 months. Graduates were from two Philippines SAHPE schools (Ateneo de Zamboanga University-School of Medicine (ADZU-SOM) on the Zamboanga Peninsula (n=212) and the University of the Philippines Manila-School of Health Sciences (SHS-Palo) in Eastern Visayas (n=71), and from two 'conventional' medical schools Methods: Current graduate practice locations in municipalities or cities were linked with their respective population size and socioeconomic income class, and geocoded using Geographical Information System software onto a geospatial map of the Philippines. Bivariate analysis compared the population size and socioeconomic class of communities where the SAHPE medical graduates practised to communities where 'conventional' medical school graduates practised. Thirty-one percent of ADZU-SOM medical graduates practised in communities <100 000 population versus 7% of graduates from the conventional school in the Zamboanga region (p<0.001), while 61% of SHS-Palo medical graduates practised in communities <100 000 population versus 12% of graduates from the conventional school in the Visayas region (p<0.001). Twenty-seven percent of ADZU-SOM graduates practised in lower income category communities (categories 2-6) versus 8% of graduates from the conventional school in the same region (p<0.001), while 49% of SHS-Palo graduates practised in lower income category communities (categories 2-6) versus 11% of graduates from the conventional school in the same region (p<0.001). SAHPE has contributed to increased medical coverage across rural and/or economically disadvantaged areas in two Philippines regions. The extensive community-based medical student placements associated with SAHPE likely play a significant role in graduates choosing to practice in rural and/or economically disadvantaged communities. Governments experiencing medical workforce maldistributions similar to those in the Philippines should consider SAHPE as a potentially cost-effective strategy in recruiting and retaining health graduates to underserved areas.

A critical commentary on management science in relation to reforms after institutional National Health Service failures.

PubMed

Regan, Paul; Ball, Elaine

2017-03-01

A discussion paper on the United Kingdom (UK) National Health Service (NHS) market reforms. NHS market reforms reliance on management science methods introduced a fundamental shift in measuring care for commissioning. A number of key reports are discussed in relation to NHS market reforms and management science. NHS market reforms were influenced through a close alliance between policy makers, the department of health, free market think tanks and management consultancies. The timing of reforms coincided with reports on NHS failings and the evolution of measurement methods to focus on finance. The balance in favour of measurement practises is of concern. Management science methods are criticised in the Francis Report yet promoted as the solution to some of the key findings; why may be explained by the close alliance. A return to principles of management involving consensus, trust and involvement to promote quality care and use management science methods to this end. © 2016 John Wiley & Sons Ltd.

Anthropometric and Physical Fitness Differences Among Brazilian Adolescents who Practise Different Team Court Sports.

PubMed

Silva, Diego Augusto Santos; Petroski, Edio Luiz; Gaya, Adroaldo Cesar Araujo

2013-03-01

The objective of this work was to compare the anthropometric and physical fitness characteristics of Brazilian adolescents who practise team court sports and to compare specific parameters obtained for adolescents with data from the general population. This was a cross-sectional study of 1,348 male adolescents grouped as follows: basketball players (n = 287), indoor soccer players (n = 665), handball players (n = 108) and volleyball players (n = 288), all between 10 and 14 years of age. Anthropometric (body mass, body height, arm span, and body mass index) and physical fitness data (flexibility, muscular strength, explosive power, speed, aerobic fitness and agility) were collected. The Brazilian population was used as a reference and compared to the adolescent subjects using Z scores for all variables. Anthropometric characteristics and performances in physical fitness tests differed (p<0.05) among players of different sports. In addition, for each variable assessed, adolescents who practised team court sports showed similar or improved results compared to their counterparts in the general population (p<0.05). Furthermore, the anthropometric and physical fitness characteristics differed depending on the team court sport practised. These findings may elucidate which physical abilities are most impacted by the practise of a particular team sport as well as help teachers and physical education and sport professionals identify talented adolescents.

Pathways to rural family practice at Memorial University of Newfoundland

PubMed Central

Rourke, James; O’Keefe, Danielle; Ravalia, Mohamed; Moffatt, Scott; Parsons, Wanda; Duggan, Norah; Stringer, Katherine; Jong, Michael; Walsh, Kristin Harris; Hippe, Janelle

2018-01-01

Abstract Objective To assess Memorial University of Newfoundland’s (MUN’s) commitment to a comprehensive pathways approach to rural family practice, and to determine the national and provincial effects of applying this approach. Design Analysis of anonymized secondary data. Setting Canada. Participants Memorial’s medical degree (MD) graduates practising family medicine in Newfoundland and Labrador as of January 2015 (N = 305), MUN’s 2011 and 2012 MD graduates (N = 120), and physicians who completed family medicine training programs in Canada between 2004 and 2013 and who were practising in Canada 2 years after completion of their postgraduate training (N = 8091). Main outcome measures National effect was measured by the proportion of MUN’s family medicine program graduates practising in rural Canada compared with those from other Canadian family medicine training programs. Provincial effect was measured by the location of MUN’s MD graduates practising family medicine in Newfoundland and Labrador as of January 2015. Commitment to a comprehensive pathways approach to rural family practice was measured by anonymized geographic data on admissions, educational placements, and practice locations of MUN’s 2011 and 2012 MD graduates, including those who completed family medicine residencies at MUN. Results Memorial’s comprehensive pathways approach to training physicians for rural practice was successful on both national and provincial levels: 26.9% of MUN family medicine program graduates were in a rural practice location 2 years after exiting their post-MD training from 2004 to 2013 compared with the national rate of 13.3% (national effect); 305 of MUN’s MD graduates were practising family medicine in Newfoundland and Labrador as of 2015, with 36% practising in rural areas (provincial effect). Of 114 MD students with known background who graduated in 2011 and 2012, 32% had rural backgrounds. Memorial’s 2011 and 2012 MD graduates spent 20% of all clinical placement weeks in rural areas; of note, 90% of all first-year placements and 95% of third-year family medicine clerkship placements were rural. For the 25 MUN 2011 and 2012 MD graduates who also completed family medicine residencies at MUN, 38% of family medicine placement weeks were spent in rural communities or rural towns. Of the 30 MUN 2011 and 2012 MD graduates practising family medicine in Canada as of January 2015, 42% were practising in rural communities or rural towns; 73% were practising in Newfoundland and Labrador and half of those were in rural communities and rural towns. Conclusion A comprehensive rural pathways approach that includes recruiting rural students and exposing all medical students to extensive rural placements and all family medicine residents to rural family practice training has resulted in more rural generalist physicians in family practice in Newfoundland and Labrador and across Canada. PMID:29540400

Pathways to rural family practice at Memorial University of Newfoundland.

PubMed

Rourke, James; O'Keefe, Danielle; Ravalia, Mohamed; Moffatt, Scott; Parsons, Wanda; Duggan, Norah; Stringer, Katherine; Jong, Michael; Walsh, Kristin Harris; Hippe, Janelle

2018-03-01

To assess Memorial University of Newfoundland's (MUN's) commitment to a comprehensive pathways approach to rural family practice, and to determine the national and provincial effects of applying this approach. Analysis of anonymized secondary data. Canada. Memorial's medical degree (MD) graduates practising family medicine in Newfoundland and Labrador as of January 2015 (N = 305), MUN's 2011 and 2012 MD graduates (N = 120), and physicians who completed family medicine training programs in Canada between 2004 and 2013 and who were practising in Canada 2 years after completion of their postgraduate training (N = 8091). National effect was measured by the proportion of MUN's family medicine program graduates practising in rural Canada compared with those from other Canadian family medicine training programs. Provincial effect was measured by the location of MUN's MD graduates practising family medicine in Newfoundland and Labrador as of January 2015. Commitment to a comprehensive pathways approach to rural family practice was measured by anonymized geographic data on admissions, educational placements, and practice locations of MUN's 2011 and 2012 MD graduates, including those who completed family medicine residencies at MUN. Memorial's comprehensive pathways approach to training physicians for rural practice was successful on both national and provincial levels: 26.9% of MUN family medicine program graduates were in a rural practice location 2 years after exiting their post-MD training from 2004 to 2013 compared with the national rate of 13.3% (national effect); 305 of MUN's MD graduates were practising family medicine in Newfoundland and Labrador as of 2015, with 36% practising in rural areas (provincial effect). Of 114 MD students with known background who graduated in 2011 and 2012, 32% had rural backgrounds. Memorial's 2011 and 2012 MD graduates spent 20% of all clinical placement weeks in rural areas; of note, 90% of all first-year placements and 95% of third-year family medicine clerkship placements were rural. For the 25 MUN 2011 and 2012 MD graduates who also completed family medicine residencies at MUN, 38% of family medicine placement weeks were spent in rural communities or rural towns. Of the 30 MUN 2011 and 2012 MD graduates practising family medicine in Canada as of January 2015, 42% were practising in rural communities or rural towns; 73% were practising in Newfoundland and Labrador and half of those were in rural communities and rural towns. A comprehensive rural pathways approach that includes recruiting rural students and exposing all medical students to extensive rural placements and all family medicine residents to rural family practice training has resulted in more rural generalist physicians in family practice in Newfoundland and Labrador and across Canada. Copyright© the College of Family Physicians of Canada.

Simulation workshops with first year midwifery students.

PubMed

Catling, Christine; Hogan, Rosemarie; Fox, Deborah; Cummins, Allison; Kelly, Michelle; Sheehan, Athena

2016-03-01

Simulated teaching methods enable a safe learning environment that are structured, constructive and reflective. We prepared a 2-day simulation project to help prepare students for their first clinical practice. A quasi-experimental pre-test - post-test design was conducted. Qualitative data from the open-ended survey questions were analysed using content analysis. Confidence intervals and p-values were calculated to demonstrate the changes in participants' levels of understanding/ability or confidence in clinical midwifery skills included in the simulation. 71 midwifery students participated. Students rated their understanding, confidence, and abilities as higher after the simulation workshop, and higher still after their clinical experience. There were five main themes arising from the qualitative data: having a learning experience, building confidence, identifying learning needs, developing communication skills and putting skills into practise. First year midwifery students felt well prepared for the clinical workplace following the simulation workshops. Self-rated understanding, confidence and abilities in clinical midwifery skills were significantly higher following consolidation during clinical placement. Longitudinal studies on the relationship between simulation activities and student's overall clinical experience, their intentions to remain in midwifery, and facility feedback, would be desirable. Copyright © 2015 Elsevier Ltd. All rights reserved.

Environmental impacts of urban snow management--the alpine case study of Innsbruck.

PubMed

Engelhard, C; De Toffol, S; Lek, I; Rauch, W; Dallinger, R

2007-09-01

In regions with colder climate, snow at roads can accumulate significant amounts of pollutant chemicals. In northern countries various efforts have been made to face this problem, but for the alpine region little is known about the pollution of urban snow. The present case study was carried out in the city of Innsbruck (Austria). It aimed at measuring pollution of roadside snow and estimating the impact of snow management practises on environmental quality. Concentrations of copper, zinc, lead, cadmium, suspended solids and chloride were determined during a series of sampling events. Various locations with low and high traffic densities and in different distances from a highway have been investigated. The concentrations of copper were generally higher at sites with high traffic density compared to locations with low traffic impact. In contrast to this, the concentrations of zinc and lead remained almost unvaried irrespective of traffic density at the different sampling sites. For cadmium, the picture was more diverse, showing moderately elevated concentrations of this metal also at the urban reference site not polluted by traffic. This indicates that there may be also other important sources for cadmium besides traffic. Suspended solids accumulated in the roadside snow, the highest concentrations were found at the sites with high traffic density. The chloride concentrations were considerable in the snow, especially at the highway. Based on the results of the present measurement campaign, the environmental impact of snow disposal in rivers was also estimated. A negative impact on rivers from snow disposal seems likely to occur, although the discharged loads could only be calculated with substantial uncertainty, considering the high variability of the measured pollutant concentrations. For a more accurate evaluation of this management practise on rivers, further investigations would be necessary.

Factors influencing medical students' motivation to practise in rural areas in low-income and middle-income countries: a systematic review

PubMed Central

Zwanikken, Prisca A C; Pokharel, Paras K; Scherpbier, Albert J

2017-01-01

Objectives There is a shortage of doctors working in rural areas all over the world, especially in low-income and middle-income countries. The choice to practise medicine in a rural area is influenced by many factors. Motivation developed as a medical student is one key determinant of this choice. This study explores influences on medical students' motivation to practise in rural areas of low-income and middle-income countries following graduation. Design A systematic review was conducted to identify influences on medical students' motivation to work in rural areas in low-income and middle-income countries. Papers reporting influences on motivation were included, and content analysis was conducted to select the articles. Articles not published in English were excluded from this review. Results A rural background (ie, being brought up in a rural area), training in rural areas with a community-based curriculum, early exposure to the community during medical training and rural location of medical school motivate medical students to work in rural areas. Perceived lack of infrastructure, high workload, poor hospital management and isolation are among the health facility factors that demotivate medical students for medical practice in rural areas. Conclusions Medical school selection criteria focusing on a rural background factor and medical education curriculum focusing on rural area are more relevant factors in low-income and middle-income countries. The factors identified in this review may assist the planners, medical educators and policymakers in low-income and middle-income countries in designing relevant interventions to positively influence rural choices where the shortage of rural physicians is an ongoing and increasing concern. PMID:28232465

Self-medication among people living with hypertension: a review.

PubMed

Rahmawati, Riana; Bajorek, Beata V

2017-04-01

Self-medication is commonly practised by patients, underpinned by health beliefs that affect their adherence to medication regimens, and impacting on treatment outcomes. This review explores the scope of self-medication practices among people with hypertension, in terms of the scale of use, types of medication and influencing factors. A comprehensive search of English language, peer-reviewed literature published between 2000 and 2014 was performed. Twenty-seven studies met the inclusion criteria; 22 of these focused on complementary and alternative medicines (CAMs). Anti-hypertensive medications are listed among the 11% of products that patients reportedly obtain over-the-counter (OTC) for self-medication. On average, 25% of patients use CAMs, mostly herbs, to lower blood pressure. Recommendations by family, friends and neighbours are the most influential factors for self-medication with CAMs. Faith in treatment with CAMs, dissatisfaction with conventional medicine and the desire to reduce medication costs are also cited. Most (70%) patients with hypertension take OTC medicines to treat minor illnesses. The concurrent use of anti-hypertensive medications with analgesics and herbal medicines is commonly practised. The sociodemographic profile of patients engaging in self-medication differs markedly in the articles reviewed; self-medication practices cannot be attributed to a particular profile. Low disclosure of self-medication is consistently reported. This review highlights a high proportion of people with hypertension practise self-medication. Further studies are needed to assess the impact of self-medication with OTC and anti-hypertensive medications on hypertension treatment. Health professionals involved in hypertension management should be mindful of any types of self-medication practices. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Current physical activity improves balance control during sensory conflicting conditions in older adults.

PubMed

Buatois, S; Gauchard, G C; Aubry, C; Benetos, A; Perrin, P

2007-01-01

Aging process is characterized by difficulties in ensuring balance control, especially in conditions of reduced or conflicting sensory information, leading to an increased risk of falling. Conversely, the practise of physical activities (PA) has been recognized as a good approach to improve the quality of balance control. This study aimed to investigate the influence of current and/or past PA on balance-related neurosensorial organization in older adults on the maintenance of the upright stance, especially during sensory conflicting situations. Postural control was evaluated by means of the Sensory Organization Test on 130 healthy noninstitutionalized volunteers aged over 65, split into four groups according to the presence or absence of PA before or after retirement. Subjects who practised PA for a long time (Gr1) and subjects who started PA after retirement (Gr2) displayed the best postural performances and better managed sensory conflicting situations compared to subjects who had stopped PA for many years (Gr3) and subjects who had never practised PA (Gr4). Multiple regression analyses revealed that current PA was the major determinant for postural parameters during sensorial conflict compared to age, gender, body mass index and past PA. Regular PA, even when started late in life, allows appropriate reorganization of the different components of postural control during sensory conflicting situations. Indeed, active subjects were more able to compensate for suppressed or perturbed sensory information by an increased usage of another referential and so to correct their posture by adopting a more appropriate balance strategy. Thus, PA counteracts the age-related decline of postural control and could consequently reduce the risk of falling.

[Concepts for the regulation of mixtures of toxic pollutants in environmental hygiene].

PubMed

Csicsaky, M J

1998-06-01

In view of the increasing accumulation of large-scale livestock production facilities in the western parts of Lower Saxony the question rises how ecology and economy can be conciliated and how the protection of human health can be assured. Based on existing legislation this is hard to achieve because of the weak legal position of the administration when trying to prohibit the further expansion of livestock production as opposed to the strong legal position of owners and investors. Presently there is no agreement within the scientific community on safe limits for airborne pathogens and it is quite obvious that thresholds for peak concentrations do not solve the problem of background level exposures. Apart from the unsatisfactory current practise to licence farm animal units in the outskirts of existing villages only, in future the introduction of the EC Environmental Management and Auditing Scheme (EMAS) in animal production may improve the situation. This management system is intended to permanently reduce the environmental impact of a production site and implements the ALARA-PRINCIPLE (as low as reasonably achievable) which is known from protection measures against radiation. As the implementation of the EMAS so far works only on a voluntary basis, an incentive is needed. If dealers and consumers give preference to products from producers having adopted the EMAS, this would be a very efficient incentive. Before this could be put into practise, however, the EMAS criteria originally designed for industrial production sites will have to be adapted to the special conditions of animal production.

Initiating undergraduate medical students into communities of research practise: what do supervisors recommend?

PubMed Central

2010-01-01

Background Much has been written in the educational literature on the value of communities of practise in enhancing student learning. Here, we take the experience of senior undergraduate medical students involved in short-term research as a member of a team as a paradigm for learning in a community of practise. Based on feedback from experienced supervisors, we offer recommendations for initiating students into the research culture of their team. In so doing, we endeavour to create a bridge between theory and practise through disseminating advice on good supervisory practise, where the supervisor is perceived as an educator responsible for designing the research process to optimize student learning. Methods Using the questionnaire design tool SurveyMonkey and comprehensive lists of contact details of staff who had supervised research projects at the University of Edinburgh during 1995 - 2008, current and previous supervisors were invited to recommend procedures which they had found successful in initiating students into the research culture of a team. Text responses were then coded in the form of derivative recommendations and categorized under general themes and sub-themes. Results Using the chi-square tests of linear trend and association, evidence was found for a positive trend towards more experienced supervisors offering responses (χ2 = 16.833, p < 0.0005, n = 215) while there was a lack of evidence of bias in the gender distribution of respondents (χ2 = 0.482, p = 0.487, n = 203), respectively. A total of 126 codes were extracted from the text responses of 65 respondents. These codes were simplified to form a complete list of 52 recommendations, which were in turn categorized under seven derivative overarching themes, the most highly represented themes being Connecting the student with others and Cultivating self-efficacy in research competence. Conclusions Through the design of a coding frame for supervisor responses, a wealth of ideas has been captured to make communities of research practise effective mediums for undergraduate student learning. The majority of these recommendations are underpinned by educational theory and have the potential to take the learner beyond the stage of initiation to that of integration within their community of research practise. PMID:21092088

Hybrid management, organizational configuration, and medical professionalism: evidence from the establishment of a clinical directorate in Portugal.

PubMed

Correia, T; Denis, J L

2016-05-24

The need of improving the governance of healthcare services has brought health professionals into management positions. However, both the processes and outcomes of this policy change highlight differences among the European countries. This article provides in-depth evidence that neither quantitative data nor cross-country comparisons have been able to provide regarding the influence of hybrids in the functioning of hospital organizations and impact on clinicians' autonomy and exposure to hybridization. The study was designed to witness the process of institutional change from the inside and while that process was underway. It reports a case study carried out in a public hospital in Portugal when the establishment of a clinical directorate was being negotiated. Data collection comprises semi-structured interviews with general managers and surgeons complemented with observations. The clinical directorate under study illustrates a divisionalized professional bureaucracy model that combines features of professional bureaucracies and divisionalized forms. The hybrid manager is key to understand the extent to which practising clinicians are more accountable and to whom given that managerial tools of control have not been strengthened, and trust-based relations allow them to keep professional autonomy untouched. In sum, clinicians are allowed to profit from their activity and to perform autonomously from the hospital's board of directors. The advantageous conditions enjoyed by the clinical directorate intensify internal re-stratification in medicine, thus suggesting forms of divisionalized medical professionalism grounded in organizational dynamics. It is discussed the extent to which policy change to the governance of health organizations regarding the relationship between medicine and management is subject to specific constraints at the workplace level, thus conditioning the expected outcomes of policy setting. The study also highlights the role of hybrid managers in determining the extent to which practising professionals are more accountable to managerial criteria. The overall conclusion is that although medical and managerial values link to each other, clinicians reconfigure managerial criteria according to specific interests. Ultimately, medical autonomy and authority may be reinforced in organizational settings subject to NPM-driven reforms.

Rules of good practice in the care of laboratory animals used in biomedical research.

PubMed

Valanzano, Angelina

2004-01-01

In recent years, the use of laboratory animals has decreased as a result of the adoption of alternative methods such as in vitro experiments and simulation studies. Nonetheless, animal models continue to be necessary in many fields of biomedical research, giving rise to ethical issues regarding the treatment of these animals. In the present work, a general overview of the rules of good practise in caring for laboratory animals is provided, focussing on housing conditions and the proper means of handling animals, including the importance of the relationship or "bond" between the researcher and the animal.

Practising Empathy: Enacting Alternative Perspectives through Imaginative Play

ERIC Educational Resources Information Center

Waite, Sue; Rees, Sarah

2014-01-01

This article reports on a collaborative study using an innovative methodology, based on "insiders" who are Steiner practitioners knowledgeable and practised in Steiner philosophy and "outsiders" from UK mainstream early years and primary perspectives. Although the study as a whole focused on assessment and observation used in…

Female family physicians in obstetrics: achieving personal balance.

PubMed Central

Carroll, J C; Brown, J B; Reid, A J

1995-01-01

OBJECTIVE: To describe the experiences of female family physicians who practise obstetrics in balancing professional obligations with personal and family needs, given the unique challenges that such practice poses for these physicians. DESIGN: Qualitative study. SETTING: Ontario. PARTICIPANTS: A purposefully selected sample of nine female family physicians who met the criteria of being married, having children and currently practising obstetrics. OUTCOME MEASURES: Experiences of female family physicians and their strategies in their personal, family and professional lives that enable them to continue practising obstetrics. RESULTS: All participants continued to practise obstetrics because of the pleasure they derived from it, despite the challenges of balancing the unpredictable demands of obstetrics with their personal and family needs. To continue in obstetrics, they needed to make changes in their lives, either through a gradual, evolutionary process or in response to a critical event. Alterations to work and family arrangements permitted them to meet the challenges and led to increased satisfaction. Changes included making supportive call-group arrangements, limiting work hours and the number of births attended and securing help with household duties. CONCLUSIONS: An in-depth examination, through the use of qualitative methods, showed the reasons why some female family physicians continue to practise obstetrics despite the stressful aspects of doing so. This knowledge may be useful for women who are residents or experienced clinicians and who are considering including obstetrics in their practice. PMID:7497390

Caring presence in practice: facilitating an appreciative discourse in nursing.

PubMed

du Plessis, E

2016-09-01

To report on an appreciation of caring presence practised by nurses in South Africa in order to facilitate an appreciative discourse in nursing and a return to caring values and attitudes. Appreciative reports on caring presence are often overlooked. Media may provide a platform for facilitating appreciation for caring presence practised by nurses. Such an appreciation may foster further practice of caring presence and re-ignite a caring ethos in nursing. This article provides an appreciative discourse on caring presence in nursing in the form of examples of caring presence practised by nurses. An anecdotal approach was followed. Social media, namely narratives on caring presence shared by nurses on a Facebook page, and formal media, namely news reports in which nurses are appreciated for their efforts, were used. Deductive content analysis was applied to analyse the narratives and news reports in relation to a definition of caring presence and types of caring presence. The analysis of the narratives and news reports resulted in an appreciative discourse in which examples of nurses practising caring presence could be provided. Examples of nurses practising caring presence could be found, and an appreciative discourse could be initiated. Appreciation ignites positive action and ownership of high-quality health care. Leadership should thus cultivate a culture of appreciating nurses, through using media, and encourage nurses to share how caring presence impact on quality in health care. © 2016 International Council of Nurses.

Why do idiopathic scoliosis patients participate more in gymnastics?

PubMed

Meyer, C; Cammarata, E; Haumont, T; Deviterne, D; Gauchard, G C; Leheup, B; Lascombes, P; Perrin, Ph P

2006-08-01

The influence of physical and sporting activities (PSA) on idiopathic scoliosis (IS) is still obscure. The aim of this study was to investigate whether such an influence exists and if so, to determine its characteristics. Two hundred and one teenagers with IS and a control group of 192 adolescents completed an epidemiological questionnaire. Those practising gymnastics were more numerous in the IS group than in the control group. Moreover, the practice of gymnastics was chosen before IS was diagnosed. As gymnastic activities are considered neither as a therapy nor as a precursor of IS, the distribution observed could be linked to a common factor that both increases the likelihood of IS and favors the practice of gymnastics. Joint laxity (JL) may be such a common factor, and was therefore tested (wrist and middle finger) on 42 girls with IS and 21 girls of a control group. IS patients, practising gymnastics or not, showed a higher JL than the control group practising gymnastics or not. Furthermore, the groups practising gymnastic activities did not show higher JL levels than the other groups. Children with a high JL could be drawn toward gymnastics because of their ability to adapt to the constraints of this sport. Girls with a high JL may therefore be prone to developing IS. The fact that most teenagers with IS practise gymnastics could be related to a higher JL.

Impact of a social network-based intervention promoting diabetes self-management in socioeconomically deprived patients: a qualitative evaluation of the intervention strategies

PubMed Central

Vissenberg, C; Stronks, K; Nijpels, G; Uitewaal, P J M; Middelkoop, B J C; Kohinor, M J E; Hartman, M A; Nierkens, V

2016-01-01

Objective There is a need for effective interventions that improve diabetes self-management (DSM) among socioeconomically deprived patients with type 2 diabetes. The group-based intervention Powerful Together with Diabetes (PTWD) aimed to increase social support for DSM and decrease social influences hindering DSM (eg, peer pressure, social norms) in patients living in deprived neighbourhoods. Through a qualitative process evaluation, this paper aims to study whether this intervention changed social support and social influences, and which elements of the intervention contributed to this. Methods The intervention group (IG) was compared with a standard group-based educational intervention (control group, CG). 27 qualitative in-depth interviews with participants (multiethnic sample) and 24 interviews with group leaders were conducted. Interviews were coded and analysed using MAXQDA according to framework analysis. Results Patients in the IG experienced more emotional support from group members and more instrumental and appraisal support from relatives than those in the CG. Also, they were better able to recognise and cope with influences that hinder their DSM, exhibited more positive norms towards DSM and increased their priority regarding DSM and their adherence. Finally, the engagement in DSM by relatives of participants increased. Creating trust between group members, skills training, practising together and actively involving relatives through action plans contributed to these changes. Conclusions A group-based intervention aimed at creating trust, practising together and involving relatives has the potential to increase social support and diminish social influences hindering DSM in socioeconomically deprived patients with diabetes. Promising elements of the intervention were skills training and providing feedback using role-playing exercises in group sessions with patients, as well as the involvement of patients' significant others in self-management tasks, and actively involving them in making an action plan for self-management. These positive results justify the value of further evaluating the effectiveness of this intervention in a larger sample. Trial registration number NTR1886, Results. PMID:27075842

Training in Project-Based Education: Practise as You Preach

ERIC Educational Resources Information Center

Weenk, Wim; Govers, Elly; Vlas, Helma

2004-01-01

Several years of experience in training lecturers for developing and tutoring project-based learning (PBL) courses have resulted in a 'practise as you preach' based and flexible training programme. This programme was successfully incorporated in the teacher training programmes of the University of Twente and other universities and polytechnics in…

Fostering employee involvement.

PubMed

Beecher, G P

1997-11-01

Every year, the ODA's Economics of Practice Committee, with the help of an independent consulting firm, carries out the Cost of Practice Monitor which tracks the various costs of running a dental practice in Ontario. This article is the result of a joint ODA-Arthur Andersen initiative to provide members with detailed information from the Monitor. Over the next year, there will be a series of articles published under the heading "Best practises for Ontario's Dental Practices." The article featured in this issue focuses on wage expenses in dental practices and how to foster employee involvement as a means of addressing cost-productivity issues. Furthermore, information relating to wage expenses may be used by practitioners to benchmark their practice against the average Ontario dental practice. Appendix C was developed for this purpose. Through benchmarking, the practitioner may gain insight into ways of evaluating their practice and in addressing issues that could improve the management of the practice. For a long time, concepts of best business practises were applied only to manufacturing organizations or large multi-national corporations but experience has demonstrated that these activities are universal to all organizations, including service companies, schools, government and not-for-profit organizations.

[Relaxation to defuse acting out for dangerous schizophrenics].

PubMed

Bogar, Mireille; Bouchard, Jean-Pierre

2015-01-01

Relaxation is often considered as a contraindication in the management of schizophrenics. An experiment carried out with dangerous schizophrenics at the unit for dangerous patients at Cadillac general hospital revealed that, on the contrary, such an opinion is not necessarily valid in all cases. Indeed, for many of these patients, relaxation can have positive effects on their clinical state. As with its other indications, relaxation must be practised by clinicians who have an in-depth knowledge of techniques to use and of mental disorders treated in that way.

Role of the dorsolateral prefrontal cortex in context-dependent motor performance.

PubMed

Lee, Y-Y; Winstein, C J; Fisher, B E

2016-04-01

Context-dependent motor performance is a phenomenon in which people perform better in the environmental context where they originally practised a task. Some animal and computer simulation studies have suggested that context-dependent performance may be associated with neural activation of the dorsolateral prefrontal cortex (DLPFC). This study aimed to determine the role of the DLPFC in context-dependent motor performance by perturbing the neural processing of the DLPFC with repetitive transcranial magnetic stimulation (rTMS) in healthy adults. Thirty healthy adults were recruited into the Control, rTMS DLPFC and rTMS Vertex groups. The participants practised three finger sequences associated with a specific incidental context (a coloured circle and a location on the computer screen). One day following practice, the rTMS groups received 1 Hz rTMS prior to the testing conditions in which the sequence-context associations remained the same as practice (SAME) or changed (SWITCH). All three groups improved significantly over practice on day 1. The second day testing results showed that the DLPFC group had a significantly lower decrease in motor performance under the SWITCH condition than the Control and Vertex groups. This finding suggests a specific role of the DLPFC in context-dependent motor performance. © 2016 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

"Hit the ground running": perspectives of new nurses and nurse managers on role transition and integration of new graduates.

PubMed

Chernomas, Wanda M; Care, W Dean; McKenzie, Jo-Ann Lapointe; Guse, Lorna; Currie, Jan

2010-01-01

The workplace for new graduates must be a constructive learning environment to facilitate their development. Nurse managers need new graduates who can "hit the ground running." Conflict between the needs of new nurses and the realities of the workplace often creates role confusion and tension in new graduates and threatens employers' ability to retain them. As part of a larger study that examined the effectiveness of a new strategy on new nurse retention and workplace integration, we conducted focus groups with new nurses and nurse managers. This paper discusses the perspectives of new nurses on their role transition from graduates to practising professionals and the perspectives of nurse managers on the workplace integration of new nurses. The thematic findings integrate new nurses' perspectives on their needs during role transition with the perspectives of nurse managers in meeting those needs. The discussion includes strategies to facilitate successful transition and integration of new nurses into the workplace within the context of recruitment and retention.

Developing the Practising Model in Physical Education: An Expository Outline Focusing on Movement Capability

ERIC Educational Resources Information Center

Barker, D. M.; Aggerholm, K.; Standal, O.; Larsson, H.

2018-01-01

Background: Physical educators currently have a number of pedagogical (or curricular) models at their disposal. While existing models have been well-received in educational contexts, these models seek to extend students' capacities within a limited number of "human activities" (Arendt, 1958). The activity of "human practising,"…

Making Links between Maths and Science

ERIC Educational Resources Information Center

Hiscock, Naomi

2012-01-01

For some children maths and science are exciting subjects that work side by side, one providing the opportunity to practise and hone skills and knowledge gained from the other. For other children the subjects are disjointed and seem to bear no relationship to each other. Science can provide a wonderful opportunity to practise a variety of math…

Work Factors and Teacher Satisfaction: The Mediating Effect of Cynicism toward Educational Change

ERIC Educational Resources Information Center

Yim, Joanne Sau-Ching; Moses, Priscilla

2016-01-01

This study investigated teachers' cynicism toward a major education transformation blueprint and their job satisfaction with a sample of 628 practising teachers. Participants were practising teachers in primary (n = 326) and secondary (n = 302) schools located in a school district in Malaysia. A self-reporting questionnaire was used, where the…

Australian Public Universities: Are They Practising a Corporate Approach to Governance?

ERIC Educational Resources Information Center

Christopher, Joseph

2014-01-01

This article draws on the multi-theoretical approach to governance and a qualitative research method to examine the extent to which the corporate approach is practised in Australian public universities. The findings reveal that in meeting the needs of multiple stakeholders, universities are faced with a number of structural, legalistic, and…

STD management by private pharmacies in Hanoi: practice and knowledge of drug sellers

PubMed Central

Chalker, J; Chuc, N; Falkenberg, T; Do N, T; Tomson, G

2000-01-01

Background: Prompt treatment of sexually transmitted infections may reduce the incidence of HIV/AIDS infections. With health sector reforms private pharmacies are increasingly the first and only contact with health delivery services. Objectives: To find out how patients with STDs are treated at private pharmacies in Hanoi, and what drug sellers know about STD management. Methods: Five simulated clients were taught to adopt a scenario stating that their friend had a urethral discharge. They visited 60 randomly selected private pharmacies in urban Hanoi and noted all questions asked, advice offered, and treatment given. Afterwards interviewers administered a semistructured questionnaire to all people working in the 60 pharmacies. Results: Drug treatment was given in 84% of the 297 encounters averaging 1.5 drugs and 1.2 antibiotics per encounter. Quinolones were given 188 times. No dispensing was adequate for chlamydia or was in accordance with the national guidelines. No questions were asked in 55% of encounters and no advice was given in 61%. Questions on sexual activity were asked in 23% (69) of cases and about the health of the partner twice (1%). Advice to practise safe sex was given in 1% of encounters and for the partner to seek treatment only once. Of 69 questionnaires administered 51% said they would refer to a doctor, 16% said they would ask about the sexual activity 1% said they would ask about the health of the partner, 7% said they would advise using a condom, and 1% advised telling the partner to seek treatment. Even after prompting, 61% would ask no questions and 80% would give no advice. Conclusions: Even though 74% of pharmacists and drug sellers know that they should not treat STD patients, 84% actually did. None gave syndromically correct treatment. In both the questionnaire and during the simulated client methods, numbers advising on partner notification and condom use were very poor. Educational or peer awareness interventions are urgently needed among private pharmacists in Vietnam. Key Words: sexually transmitted diseases; private pharmacies; simulated client methods PMID:11026888

Colocating an accredited practising dietitian to an adult community mental health service: An exploratory study.

PubMed

Furness, Trentham; Wallace, Elizabeth; McElhinney, Jo; McKenna, Brian; Cuzzillo, Celeste; Foster, Kim

2018-04-27

For people with severe mental illness, accredited practising dietitians may assist with a nutrition care plan that considers the medical, psychiatric, psychological, social, spiritual, and pharmacological aspects of their care. However, consumers' access to care has been limited by difficulties attending appointments and suboptimal interface between nutritional and mental health services. Therefore, the objectives of this exploratory study were to describe access to, and key stakeholder perspectives of, the accredited practising dietitian role colocated in a community mental health service. A total of 16 key stakeholders participated in one-to-one interviews. Two main themes with subthemes were derived from analysis of interviews: (i) 'building empowerment and collaboration' and included the subthemes, (a) nutrition awareness and education and (b) healthy lifestyle changes, and (ii) 'overcoming challenges to optimal nutrition and effective health care'. In addition, improved access to the role was demonstrated with 124 (79%) consumers attending at least one appointment with an accredited practising dietitian. A total of 15 (12%) consumers attended more than 10 appointments during their outpatient admission to the community mental health service. Colocating an accredited practising dietitian was perceived to build empowerment and collaboration, and overcome challenges to optimal nutrition and effective health care for consumers, carers, and clinicians. The colocation of a dietitian can empower consumers' to make health-informed decisions and support their willingness to engage with physical healthcare provision when it is prioritized alongside mental healthcare provision. © 2018 Australian College of Mental Health Nurses Inc.

[Predictors of successful transfer to everyday live of a relaxation method acquired in psychosomatic rehabilitation].

PubMed

Bernardy, K; Krampen, G; Köllner, V

2008-12-01

The aim of the present study was to identify factors at the beginning and at the end of an inpatient psychosomatic rehabilitation predicting the successful transfer of Progressive Relaxation (PR) according to Jacobson three months after the stay. Eighty patients in a psychosomatic rehabilitation centre were studied in the beginning (T1), at discharge (T2) and three months after discharge (T3). Every patient participated in courses on PR. To evaluate the course, parts of the "Diagnostisches und evaluatives Instrumentarium für Entspannungstraining und Entspannungstherapie" were used. Transfer was defined as successful if patients practised PR at least once a week three months after their stay. Potential predictors were: diagnosis, age, symptoms, previous experiences, and motives at T1 and frequency of practising, adequateness of group size and change of symptoms at T2. Stepwise logistic regression analysis was used to identify predictors. Three months after the course 52,5% of the patients were able to transfer PR successfully into their daily lives. 68,8% of cases had been correctly classified by logistic regression through: participation motive "positive thoughts" (T1) and "frequency of practising PR outside the course" (T2). Intrinsic participation motives and practising independently are significant predictors of long-term transfer of PR. This indicates the necessity of discussing motives at the beginning as well as frequency of practising during the PR course. It would be particularly interesting to know whether specific encouraging of motivation would improve the transfer to everyday life.

Consideration of using virtual reality for teaching neonatal resuscitation to midwifery students.

PubMed

Williams, Jessica; Jones, Donovan; Walker, Rohan

2018-05-28

Within the last decade, there has been significant change in the way tertiary midwifery education has been delivered to students. The use of blended teaching methods and the introduction of simulated learning experiences has been observed in the literature to improve students' self-confidence, competence, clinical judgement and decision-making abilities. Simulation is seen to be particularly important when practising skills that may be infrequently encountered in practice, such as clinical emergencies. Neonatal resuscitation is the most common neonatal emergency encountered within midwifery today, with up to 15% of babies requiring some form of resuscitation at birth. Recent research describes the benefits of using a multi-modal approach to teaching neonatal resuscitation, utilising both theory and simulated learning methods. One emerging method of simulation is that of virtual reality (VR), which has been recognised for its enormous educational potential in risk-free clinical skills training. Currently, however, there is limited research looking at the use of VR in emergency skills training. This article examines the literature to highlight the potential benefits that VR simulation could provide for emergency skills training, as well as the potential challenges that should be acknowledged. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

Round-the-table teaching: a novel approach to resuscitation education

PubMed Central

McGarvey, Kathryn; Scott, Karen; O'Leary, Fenton

2014-01-01

Background Effective cardiopulmonary resuscitation saves lives. Health professionals who care for acutely unwell children need to be prepared to care for a child in arrest. Hospitals must ensure that their staff have the knowledge, confidence and ability to respond to a child in cardiac arrest. RESUS4KIDS is a programme designed to teach paediatric resuscitation to health care professionals who care for acutely unwell children. The programme is delivered in two components: an e–learning component for pre-learning, followed by a short, practical, face-to-face course that is taught using the round-the-table teaching approach. Context Round-the-table teaching is a novel, evidence-based small group teaching approach designed to teach paediatric resuscitation skills and knowledge. Round-the-table teaching uses a structured approach to managing a collapsed child, and ensures that each participant has the opportunity to practise the essential resuscitation skills of airway manoeuvres, bag mask ventilation and cardiac compressions. Innovation Round-the-table teaching is an engaging, non-threatening approach to delivering interdisciplinary paediatric resuscitation education. The methodology ensures that all participants have the opportunity to practise each of the different essential skills associated with the Danger, Response, Send for help, Airway, Breathing, Circulation, Defibrillation or rhythm recognition (DRSABCD) approach to the collapsed child. Implications Round-the-table teaching is based on evidence-based small group teaching methods. The methodology of round-the-table teaching can be applied to any topic where participants must demonstrate an understanding of a sequential approach to a clinical skill. Round-the-table teaching uses a structured approach to managing a collapsed child PMID:25212931

How do school girls deal with dysmenorrhoea?

PubMed

Chaudhuri, Aditi; Singh, Amarjeet

2012-05-01

To estimate the prevalence of primary dysmenorrhoea among the school girls, to determine its impact on their routine life and to ascertain the practices adopted by them for management of primary dysmenorrhoea, a cross-sectional study was conducted in two schools of Chandigarh, India. Two hundred twenty-four school girls in the standard VIII to X of the selected schools, who had attained menarche, were included in the study. A modified menstrual distress questionnaire was used to score the severity of dysmenorrhoea and its impact on their life. Visual analogue scale for pain was used to measure pain during menstruation. Analysis was done by percentage, mean and standard deviation. Prevalence of dysmenorrhoea was 59.82%. Sickness absenteeism due to dysmenorrhoea was reported in 25.8% girls. According to visual analogue scale for pain scoring, 52.3% had moderate pain and 25% cases had severe pain. Menstrual distress questionnaire scores showed mood swings, irritability, difficulty in concentrating, poor school performances were common problems; 8.6% of the study population went for physicians' consultation, 15.6% took painkillers, 12.5% used hot water bottles, 3.1% practised exercise, 26.6% practised dietary modifications for reducing pain. Most of the cases were partially or completely relieved by these measures. Dysmenorrhoea is rapidly developing as a public health problem with its high prevalence, the degree of discomfort felt by the sufferer as well as the reduction in their quality of life. School based counselling of the suffering girls can be useful for empowering them with different options for managing their menstrual pain.

The association of health management with the health of elderly people.

PubMed

Nakanishi, N; Tatara, K; Takashima, Y; Fujiwara, H; Takamori, Y; Takabayashi, H; Scott, R

1995-07-01

To assess the effect of health management on the health of a community-based sample of people aged 65 years and over, a cross-sectional survey was carried out of 1491 people aged 65 years and over (22.3%) randomly drawn from the computerized age-sex register in Settsu City, Osaka. A total of 1473 people were contacted and complete responses were obtained from 1383 of these (a response rate of 93.9%). The proportion of the sample who had been receiving regular health checks or had been taking care of their health decreased with a decline in Activities of Daily Living (ADL). This trend was more pronounced among the younger subjects aged 65-74 years. For disability, those who had been receiving regular health checks had lower overall severity scores in both the 65-74 years and 75 years and over age groups. There were no significant differences in the severity scores for those practising health maintenance (watching diet and exercise) in both age groups, but those practising health maintenance tended to have less disability. The percentage of those who were socially active and thought life worth living also decreased with the decline in ADL for both age groups. These psycho-social factors were also associated with a lower overall severity score. A multiple linear regression analysis showed that health checks, social activity and the presence of aspects of life subjectively evaluated as making it worth living (Ikigai) were shown to have statistically significant negative associations with disability when other factors were controlled for.

"Part of Me Feels Like There Must Be Something Missing": A Phenomenological Exploration of Practising Psychotherapy as a Clinical Psychologist

ERIC Educational Resources Information Center

McMahon, Aisling

2018-01-01

The experience of practising psychotherapy as a clinical psychologist was explored through a small number of in-depth interviews. Using Interpretative Phenomenological Analysis, three main themes were identified: "Feeling there's something missing", "Being able to get in there emotionally" and "Needing somewhere to go for…

Addressing the Baseline: Erving Goffman and Ethics in a Postgraduate Degree for Practising Teachers

ERIC Educational Resources Information Center

McDonald, Geraldine; Higgins, Joanna; Shuker, Mary Jane

2008-01-01

In response to the claim that students who have received an undergraduate degree in education lack adequate preparation for postgraduate study, the designers of a masters course in research methods set an assignment at the first meeting which asked practising teachers to match Goffman's dramaturgical concepts to observation of behaviour in public.…

Please Touch the Children: Appropriate Touch in the Primary Classroom

ERIC Educational Resources Information Center

Owen, Pamela M.; Gillentine, Jonathan

2011-01-01

This study proposes to shift the current theoretical framework in which teachers practise a guarded approach regarding the touching of children in early childhood settings, towards a practice of acceptance. A brief historical context of touching is presented and supplemented with a survey of 63 currently practising K-3rd grade teachers. The survey…

Music behind Scores: Case Study of Learning Improvisation with "Playback Orchestra" Method

ERIC Educational Resources Information Center

Juntunen, P.; Ruokonen, I.; Ruismäki, H.

2015-01-01

For music students in the early stages of learning, the music may seem to be hidden behind the scores. To support home practising, Juntunen has created the "Playback Orchestra" method with which the students can practise with the support of the notation program playback of the full orchestra. The results of testing the method with…

Documenting with Early Childhood Education Teachers: Pedagogical Documentation as a Tool for Developing Early Childhood Pedagogy and Practises

ERIC Educational Resources Information Center

Rintakorpi, Kati

2016-01-01

The Finnish social pedagogical curriculum for early childhood education directs early childhood teachers to use documentation to assess and develop pedagogy and practise. This empirical study examines the challenges and benefits a group of Finnish preschool teachers experienced when they learned to document their work. Although the idea of…

Practice under pressure: what neurology can learn from anaesthesia

PubMed Central

Stacey, Mark

2017-01-01

Performing a stressful task under pressure is challenging. Strategies to optimise our training must focus on learning a skill correctly, and then practising that skill sufficiently to avoid compromising that performance in the cauldron of the clinical environment. This article discusses ways of doing things better, based on practical strategies employed in anaesthesia, but developed primarily in elite sport and the military. It involves taking a skill, practising it until it becomes a habit and over time making it part of normal behaviour. The philosophy is simple (but difficult to apply): control what you can control and always do your best. The best summary of this strategy is: learn it right, practise it right, perform it right. PMID:28972035

[SERV clinical practice guidelines: management of retinal vein occlusion. Sociedad Española de Retina y Vitreo].

PubMed

Gómez-Ulla, F; Abraldes, M J; Basauri, E; Fernández, M; García-Layana, A; Gili, P; Montero, J; Nadal, J; Morales, V; Saravia, M; Cabrera, F; Cervera, E

2010-09-01

A guidelines for the management of retinal vein occlusion is presented. This is necessary because at this moment several therapeutic alternatives have been developed although their role is not yet sufficiently defined. Review of the literature for evidence published up to date. Relevant literature was identified and the level of evidence graded. Evidence was then assessed for consistency, applicability and clinical impact. The information was contrasted with those guides published in other countries. Taking into account the different options of treatment that are currently used, several modes of action are suggested. The role of the various complementary examinations are discussed and it is recommended that criteria for the treatment are based on clinical, angiographic, and tomographic findings. Although there is no overall consensus, these guidelines promote a good standard of clinical practise and provide an update of the management of retinal vein occlusion. Copyright © 2010. Published by Elsevier Espana.

Student performance and appreciation using 3D vs. 2D vision in a virtual learning environment.

PubMed

de Boer, I R; Wesselink, P R; Vervoorn, J M

2016-08-01

The aim of this study was to investigate the differences in the performance and appreciation of students working in a virtual learning environment with two (2D)- or three (3D)-dimensional vision. One hundred and twenty-four randomly divided first-year dental students performed a manual dexterity exercise on the Simodont dental trainer with an automatic assessment. Group 1 practised in 2D vision and Group 2 in 3D. All of the students practised five times for 45 min and then took a test using the vision they had practised in. After test 1, all of the students switched the type of vision to control for the learning curve: Group 1 practised in 3D and took a test in 3D, whilst Group 2 practised in 2D and took the test in 2D. To pass, three of five exercises had to be successfully completed within a time limit. The students filled out a questionnaire after completing test 2. The results show that students working with 3D vision achieved significantly better results than students who worked in 2D. Ninety-five per cent of the students filled out the questionnaire, and over 90 per cent preferred 3D vision. The use of 3D vision in a virtual learning environment has a significant positive effect on the performance of the students as well as on their appreciation of the environment. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The impact of urinary stress incontinence in young and middle-age women practising recreational sports activity: an epidemiological study.

PubMed

Salvatore, S; Serati, M; Laterza, R; Uccella, S; Torella, M; Bolis, P-F

2009-12-01

To evaluate the prevalence of urinary stress incontinence (USI) in menstruating women practising recreational sports activity, to detect specific sports with a stronger association with urinary incontinence (UI) and to evaluate risk factors possibly related to this condition. Epidemiological study. Non-competitive sports organisations in the province of Varese, Italy. 679 women of fertile age, practising recreational sports activity. Anonymous questionnaire on UI. The questionnaire included questions about patients' general characteristics, occurrence of UI in relation to sport or daily general activities, time of onset of this condition, frequency of leakage episodes, correlation of incontinence with types of movements or sports, subjective impression of being limited on such occasions and/or necessity to modify the type of sport. UI was reported by 101 women (14.9%). Of these, 32 (31.7%) complained of UI only during sports activity, 48 (47.5%) only during daily life and 21 (20.8%) in both circumstances. Body mass index and parity were significantly associated with the risk of UI. Looking at the different sports activities, a higher rate of incontinence was found in women participating in basketball (16.6%), athletics (15%), and tennis or squash (11%). 10.4% of women abandoned their favourite sport, because of USI, and a further 20% limited the way they practised their favourite sport to reduce leakage episodes. Female UI affects a significant proportion of young women practising non-competitive sports activity; it can cause abandonment of the sport or limitation of its practice.

CSIR Contribution to Defining Adaptive Capacity in the Context of Environmental Change

DTIC Science & Technology

2014-03-31

Pollution rates Cultural norms Roads Agricultu ral practises / norms Level of Income Access to safe water Gender based discriminati on Fear of...internal conflicts Civil rights Quality of nutrition Status of environm ental policies Spiritual practises Dams Food for sale ... Fertility rates Literacy rates These developed categories are currently being tested by using both qualitative and

Comparison of Total Antioxidant Capacity Oxidative Stress and Blood Lipoprotein Parameters in Volleyball Players and Sedentary

ERIC Educational Resources Information Center

Gokhan, Ismail

2013-01-01

This study aims to measure, then compare sedentary blood lipoproteins, oxidant- antioxidant state and oxidative stress index in volleyball players. The experimental group of the research consists of regularly practising 20 boys between the ages of 12 and 17, and the control group comprises 32 children practising no particular sports branch, 12 of…

Constraints to Hamari sheep farming under range conditions in Darfur and Kordofan Regions of Western Sudan.

PubMed

Tirab, Ahmed Berima; Chimonyo, Michael

2016-08-01

The study was conducted to identify the major production constraints of Hamari sheep in Darfur and Kordofan Regions of Western Sudan. A structured questionnaire was administered to 128 farmers in Darfur and Kordofan. Feed shortages, prevalence of diseases and parasites, and predation were more severe in Darfur than Kordofan (P < 0.05). Thefts were ranked higher by farmers using the sedentary system compared to those using semi-nomadic system (P < 0.05). Water shortage was ranked higher by farmers with small flocks, large flocks, semi-nomadic and sedentary husbandry system in Kordofan than their counterparts in Darfur Region (P < 0.05). Farmers practising semi-nomadic husbandry system and sedentary system in Darfur region ranked diseases, parasites and predation higher than those practising semi-nomadic and sedentary system in Kordofan region (P < 0.05). Feed shortage was ranked higher as a challenge by farmers practising semi-nomadic system in Darfur Region than those practising semi-nomadic system in Kordofan Region (P < 0.05). It can be concluded that the severity of challenges facing Hamari sheep producers vary with flock size, region and production system used.

Bioengineering Technology to Control River Soil Erosion using Vetiver (Vetiveria Zizaniodes)

NASA Astrophysics Data System (ADS)

Sriwati, M.; Pallu, S.; Selintung, M.; Lopa, R.

2018-04-01

Erosion is the action of surface processes (such as water flow or wind) that removes soil, rock or dissolved material from one location on the earth’s crust, and then transport it away to another location. Bioengineering is an attempt to maximise the use of vegetation components along riverbanks to cope with landslides and erosion of river cliffs and another riverbank damage. This study aims to analyze the bioengineering of Vetiver as a surface layer for soil erosion control using slope of 100, 200, and 300. This study is conducted with 3 variations of rain intensity (I), at 103 mm/hour, 107 mm/hour, and 130 mm/hour by using rainfall simulator tool. In addition, the USLE (Universal Soil Loss Equation) method is used in order to measure the rate of soil erosion. In this study, there are few USLE model parameters were used such as rainfall erosivity factor, soil erodibility factor, length-loss slope and stepness factor, cover management factor, and support practise factor. The results demonstrated that average of reduction of erosion rate using Vetiver, under 3 various rainfalls, namely rainfall intensity 103 mm/hr had reduced 84.971%, rainfall intensity 107 mm/hr had reduced 86.583 %, rainfall intensity 130 mm/hr had reduced 65.851%.

Constrained Local UniversE Simulations: a Local Group factory

NASA Astrophysics Data System (ADS)

Carlesi, Edoardo; Sorce, Jenny G.; Hoffman, Yehuda; Gottlöber, Stefan; Yepes, Gustavo; Libeskind, Noam I.; Pilipenko, Sergey V.; Knebe, Alexander; Courtois, Hélène; Tully, R. Brent; Steinmetz, Matthias

2016-05-01

Near-field cosmology is practised by studying the Local Group (LG) and its neighbourhood. This paper describes a framework for simulating the `near field' on the computer. Assuming the Λ cold dark matter (ΛCDM) model as a prior and applying the Bayesian tools of the Wiener filter and constrained realizations of Gaussian fields to the Cosmicflows-2 (CF2) survey of peculiar velocities, constrained simulations of our cosmic environment are performed. The aim of these simulations is to reproduce the LG and its local environment. Our main result is that the LG is likely a robust outcome of the ΛCDMscenario when subjected to the constraint derived from CF2 data, emerging in an environment akin to the observed one. Three levels of criteria are used to define the simulated LGs. At the base level, pairs of haloes must obey specific isolation, mass and separation criteria. At the second level, the orbital angular momentum and energy are constrained, and on the third one the phase of the orbit is constrained. Out of the 300 constrained simulations, 146 LGs obey the first set of criteria, 51 the second and 6 the third. The robustness of our LG `factory' enables the construction of a large ensemble of simulated LGs. Suitable candidates for high-resolution hydrodynamical simulations of the LG can be drawn from this ensemble, which can be used to perform comprehensive studies of the formation of the LG.

Autism: the aetiology, management and implications for treatment modalities from the dental perspective.

PubMed

Chew, Leslie C T; King, Nigel M; O'Donnell, David

2006-03-01

Autism is defined as a rare and severe psychiatric disorder of childhood. It is marked by severe difficulties in communicating, and forming relationships with other people, in developing language, repetitive and limited patterns of behaviour and obsessive resistance to small changes in familiar surroundings. Hence, affected children offer a special challenge to the practising dentist. To meet this challenge, it is necessary to understand the condition and how to manage its varying presentations in different individuals. The purpose of this article is to review the literature on the topic of autism with an emphasis on the dental perspective. A better understanding of the effects of autism on the behaviour of an affected individual provides the dental practitioner with the opportunity to deliver oral healthcare in an empathetic and appropriate manner.

Psychosomatic approaches to obstetrics, gynaecology and andrology--a review.

PubMed

Lal, Mira

2009-01-01

This review aims to clarify the scope and clinical importance of psychosomatic approaches to obstetrics, gynaecology and andrology. This gradually expanding sub-specialty covers a wide domain of complex disease conditions that can be managed more effectively if the various biological, psychological and social aspects are recognised at the start and concurrent treatment initiated. The current need to practise biopsychosocial management of disease conditions is highlighted along with a description of what this would involve. The nine-field psychosomatic approach, which can be applied to everyday clinical encounters, has been illustrated. Clinical applications of the psychosomatic approach are discussed for various conditions including chronic pelvic pain, eating disorders, tokophobia, post-traumatic stress disorder, depression, menstrual disorders, infertility, bereavement and testicular cancer. Cultural considerations and the need for further research are also briefly discussed.

Talking about a (business continuity) revolution: Why best practices are wrong and possible solutions for getting them right.

PubMed

Armour, Mark

The business continuity profession has been following a methodology that has barely evolved since its inception. Unfortunately, the stodgy, labour-intensive practices of the past are poorly suited to today's fast-paced and ever-changing work environments. Proposed herein is a new approach to the discipline. Just as agile methodology revolutionised project management, new tactics in preparedness can drastically change how this profession is practised. That is the hope. If there is to be any significant change in business continuity ahead, it may just take a revolution.

Dietary management of a patient with diabetes mellitus: a case report.

PubMed

Sidik, Sherina Mohd; Ahmad, Rozali

2003-09-01

The Ministry of Health has launched healthy lifestyle and diabetes campaigns. However, adopting healthy lifestyle practices is not easy as revealed in this case. Patients and their families need to be supervised personally and counseled regularly. Healthy lifestyle habits such as maintaining a balanced diet, ideal body weight and physical activities need to be cultivated and practised. Dietary counseling sessions need to be implemented, preferably by dietitians as this has been shown to be effective in motivating diabetic patients to achieve a better food choice, as well as better glycaemic, lipid and weight control, as shown in this case.

Challenging the myth of the irrational dairy farmer; understanding decision-making related to herd health.

PubMed

Kristensen, E; Jakobsen, E B

2011-01-01

Veterinarians working with dairy cows are suggested to refocus their efforts from being task-oriented providers of single-cow therapy and develop themselves into advice-oriented herd health management advisors. The practising cattle veterinarian's ability to translate knowledge into on-farm application requires a profound understanding of the dairy farm as an integrated system. Consequently, educating and motivating farmers are key issues. To achieve such insight the veterinarian needs to work with several scientific disciplines, especially epidemiology and (behavioural) economics. This trans-disciplinary approach offers new methodological possibilities and challenges to students of dairy herd health management. Advisors working with dairy herd health management may sometimes experience that farmers do not follow their advice. Potentially, this could lead to the interpretation that such farmers are behaving irrationally. However, farmers who are confronted with advice suggesting a change of behaviour are placed in a state of cognitive dissonance. To solve such dissonance they may either comply with the advice or reduce the dissonance by convincing themselves that the suggested change in management is impossible to implement. Consequently, herd health management advisors must understand the fundamental and instrumental relationships between individual farmers' values, behaviour and perception of risk, to stimulate and qualify the farmer's decision-making in a way that will increase the farmer's satisfaction and subjective well-being. Traditionally, studies on herd health economics have focussed on financial methods to measure the value of technical outcomes from suggested changes in management, following the basic assumption that farmers strive to maximise profit. Farmers, however, may be motivated by very different activities, e.g. animal health and welfare or other farmers' recognition, making it impossible to provide 'one-size-fts-all' consultancy because the best decision depends heavily on the internal logic and context-bound reality on each dairy farm. Relevant information may be available, but to be implemented at farm level it has to be communicated effectively. This requires a trustworthy communicator. Consequently, veterinarians are recommended to receive training in communication; keywords in this process are dialogue and reflection. An educational framework based on science and the authors' experience is presented. The aim is to guide practising cattle veterinarians into a personal learning process considered necessary for them to be recognised by farmers as trustworthy dairy herd health advisors.

Factors influencing medical students' motivation to practise in rural areas in low-income and middle-income countries: a systematic review.

PubMed

Budhathoki, Shyam Sundar; Zwanikken, Prisca A C; Pokharel, Paras K; Scherpbier, Albert J

2017-02-22

There is a shortage of doctors working in rural areas all over the world, especially in low-income and middle-income countries. The choice to practise medicine in a rural area is influenced by many factors. Motivation developed as a medical student is one key determinant of this choice. This study explores influences on medical students' motivation to practise in rural areas of low-income and middle-income countries following graduation. A systematic review was conducted to identify influences on medical students' motivation to work in rural areas in low-income and middle-income countries. Papers reporting influences on motivation were included, and content analysis was conducted to select the articles. Articles not published in English were excluded from this review. A rural background (ie, being brought up in a rural area), training in rural areas with a community-based curriculum, early exposure to the community during medical training and rural location of medical school motivate medical students to work in rural areas. Perceived lack of infrastructure, high workload, poor hospital management and isolation are among the health facility factors that demotivate medical students for medical practice in rural areas. Medical school selection criteria focusing on a rural background factor and medical education curriculum focusing on rural area are more relevant factors in low-income and middle-income countries. The factors identified in this review may assist the planners, medical educators and policymakers in low-income and middle-income countries in designing relevant interventions to positively influence rural choices where the shortage of rural physicians is an ongoing and increasing concern. 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/.

"A costly turn on": patterns of use and perceived consequences of mephedrone based head shop products amongst Irish injectors.

PubMed

Van Hout, Marie Claire; Bingham, Tim

2012-05-01

Mephedrone injecting has recently been reported in Romania, Slovenia, Guernsey and Ireland. The research reported here aimed to describe the experiences of a group of Irish injecting drug users, who were injecting mephedrone based headshop products prior to the introduction of legislative controls in Ireland, with particular focus on pre- and post-legislative use, effects of injecting mephedrone, settings and contexts for injecting, polydrug use and serial drug injecting, risk perceptions and harm reduction practises. Following a predevelopment phase with a Privileged Access Interviewer, in-depth interviews using a phenomenological approach were conducted with eleven attendees of a low threshold harm reduction service. The findings describe the abuse potential of these mephedrone based headshop products when used by intravenous injection. Although participants were aware of risks and safe injecting practises, compulsive re injecting with excessive binge use over long periods of time was common. Nasal to injection route transitions, intense paranoia, violent behaviour and aggression, emergence of Parkinson type symptomatologies (in the form of spasms and 'wobbling'), and permanent numbness in lower extremities were reported. Multi and serial drug injecting with heroin was used in efforts to manage the intense rush and avoid unpleasant comedown. Participants reported limb abscesses, vein clotting, damage and recession resulting from product toxicity, crystallisation of the products when diluted and flushing practises. Seven participants were homeless, with groin and street injecting common. Following legislative changes use of mephedrone products declined due to closure of headshops, increased street prices, concerns around contamination and the emergence of new street stimulant drugs. Continued monitoring of drug displacement patterns in post legislative time frames is advised, alongside longitudinal ethnographic research to track the diffusion of mephedrone and other cathinone derivatives within injecting networks. Further investigation of the adverse health consequences of these drugs on injection is warranted. Copyright © 2012 Elsevier B.V. All rights reserved.

Pharmacy Apps: a new frontier on the digital landscape?

PubMed Central

Davies, Michael J.; Collings, Matthew; Fletcher, William; Mujtaba, Hassan

2014-01-01

Background Over the course of recent years smartphone and tablet technology has evolved rapidly. Similarly, the sphere of healthcare is constantly developing and striving to embrace the newest forms of technology in order to optimise function. Many opportunities for mobile applications (i.e. ‘apps’) pertinent to the healthcare sector are now emerging. Objective This study will consider whether registered pharmacists within the United Kingdom (UK) believe it appropriate to use mobile apps during the provision of healthcare within the community setting. Methods Further to Liverpool John Moores University (LJMU) ethical approval, the 30 item questionnaire was distributed to UK registered pharmacists (n=600) practising within inner city Manchester, Liverpool and Newcastle. The questions were formatted as multiple choice, Likert scales or the open answer type. On questionnaire completion and return, data were analysed using simple frequencies, cross tabulations and non-parametric techniques in the Statistical Package for the Social Sciences (SPSS) (v18). Results The majority of respondents (78.4% of 211 participants) confirmed that they were confident when using mobile apps on their technology platform. In general, mobile apps were perceived to be useful in facilitating patient consultations (55%) and supporting healthcare education (80%). The main barrier for mobile app use within the workplace was company policy, deemed significant in the case of regional / national chain pharmacies (p<0.001). Pharmacists alluded to the fact that whilst mobile apps demonstrate potential in modern day practise, they will have a greater impact in the future (p<0.001). Conclusion The data indicate that although pharmacists are supportive of mobile apps in healthcare, a number of factors (i.e. risk, company policy and lack of regulation) may preclude their use in modern day pharmacy practise. Clearly, limitations of the technology must be addressed in order to maximise uptake within healthcare systems. Pharmacists suggest that as the younger generation ages, mobile apps will become a more accepted method by which to manage healthcare in the wider population. PMID:25243034

A survey analysis of indigenous goat production in communal farming systems of Botswana.

PubMed

Monau, P I; Visser, C; Nsoso, S J; Van Marle-Köster, E

2017-08-01

A total of 153 communal farmers in four agro-ecological regions of Botswana were interviewed using a structured questionnaire. The aims of the survey were to characterise existing communal goat production systems, evaluate the importance of goats to farmers and identify breeding practices and constraints encountered in goat production in Botswana. Data was collected on socio-economic parameters, general and breeding management practices and major constraints limiting goat production in Botswana. All respondents were small-scale communal farmers with 63% respondents practising mixed crop-livestock farming and 37% keeping livestock as their primary activity. The majority (33%) of respondents were older than 60 years. Over 80% of the farmers kept goats for cash required for tuition, school uniforms and household commodities as well as re-stocking of animals. Most farmers (62%) kept indigenous crossed genotypes. Generally, uncontrolled mating was practised with the majority of farmers (41%) using on-farm reared bucks for more than two years of breeding and communal bucks (36%) as an alternative. The major constraints limiting goat productivity in communal areas included uncontrolled breeding, predators, theft and diseases. Issues raised by farmers should be considered in designing and implementing effective breeding programs for goats to improve their overall productivity and contribution to poverty alleviation in these communities.

The Monros - three medical dynasties with a common origin.

PubMed

Macintyre, I; Munro, A

2015-03-01

From origins in their heartlands in Easter Ross, clan Munro produced no fewer than three distinct medical dynasties, all descended from Hugh Munro, 9th Baron Foulis (c1352-1425), 12th chief of the clan. This paper describes what we believe to be a unique family of related medical dynasties which were influential in Edinburgh, London and the Scottish Highlands. It sets out in detail the family genealogy, provides some biographical information, and explores the reasons for the development of such medical dynasties, which appear to be different for each of the three dynasties within this family. The 'Edinburgh Monros' included the three Alexanders Monro, primus, secundus and tertius, who between them occupied the university chair of Anatomy at the University of Edinburgh for 126 years from 1720. Dr David Monro, son of Alexander Monro tertius, emigrated to New Zealand where his descendants included several doctors, the last of whom died in 2013. The 'Bedlam Monros' achieved fame, and some notoriety, in managing mental illness in London for the 154 years from 1728-1882. In contrast, the 'Bonesetter Munros' practised their skills in the local community in Ross-shire and one of them attracted patients from all over Britain. They practised their trade for over 100 years from the start of the 19th to the early 20th century.

Traditional Chinese medicine practitioners in New Zealand: differences associated with being a practitioner in New Zealand compared to China.

PubMed

Patel, Asmita; Toossi, Vahideh

2016-10-28

While New Zealand has experienced an increase in the use of traditional Chinese medicine (TCM) based acupuncture, very little is known about the practitioners who provide this type of treatment modality. Therefore, this study was designed to identify differences associated with being a TCM practitioner in New Zealand compared to China. Ten Auckland-based TCM practitioners were individually interviewed. The interview schedule comprised of questions that were designed to identify any potential differences in practising TCM in New Zealand compared to China. Data were analysed using an inductive thematic approach. The main differences in practising between the two countries were related to the role and authority that a TCM practitioner had. This in turn resulted in differences between the conditions that were treated in these two countries. Differences in patient demography were also identified between the two countries. TCM is used as a form of alternative healthcare treatment in New Zealand for non-Chinese individuals. Acupuncture is the most utilised form of TCM treatment in New Zealand, and is predominantly used for pain management purposes. TCM treatment has been utilised by individuals from a number of different ethnic groups, reflecting the ethnic diversity of the New Zealand population.

Isolation and characterization of pathogenic Vibrio alginolyticus from sea cage cultured cobia (Rachycentron canadum (Linnaeus 1766)) in India.

PubMed

Rameshkumar, P; Nazar, A K A; Pradeep, M A; Kalidas, C; Jayakumar, R; Tamilmani, G; Sakthivel, M; Samal, A K; Sirajudeen, S; Venkatesan, V; Nazeera, B M

2017-11-01

Mass mortalities of cobia, Rachycentron canadum, sub-adults occurred during August 2013 in cage culture in the Gulf of Mannar, Mandapam Tamil Nadu, India. The epizootic of disease was started with typical classical clinical signs followed by acute mortality. Grossly, severe haemorrhage and congestion were observed in the gastric mucosa. The abdomen was distended with peritoneal fluid. The heart revealed haemopericardium and fibrinous pericardium. Histologically, the gastric mucosa showed severe erosion and necrosis. Haemorrhagic pericarditis and an increased size of the melano macrophage centre (MMC) in the tail kidney were other histopathological changes. Vibrio sp. was isolated from the gastric lesions and heart blood swab of moribund fishes and it was found to be virulent to the cobia fingerlings. After the challenge, the same bacterium could be re-isolated from moribund fingerlings. The 16S ribosomal RNA of the isolate was amplified and blast analysis of the sequence confirmed that the pathogen was Vibrio alginolyticus. The confirmation was also correlated with its cultural, biochemical and pathomorphological changes. This is the second report and the first incidence of epizootics with severe pathological lesions in cultured cobia in India. The study throws light on the pathology of vibriosis. By practising cage farm management measures, occurrences of infection may be prevented. The epizootics of vibriosis caused serious economic losses to farmers. Natural blooms of the pathogen can be prevented by sea cage management measures such as, changing the inner net of the cages, changing the location of the cages to relatively clean water (about 50 m apart) from the affected site and providing shade over the cages while the water temperature rises. Supplementation of the feed with immunostimulants and mineral mixture may be practised to improve the immune response against infection. Early diagnosis and sea cage management measures may prevent occurrences of the infection. © 2017 The Society for Applied Microbiology.

Self-regulated learning in simulation-based training: a systematic review and meta-analysis.

PubMed

Brydges, Ryan; Manzone, Julian; Shanks, David; Hatala, Rose; Hamstra, Stanley J; Zendejas, Benjamin; Cook, David A

2015-04-01

Self-regulated learning (SRL) requires an active learner who has developed a set of processes for managing the achievement of learning goals. Simulation-based training is one context in which trainees can safely practise learning how to learn. The purpose of the present study was to evaluate, in the simulation-based training context, the effectiveness of interventions designed to support trainees in SRL activities. We used the social-cognitive model of SRL to guide a systematic review and meta-analysis exploring the links between instructor supervision, supports or scaffolds for SRL, and educational outcomes. We searched databases including MEDLINE and Scopus, and previous reviews, for material published until December 2011. Studies comparing simulation-based SRL interventions with another intervention for teaching health professionals were included. Reviewers worked independently and in duplicate to extract information on learners, study quality and educational outcomes. We used random-effects meta-analysis to compare the effects of supervision (instructor present or absent) and SRL educational supports (e.g. goal-setting study guides present or absent). From 11,064 articles, we included 32 studies enrolling 2482 trainees. Only eight of the 32 studies included educational supports for SRL. Compared with instructor-supervised interventions, unsupervised interventions were associated with poorer immediate post-test outcomes (pooled effect size: -0.34, p = 0.09; n = 19 studies) and negligible effects on delayed (i.e. > 1 week) retention tests (pooled effect size: 0.11, p = 0.63; n = 8 studies). Interventions including SRL supports were associated with small benefits compared with interventions without supports on both immediate post-tests (pooled effect size: 0.23, p = 0.22; n = 5 studies) and delayed retention tests (pooled effect size: 0.44, p = 0.067; n = 3 studies). Few studies in the simulation literature have designed SRL training to explicitly support trainees' capacity to self-regulate their learning. We recommend that educators and researchers shift from thinking about SRL as learning alone to thinking of SRL as comprising a shared responsibility between the trainee and the instructional designer (i.e. learning using designed supports that help prepare individuals for future learning). © 2015 John Wiley & Sons Ltd.

Speech Skill Learning of Persons Who Stutter and Fluent Speakers under Single and Dual Task Conditions

ERIC Educational Resources Information Center

Smits-Bandstra, Sarah; De Nil, Luc

2009-01-01

Two studies compared the accuracy and efficiency of initiating oral reading of nonsense syllables by persons who stutter (PWS) and fluent speakers (PNS) over practise. Findings of Study One, comparing 12 PWS and 12 PNS, replicated previous findings of slow speech sequence initiation over practise by PWS relative to PNS. In Study Two, nine PWS and…

Attitudes on cost-effectiveness and equity: a cross-sectional study examining the viewpoints of medical professionals

PubMed Central

Li, David G; Wong, Gordon X; Martin, David T; Tybor, David J; Kim, Jennifer; Lasker, Jeffrey; Mitty, Roger; Salem, Deeb

2017-01-01

Objective To determine the attitudes of physicians and trainees in regard to the roles of both cost-effectiveness and equity in clinical decision making. Design In this cross-sectional study, electronic surveys containing a hypothetical decision-making scenario were sent to medical professionals to select between two colon cancer screening tests for a population. Setting Three Greater Boston academic medical institutions: Tufts University School of Medicine, Tufts Medical Centre and Lahey Hospital and Medical Centre. Participants 819 medical students, 497 residents-in-training and 671 practising physicians were contacted electronically using institutional and organisational directories. Main outcome(s) and measure(s) Stratified opinions of medical providers and trainee subgroups regarding cost-effectiveness and equity. Results A total of 881 respondents comprising 512 medical students, 133 medical residents-in-training and 236 practising physicians completed the survey (total response rate 44.3%). Thirty-six per cent of medical students, 44% of residents-in-training and 53% of practising physicians favoured the less effective and more equitable screening test. Residents-in-training (OR 1.49, CI 1.01 to 2.21; p=0.044) and practising physicians (OR 2.12, CI 1.54 to 2.92; p<0.001) were more likely to favour the equitable option compared with medical students. Moreover, female responders across all three cohorts favoured the more equitable screening test to a greater degree than did male responders (OR 1.70, CI 1.29 to 2.24; p<0.001). Conclusions Cost-effectiveness analysis does not accurately reflect the importance that medical professionals place on equity. Among medical professionals, practising physicians appear to be more egalitarian than residents-in-training, while medical students appear to be most utilitarian and cost-effective. Meanwhile, female respondents in all three cohorts favoured the more equitable option to a greater degree than their male counterparts. Healthcare policies that trade off equity in favour of cost-effectiveness may be unacceptable to many medical professionals, especially practising physicians and women. PMID:28765138

Attitudes on cost-effectiveness and equity: a cross-sectional study examining the viewpoints of medical professionals.

PubMed

Li, David G; Wong, Gordon X; Martin, David T; Tybor, David J; Kim, Jennifer; Lasker, Jeffrey; Mitty, Roger; Salem, Deeb

2017-08-01

To determine the attitudes of physicians and trainees in regard to the roles of both cost-effectiveness and equity in clinical decision making. In this cross-sectional study, electronic surveys containing a hypothetical decision-making scenario were sent to medical professionals to select between two colon cancer screening tests for a population. Three Greater Boston academic medical institutions: Tufts University School of Medicine, Tufts Medical Centre and Lahey Hospital and Medical Centre. 819 medical students, 497 residents-in-training and 671 practising physicians were contacted electronically using institutional and organisational directories. Stratified opinions of medical providers and trainee subgroups regarding cost-effectiveness and equity. A total of 881 respondents comprising 512 medical students, 133 medical residents-in-training and 236 practising physicians completed the survey (total response rate 44.3%). Thirty-six per cent of medical students, 44% of residents-in-training and 53% of practising physicians favoured the less effective and more equitable screening test. Residents-in-training (OR 1.49, CI 1.01 to 2.21; p=0.044) and practising physicians (OR 2.12, CI 1.54 to 2.92; p<0.001) were more likely to favour the equitable option compared with medical students. Moreover, female responders across all three cohorts favoured the more equitable screening test to a greater degree than did male responders (OR 1.70, CI 1.29 to 2.24; p<0.001). Cost-effectiveness analysis does not accurately reflect the importance that medical professionals place on equity. Among medical professionals, practising physicians appear to be more egalitarian than residents-in-training, while medical students appear to be most utilitarian and cost-effective. Meanwhile, female respondents in all three cohorts favoured the more equitable option to a greater degree than their male counterparts. Healthcare policies that trade off equity in favour of cost-effectiveness may be unacceptable to many medical professionals, especially practising physicians and women. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Milestones on the social accountability journey: Family medicine practice locations of Northern Ontario School of Medicine graduates.

PubMed

Hogenbirk, John C; Timony, Patrick E; French, Margaret G; Strasser, Roger; Pong, Raymond W; Cervin, Catherine; Graves, Lisa

2016-03-01

To assess the effect of different levels of exposure to the Northern Ontario School of Medicine's (NOSM's) distributed medical education programs in northern Ontario on FPs' practice locations. Cross-sectional design using longitudinal survey and administrative data. Canada. All 131 Canadian medical graduates who completed FP training in 2011 to 2013 and who completed their undergraduate (UG) medical degree or postgraduate (PG) residency training or both at NOSM. Exposure to NOSM's medical education program at the UG (n = 49) or PG (n = 31) level or both (n = 51). Primary practice location in September of 2014. Approximately 16% (21 of 129) of FPs were practising in rural northern Ontario, 45% (58 of 129) in urban northern Ontario, and 5% (7 of 129) in rural southern Ontario. Logistic regression found that more rural Canadian background years predicted rural practice in northern Ontario or Ontario, with odds ratios of 1.16 and 1.12, respectively. Northern Canadian background, sex, marital status, and having children did not predict practice location. Completing both UG and PG training at NOSM predicted practising in rural and northern Ontario locations with odds ratios of 4.06 to 48.62. Approximately 61% (79 of 129) of Canadian medical graduate FPs who complete at least some of their training at NOSM practise in northern Ontario. Slightly more than a quarter (21 of 79) of these FPs practise in rural northern Ontario. The FPs with more years of rural background or those with greater exposure to NOSM's medical education programs had higher odds of practising in rural northern Ontario. This study shows that NOSM is on the road to reaching one of its social accountability milestones.

Interdental cleaning among persons with diabetes: relationships with individual characteristics.

PubMed

Strauss, S M; Stefanou, L B

2014-05-01

Given the existence of many potential oral health complications for adults with diabetes (especially for those who do not practise regular oral self-care), and the specific importance of regular interdental cleaning, the research determined the proportion of U.S. adults with diabetes who practise daily interdental cleaning and their socio-demographic, economic and oral health characteristics related to this practice. Analyses were conducted using data collected from 573 dentulous adults with diabetes ≥ 30 years who participated in the U.S. 2009-2010 National Health and Nutrition Examination survey. Using complex sample survey software, findings were extrapolated to >15 million U.S. adults. Descriptive statistics were used to determine the frequency of interdental cleaning, and chi-square tests were used to identify salient individual characteristics related to this practice. 41.2% reported that they never used any interdental device, while 24.8% indicated that they practised interdental cleaning daily. Statistically significant relationships (P < 0.05) with daily interdental cleaning included female sex, ever having had treatment for gum disease and using mouthwash daily for a dental problem. Because so many adults with diabetes do not practise regular interdental cleaning, and in view of the important role that dental hygienists fulfil as oral healthcare educators, there is a great need for dental hygienists to teach and motivate adults with diabetes to practise regular interdental cleaning. This need is especially great for subgroups of these adults who are men, have not been treated for periodontitis and do not regularly use a mouthwash for dental problems. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Communication and implementation of change in crop protection.

PubMed

Escalada, M M; Heong, K L

1993-01-01

The slow adoption of integrated pest management (IPM) has been attributed to the widespread gaps in farmers' knowledge of rational pest management. Other factors such as farmers' perception of high input use and promotion of pesticides also influence decisions to practise rational pest management. To bridge these gaps and improve farmers' pest management practices, most IPM implementation programmes rely on communication strategies. These communication approaches utilize either mass media or interpersonal channels or a combination. The choice of which communication approach to employ depends on project objectives and resources. Among extension and communication approaches used in crop protection, strategic extension campaigns, farmer field schools and farmer participatory research stand out in their ability to bring about significant changes in farmers' pest management practices. While extension campaigns have greater reach, farmer participation and experiential learning achieve more impact because learning effects are sustained. Communication media are important in raising awareness and creating a demand for IPM information but interpersonal channels and group methods such as the farmer field school and farmer participatory research are essential to accomplish the tasks of discovery and experiential learning of IPM skills.

Impact of a social network-based intervention promoting diabetes self-management in socioeconomically deprived patients: a qualitative evaluation of the intervention strategies.

PubMed

Vissenberg, C; Stronks, K; Nijpels, G; Uitewaal, P J M; Middelkoop, B J C; Kohinor, M J E; Hartman, M A; Nierkens, V

2016-04-13

There is a need for effective interventions that improve diabetes self-management (DSM) among socioeconomically deprived patients with type 2 diabetes. The group-based intervention Powerful Together with Diabetes (PTWD) aimed to increase social support for DSM and decrease social influences hindering DSM (eg, peer pressure, social norms) in patients living in deprived neighbourhoods. Through a qualitative process evaluation, this paper aims to study whether this intervention changed social support and social influences, and which elements of the intervention contributed to this. The intervention group (IG) was compared with a standard group-based educational intervention (control group, CG). 27 qualitative in-depth interviews with participants (multiethnic sample) and 24 interviews with group leaders were conducted. Interviews were coded and analysed using MAXQDA according to framework analysis. Patients in the IG experienced more emotional support from group members and more instrumental and appraisal support from relatives than those in the CG. Also, they were better able to recognise and cope with influences that hinder their DSM, exhibited more positive norms towards DSM and increased their priority regarding DSM and their adherence. Finally, the engagement in DSM by relatives of participants increased. Creating trust between group members, skills training, practising together and actively involving relatives through action plans contributed to these changes. A group-based intervention aimed at creating trust, practising together and involving relatives has the potential to increase social support and diminish social influences hindering DSM in socioeconomically deprived patients with diabetes. Promising elements of the intervention were skills training and providing feedback using role-playing exercises in group sessions with patients, as well as the involvement of patients' significant others in self-management tasks, and actively involving them in making an action plan for self-management. These positive results justify the value of further evaluating the effectiveness of this intervention in a larger sample. NTR1886, Results. 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/

Better governance, better access: practising responsible data sharing in the METADAC governance infrastructure.

PubMed

Murtagh, Madeleine J; Blell, Mwenza T; Butters, Olly W; Cowley, Lorraine; Dove, Edward S; Goodman, Alissa; Griggs, Rebecca L; Hall, Alison; Hallowell, Nina; Kumari, Meena; Mangino, Massimo; Maughan, Barbara; Mills, Melinda C; Minion, Joel T; Murphy, Tom; Prior, Gillian; Suderman, Matthew; Ring, Susan M; Rogers, Nina T; Roberts, Stephanie J; Van der Straeten, Catherine; Viney, Will; Wiltshire, Deborah; Wong, Andrew; Walker, Neil; Burton, Paul R

2018-04-26

Genomic and biosocial research data about individuals is rapidly proliferating, bringing the potential for novel opportunities for data integration and use. The scale, pace and novelty of these applications raise a number of urgent sociotechnical, ethical and legal questions, including optimal methods of data storage, management and access. Although the open science movement advocates unfettered access to research data, many of the UK's longitudinal cohort studies operate systems of managed data access, in which access is governed by legal and ethical agreements between stewards of research datasets and researchers wishing to make use of them. Amongst other things, these agreements aim to respect the reasonable expectations of the research participants who provided data and samples, as expressed in the consent process. Arguably, responsible data management and governance of data and sample use are foundational to the consent process in longitudinal studies and are an important source of trustworthiness in the eyes of those who contribute data to genomic and biosocial research. This paper presents an ethnographic case study exploring the foundational principles of a governance infrastructure for Managing Ethico-social, Technical and Administrative issues in Data ACcess (METADAC), which are operationalised through a committee known as the METADAC Access Committee. METADAC governs access to phenotype, genotype and 'omic' data and samples from five UK longitudinal studies. Using the example of METADAC, we argue that three key structural features are foundational for practising responsible data sharing: independence and transparency; interdisciplinarity; and participant-centric decision-making. We observe that the international research community is proactively working towards optimising the use of research data, integrating/linking these data with routine data generated by health and social care services and other administrative data services to improve the analysis, interpretation and utility of these data. The governance of these new complex data assemblages will require a range of expertise from across a number of domains and disciplines, including that of study participants. Human-mediated decision-making bodies will be central to ensuring achievable, reasoned and responsible decisions about the use of these data; the METADAC model described in this paper provides an example of how this could be realised.

Uranium adsorption on weathered schist - Intercomparison of modeling approaches

USGS Publications Warehouse

Payne, T.E.; Davis, J.A.; Ochs, M.; Olin, M.; Tweed, C.J.

2004-01-01

Experimental data for uranium adsorption on a complex weathered rock were simulated by twelve modelling teams from eight countries using surface complexation (SC) models. This intercomparison was part of an international project to evaluate the present capabilities and limitations of SC models in representing sorption by geologic materials. The models were assessed in terms of their predictive ability, data requirements, number of optimised parameters, ability to simulate diverse chemical conditions and transferability to other substrates. A particular aim was to compare the generalised composite (GC) and component additivity (CA) approaches for modelling sorption by complex substrates. Both types of SC models showed a promising capability to simulate sorption data obtained across a range of chemical conditions. However, the models incorporated a wide variety of assumptions, particularly in terms of input parameters such as site densities and surface site types. Furthermore, the methods used to extrapolate the model simulations to different weathered rock samples collected at the same field site tended to be unsatisfactory. The outcome of this modelling exercise provides an overview of the present status of adsorption modelling in the context of radionuclide migration as practised in a number of countries worldwide.

Nursing leadership in an academic hospital in Gauteng.

PubMed

Maboko, D R

2012-10-01

This study was aimed at describing nursing leadership in an academic hospital in Gauteng, South Africa. Nurse managers' leadership styles affect nurses' attitudes, behaviour and work performance. However, little is known about how nurses experience nurse leadership and what leadership styles are found in academic hospitals in Gauteng. The study was based on Maxwell's framework of leadership (relationships, equipping, leadership and attitude). A qualitative design was used in order to describe the experiences of registered nurses and nurse managers. The population of the study was all registered nurses and nurse managers of the hospital in which the study was conducted. In phase one of the study, a discussion group with 35 registered nurses using the nominal group technique was held to respond to the following statement: 'Please explain how you have experienced leadership by nurse managers in this hospital'. In phase two of the study, five nurse managers were interviewed individually, using a semi-structured interview guide. Some nurse managers were practising autocratic leadership in this hospital. he nurse managers need to be taught about contemporary leadership styles such as transformational leadership and visionary leadership and also about supervision, role modelling and caring. © 2011 Blackwell Publishing Ltd.

Current management of acute diverticulitis: a survey of Australasian surgeons.

PubMed

Jaung, Rebekah; Robertson, Jason; Rowbotham, David; Bissett, Ian

2016-03-11

To evaluate the current practice and degree of consensus amongst Australasian surgeons regarding non-surgical management of acute diverticulitis (AD) and to determine whether newer approaches to management are being translated into practice. An online survey was distributed to all Australasian colorectal surgeons and all general surgeons in the Auckland region. Responses were collected over two months and analysed to identify points of consensus and areas of significant difference in opinion between these groups. Responses were received from a total of 99 of 200 (49.5%) colorectal surgeons, and 19 of 36 (52.7%) general surgeons. The Hinchey Classification was the most commonly used measure of disease severity, used by 67 (95.7%) colorectal surgeons and 12 (92.3%) general surgeons. There was lack of consensus around important aspects of AD management, including antibiotic therapy, and use and modality of follow-up imaging. Selective antibiotic therapy and use of anti-inflammatory medication as adjuncts to treatment were practised by a minority of those surveyed. Newer approaches to management were being utilised by some respondents. The lack of consensus regarding management of AD may be a consequence of a paucity of high-level evidence to support specific management approaches, particularly in patients with uncomplicated AD.

Round-the-table teaching: a novel approach to resuscitation education.

PubMed

McGarvey, Kathryn; Scott, Karen; O'Leary, Fenton

2014-10-01

Effective cardiopulmonary resuscitation saves lives. Health professionals who care for acutely unwell children need to be prepared to care for a child in arrest. Hospitals must ensure that their staff have the knowledge, confidence and ability to respond to a child in cardiac arrest. RESUS4KIDS is a programme designed to teach paediatric resuscitation to health care professionals who care for acutely unwell children. The programme is delivered in two components: an e-learning component for pre-learning, followed by a short, practical, face-to-face course that is taught using the round-the-table teaching approach. Round-the-table teaching is a novel, evidence-based small group teaching approach designed to teach paediatric resuscitation skills and knowledge. Round-the-table teaching uses a structured approach to managing a collapsed child, and ensures that each participant has the opportunity to practise the essential resuscitation skills of airway manoeuvres, bag mask ventilation and cardiac compressions. Round-the-table teaching is an engaging, non-threatening approach to delivering interdisciplinary paediatric resuscitation education. The methodology ensures that all participants have the opportunity to practise each of the different essential skills associated with the Danger, Response, Send for help, Airway, Breathing, Circulation, Defibrillation or rhythm recognition (DRSABCD) approach to the collapsed child. Round-the-table teaching is based on evidence-based small group teaching methods. The methodology of round-the-table teaching can be applied to any topic where participants must demonstrate an understanding of a sequential approach to a clinical skill. Round-the-table teaching uses a structured approach to managing a collapsed child. © 2014 The Authors. The Clinical Teacher published by Association for the Study of Medical Education and John Wiley & Sons Ltd.

"Become a Reporter", the Four Skills News Project: Applying and Practising Language Skills Using Digital Tools for Level C1/C2 Students

ERIC Educational Resources Information Center

Magedera-Hofhansl, Hanna

2016-01-01

The Four Skills News Project is an example of communicative language learning, developed for final year German students at the University of Liverpool. It focuses on how students use and practise their reading, writing, listening and speaking skills via the creative use of news reports and digital technology. Each student creates an avatar using…

Brain lateralisation and motor learning: selective effects of dominant and non-dominant hand practice on the early acquisition of throwing skills.

PubMed

Stöckel, Tino; Weigelt, Matthias

2012-01-01

Findings from neurosciences indicate that the two brain hemispheres are specialised for the processing of distinct movement features. How this knowledge can be useful in motor learning remains unclear. Two experiments were conducted to investigate the influence of initial practice with the dominant vs non-dominant hand on the acquisition of novel throwing skills. Within a transfer design two groups practised a novel motor task with the same amount of practice on each hand, but in opposite hand-order. In Experiment 1, participants acquired the position throw in basketball, which places high demands on throwing accuracy. Participants practising this task with their non-dominant hand first, before changing to the dominant hand, showed better skill acquisition than participants practising in opposite order. In Experiment 2 participants learned the overarm throw in team handball, which requires great throwing strength. Participants initially practising with their dominant hand benefited more from practice than participants beginning with their non-dominant hand. These results indicate that spatial accuracy tasks are learned better after initial practice with the non-dominant hand, whereas initial practice with the dominant hand is more efficient for maximum force production tasks. The effects are discussed in terms of brain lateralisation and bilateral practice schedules.

Referral for secondary restorative dental care in rural and urban areas of Scotland: findings from the Highlands Et Islands Teledentistry Project.

PubMed

Nuttall, N M; Steed, M S; Donachie, M A

2002-02-23

To compare the reported level of use of secondary care services for restorative dental care in rural and urban areas of Scotland. Postal questionnaire survey Postal questionnaire sent to all dentists in the Highland region, the island regions in Scotland and Dumfries Et Galloway (n = 150) and an equal number were sampled from the remainder of Scotland stratified by health board area. Non-respondents were sent 2 reminders after which 62% of the sample had responded. Most dentists (85%) who practised in what they considered were urban areas of Scotland said they felt that they had good access to a secondary referral service. Whereas most of those who practised in what they considered were rural areas either said they had no access to such a service (26%) or that access was difficult (53%), only 3% of those in urban areas said they had no access to a secondary restorative consultative service compared with 14% of dentists practising in rural areas of mainland Scotland and 54% of those practising on Scottish islands. The survey suggests the people of the Scottish islands and some of the remoter parts of the Scottish mainland would be among those who might benefit from improvement in access to a restorative dentistry consultant service.

Integration of role-playing into technical skills training: a randomized controlled trial.

PubMed

Nikendei, C; Kraus, B; Schrauth, M; Weyrich, P; Zipfel, S; Herzog, W; Jünger, J

2007-11-01

Recently, efforts have been undertaken to enhance the face validity of technical skills training by introducing role-plays and standardised patients. Since little is known about the effects of role-playing with respect to the realism of a training situation and students' objective performance, we performed a randomized controlled trial. 36 medical students participated in videotaped small group skills-lab sessions on the topics of Doppler sonography and gastric tube insertion. One half of the students participated in role-plays and the other half practised without role-playing. Realism of the training situation was analysed by means of post-intervention self-selected student survey evaluations. Technical performance and patient-physician communication were assessed by independent ratings of the videotaped sessions. The physician's role was regarded to be significantly more realistic when performing role-plays. Assessment of videotaped sessions showed that practising technical skills by performing role-plays resulted in significantly better patient-physician communication whereas students' technical performance did not differ between groups. Introducing role-plays enhances the realism of technical skills training and leads to better patient-physician communication. Students do not seem to be overstrained by practising clinical technical skills using role-plays. We conclude that role-playing is a valuable method in practising technical skills.

Exploring Native American Students' Perceptions of Scientists

NASA Astrophysics Data System (ADS)

Laubach, Timothy A.; Crofford, Geary Don; Marek, Edmund A.

2012-07-01

The purpose of this descriptive study was to explore Native American (NA) students' perceptions of scientists by using the Draw-A-Scientist Test and to determine if differences in these perceptions exist between grade level, gender, and level of cultural tradition. Data were collected for students in Grades 9-12 within a NA grant off-reservation boarding school. A total of 133 NA students were asked to draw a picture of a scientist at work and to provide a written explanation as to what the scientist was doing. A content analysis of the drawings indicated that the level of stereotype differed between all NA subgroups, but analysis of variance revealed that these differences were not significant between groups except for students who practised native cultural tradition at home compared to students who did not practise native cultural tradition at home (p < 0.05). The results suggest that NA students who practise cultural traditions at home are more able to function fluidly between indigenous knowledge and modern western science than their non-practising counterparts. Overall, these NA students do not see themselves as scientists, which may influence their educational and career science, technology, engineering, and mathematics paths in the future. The educational implication is that once initial perceptions are identified, researchers and teachers can provide meaningful experiences to combat the stereotypes.

Chromosome damage and cytotoxicity in oral mucosa cells after 2 months of exposure to anabolic steroids (decadurabolin and winstrol) in weight lifting.

PubMed

Martins, Renato A; Gomes, Guilherme A S; Aguiar, Odair; Medalha, Carla C; Ribeiro, Daniel A

2010-12-01

The aim of the present study was to evaluate DNA damage (micronucleus) and cellular death (pyknosis, karyolysis and karyorrhexis) in exfoliated buccal mucosa cells from anabolic steroid users after 2 months of exposure. Two experimental groups consisting of 15 adult males who practise weight lifting and are anabolic steroid users or 15 adult males who practise weight lifting, but are non-anabolic steroid users, were recruited. In addition, 20 sedentary males, who do not practise any physical activity regularly, were matched by age with experimental groups. No significant statistical differences (p>0.05) were noticed in individuals who practise physical activity only. On the other hand, an increase of micronucleated cells (MNCs) in anabolic steroid (decadurabulin and Winstrol) users was observed. Regarding cytotoxic parameters, the same observation has occurred, that is, significant statistical differences (p<0.05) were noticed in the group exposed to anabolic steroids when compared with other controls, as depicted by high frequencies of pyknosis, karyolysis and karyorrhexis. Taken together, our results suggest that genomic instability and cytotoxicity are induced by anabolic steroid administration in oral mucosa cells as assessed by the micronucleus test. Copyright 2010 Elsevier Inc. All rights reserved.

[Surgical Simulation Models for Sialendoscopy].

PubMed

Geisthoff, U; Volk, G F; Finkensieper, M; Wittekindt, C; Guntinas-Lichius, O

2015-09-01

Different simulation models are in use to teach the technique of sialendoscopy. Only a few reports in literature deal with this topic with no comparison having been published, yet. We therefore asked sialendoscopy training course participants about our applied models by using a questionnaire. Material und Methods: A tube-, a pepper-, a porcine kidney-, and a pig head-model were developed as training models and used during 6 consecutive practical sialendoscopy courses from 2012 to 2014. Participants were asked to answer a questionnaire specifically designed to assess the value of the different training models. All respondents (n=61) rated all training models positively. However, porcine kidney- and pig head-models were described to be superior, especially with respect to realistic simulation. Intubation of the papilla can be practised sufficiently only in the pig head-model. The tube- and peppers-models have the advantage of being less expensive, easier to handle and cleaner. The models described are all useful in learning the sialendoscopy technique. However, they have distinct advantages and disadvantages making a combination of different models useful. © Georg Thieme Verlag KG Stuttgart · New York.

Key principles in assessing students' practice-based learning.

PubMed

Price, Bob

Assessing student learning in the practice setting is one of the most sophisticated and complex forms of evaluation undertaken by registered nurses. The Nursing and Midwifery Council sets standards relating to learning and assessment in practice, focusing on professional values, communication and interpersonal skills, nursing practice, decision making, leadership, management and teamworking. Assessment needs to include evaluation of skill (technical, psychomotor and interpersonal), attitudes and insights, and reasoning. As assessment of student learning is conducted in the practice setting, risks have to be managed, and targets and service standards met. Therefore, it is understandable that mentors may express doubts about their ability to assess student learning rigorously and fairly. It is particularly challenging for mentors to state confidently what represents a demonstration of learning and competence when asked to decide whether a student is fit to practise.

The Future Role of the Combined Action Program

DTIC Science & Technology

1991-05-06

control predominates the VC can gain resources by means of covert purchase or hit-and-run raids if not by direct taxation . 36 Similar to the personnel...It may require changing accepted practises that are hundreds of years old. Nevertheless, change is imperative if CAP is to be successful. This is...8217Communist Party of the Philippines: Theory and Practise of United Front.* Masters Thesis, United States Army Command and General Staff College, Ft

Data Entities and Information System Matrix for Integrated Agriculture Information System (IAIS)

NASA Astrophysics Data System (ADS)

Budi Santoso, Halim; Delima, Rosa

2018-03-01

Integrated Agriculture Information System is a system that is developed to process data, information, and knowledge in Agriculture sector. Integrated Agriculture Information System brings valuable information for farmers: (1) Fertilizer price; (2) Agriculture technique and practise; (3) Pest management; (4) Cultivation; (5) Irrigation; (6) Post harvest processing; (7) Innovation in agriculture processing. Integrated Agriculture Information System contains 9 subsystems. To bring an integrated information to the user and stakeholder, it needs an integrated database approach. Thus, researchers describes data entity and its matrix relate to subsystem in Integrated Agriculture Information System (IAIS). As a result, there are 47 data entities as entities in single and integrated database.

Pressure ulcer prevention is everyone's business: the PUPS project.

PubMed

Blenman, Juliet; Marks-Maran, Di

2017-03-23

Prevention of pressure ulcers is one of the greatest healthcare challenges in terms of reducing patient harm. The literature shows that although numerous reports and policy documents have been published, pressure ulcer prevention remains an ongoing challenge. A number of innovations have been published offering practising nurses and managers ideas for raising awareness of skin care and preventing pressure ulcers. The majority of these have focused on patients in hospital settings with very little in the literature related to care-home and community initiatives. This article reports on an innovative approach to education for pressure ulcer prevention through collaboration between patients, carers and health and social care professionals.

Simulation of patient encounters using a virtual patient in periodontology instruction of dental students: design, usability, and learning effect in history-taking skills.

PubMed

Schittek Janda, M; Mattheos, N; Nattestad, A; Wagner, A; Nebel, D; Färbom, C; Lê, D-H; Attström, R

2004-08-01

Simulations are important educational tools in the development of health care competence. This study describes a virtual learning environment (VLE) for diagnosis and treatment planning in oral health care. The VLE is a web-based, database application where the learner uses free text communication on the screen to interact with patient data. The VLE contains forms for history taking, clinical images, clinical data and X-rays. After reviewing the patient information, the student proposes therapy and makes prognostic evaluations of the case in free text. A usability test of the application was performed with seven dental students. The usability test showed that the software responded with correct answers to the majority of the free text questions. The application is generic in its basic functions and can be adapted to other dental or medical subject areas. A randomised controlled trial was carried out with 39 students who attended instruction in history taking with problem-based learning cases, lectures and seminars. In addition, 16 of the 39 students were randomly chosen to practise history taking using the virtual patient prior to their first patient encounter. The performance of each student was recorded on video during the patient sessions. The type and order of the questions asked by the student and the degree of empathy displayed towards the patient were analysed systematically on the videos. The data indicate that students who also undertook history taking with a virtual patient asked more relevant questions, spent more time on patient issues, and performed a more complete history interview compared with students who had only undergone standard teaching. The students who had worked with the virtual patient also seemed to have more empathy for the patients than the students who had not. The practising of history taking with a virtual patient appears to improve the capability of dental students to take a relevant oral health history.

Psychotherapeutic and psychosocial interventions for managing stress in multiple sclerosis: the contribution of mindfulness-based interventions.

PubMed

Muñoz San José, A; Oreja-Guevara, C; Cebolla Lorenzo, S; Carrillo Notario, L; Rodríguez Vega, B; Bayón Pérez, C

2016-03-01

Depression or anxiety in multiple sclerosis (MS) has been linked to a more severe course of the disease and higher numbers of relapses, in addition to poorer treatment adherence and exacerbated immune system dysregulation. Recent investigations indicate that psychotherapeutic interventions for stress management, such as mindfulness-based interventions (MBIs), could improve quality of life, depression, anxiety, and fatigue in MS patients. Mindfulness fosters the ability to slow down and observe experiences as they truly are, which improves affect regulation. Mindfulness is acquired through training; its advantage over other psychotherapeutic interventions is that effects may remain over time, since cultivating mindfulness depends on regular practising of abilities learned during training. The objective of this article is to review the current evidence of psychotherapeutic and psychosocial interventions, including MBIs for stress management, and their beneficial effects on MS patients. Copyright © 2015 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

Decompression illness secondary to occupational diving: recommended management based current legistation and practice in Malaysia.

PubMed

Rozali, A; Khairuddin, H; Sherina, M S; Zin, B Mohd; Sulaiman, A

2008-06-01

Occupational divers are exposed to hazards which contribute to the risk of developing decompression illnesses (DCI). DCI consists of Type I decompression sickness (DCS), Type II DCS and arterial gas embolism (AGE), developed from formation of bubbles in the tissues or circulation as a result of inadequate elimination of inert gas (nitrogen) after a dive. In Malaysia, DCI is one of the significant contributions to mortality and permanent residual morbidity in diving accidents. This is a case of a diver who suffered from Type II DCS with neurological complications due to an occupational diving activity. This article mentions the clinical management of the case and makes several recommendations based on current legislations and practise implemented in Malaysia in order to educate medical and health practitioners on the current management of DCI from the occupational perspective. By following these recommendations, hopefully diving accidents mainly DCI and its sequalae among occupational divers can be minimized and prevented, while divers who become injured receive the proper compensation for their disabilities.

The effect of a multidisciplinary obstetric emergency team training program, the In Time course, on diagnosis to delivery interval following umbilical cord prolapse - A retrospective cohort study.

PubMed

Copson, Sean; Calvert, Katrina; Raman, Puvaneswary; Nathan, Elizabeth; Epee, Mathias

2017-06-01

Cord prolapse is an uncommon obstetric emergency, with potentially fatal consequences for the baby if prompt action is not taken. Simulation training provides a means by which uncommon emergencies can be practised, with the aim of improving teamwork and clinical outcomes. This study aimed to determine if the introduction of a simulation-based training course was associated with an improvement in the management of cord prolapse, in particular the diagnosis to delivery interval. We also aimed to investigate if an improvement in perinatal outcomes could be demonstrated. A retrospective cohort study was performed. All cases of cord prolapse in the designated time period were identified and reviewed and a comparison of outcome measures pre- and post-training was undertaken. Thirty-one cases were identified in the pre-training period, and compared to 64 cases post-training. Documentation improved significantly post-training. There were non-significant improvements in use of spinal anaesthetic, and in the length of stay in the special care neonatal unit. There was a significant increase in the number of babies with Apgar scores less than seven at 5 min. There were no differences in the diagnosis to delivery interval, or in perinatal mortality rates. Obstetric emergency training was associated with improved teamwork, as evidenced by the improved documentation post-training in this study, but not with improved diagnosis to delivery interval. Long-term follow-up studies are required to ascertain whether training has an impact on longer-term paediatric outcomes, such as cerebral palsy rates. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Co-Leadership - A Management Solution for Integrated Health and Social Care.

PubMed

Klinga, Charlotte; Hansson, Johan; Hasson, Henna; Sachs, Magna Andreen

2016-05-23

Co-leadership has been identified as one approach to meet the managerial challenges of integrated services, but research on the topic is limited. In the present study, co-leadership, practised by pairs of managers - each manager representing one of the two principal organizations in integrated health and social care services - was explored. To investigate co-leadership in integrated health and social care, identify essential preconditions in fulfilling the management assignment, its operationalization and impact on provision of sustainable integration of health and social care. Interviews with eight managers exercising co-leadership were analysed using directed content analysis. Respondent validation was conducted through additional interviews with the same managers. Key contextual preconditions were an organization-wide model supporting co-leadership and co-location of services. Perception of the management role as a collective activity, continuous communication and lack of prestige were essential personal and interpersonal preconditions. In daily practice, office sharing, being able to give and take and support each other contributed to provision of sustainable integration of health and social care. Co-leadership promoted robust management by providing broader competence, continuous learning and joint responsibility for services. Integrated health and social care services should consider employing co-leadership as a managerial solution to achieve sustainability.

Co-Leadership – A Management Solution for Integrated Health and Social Care

PubMed Central

Hansson, Johan; Hasson, Henna; Sachs, Magna Andreen

2016-01-01

Introduction: Co-leadership has been identified as one approach to meet the managerial challenges of integrated services, but research on the topic is limited. In the present study, co-leadership, practised by pairs of managers – each manager representing one of the two principal organizations in integrated health and social care services – was explored. Aim: To investigate co-leadership in integrated health and social care, identify essential preconditions in fulfilling the management assignment, its operationalization and impact on provision of sustainable integration of health and social care. Method: Interviews with eight managers exercising co-leadership were analysed using directed content analysis. Respondent validation was conducted through additional interviews with the same managers. Results: Key contextual preconditions were an organization-wide model supporting co-leadership and co-location of services. Perception of the management role as a collective activity, continuous communication and lack of prestige were essential personal and interpersonal preconditions. In daily practice, office sharing, being able to give and take and support each other contributed to provision of sustainable integration of health and social care. Conclusion and discussion: Co-leadership promoted robust management by providing broader competence, continuous learning and joint responsibility for services. Integrated health and social care services should consider employing co-leadership as a managerial solution to achieve sustainability. PMID:27616963

Food Culture, Preferences and Ethics in Dysphagia Management.

PubMed

Kenny, Belinda

2015-11-01

Adults with dysphagia experience difficulties swallowing food and fluids with potentially harmful health and psychosocial consequences. Speech pathologists who manage patients with dysphagia are frequently required to address ethical issues when patients' food culture and/ or preferences are inconsistent with recommended diets. These issues incorporate complex links between food, identity and social participation. A composite case has been developed to reflect ethical issues identified by practising speech pathologists for the purposes of illustrating ethical concerns in dysphagia management. The case examines a speech pathologist's role in supporting patient autonomy when patients and carers express different goals and values. The case presents a 68-year-old man of Australian/Italian heritage with severe swallowing impairment and strong values attached to food preferences. The case is examined through application of the dysphagia algorithm, a tool for shared decision-making when patients refuse dietary modifications. Case analysis revealed the benefits and challenges of shared decision-making processes in dysphagia management. Four health professional skills and attributes were identified as synonymous with shared decision making: communication, imagination, courage and reflection. © 2015 John Wiley & Sons Ltd.

Global physician budgets as common-property resources: some implications for physicians and medical associations.

PubMed Central

Hurley, J; Card, R

1996-01-01

Since 1990 payment for physician services in the fee-for-service sector has shifted from an open-ended system to fixed global budgets. This shift has created a new economic context for practising medicine in Canada. A global cap creates a conflict between physicians' individual economic self-interest and their collective interest in constraining total billings within the capped budget. These types of incentive problems occur in managing what are known in economics as "common-property resources." Analysts studying common-property resources have documented several management principles associated with successful, long-run use of such resources in the face of these conflicting incentives. These management principles include early defining the boundaries of the common-property resource, explicitly specifying rules for using the resource, developing collective decision-making arrangements and monitoring mechanisms, and creating low-cost conflict-resolution mechanisms. The authors argue that global physician budgets can usefully be viewed as common-property-resources. They describe some of the key management principles and note some implications for physicians and the provincial and territorial medical associations as they adapt to global budgets. PMID:8612251

Prefrontal involvement in imitation learning of hand actions: effects of practice and expertise.

PubMed

Vogt, Stefan; Buccino, Giovanni; Wohlschläger, Afra M; Canessa, Nicola; Shah, N Jon; Zilles, Karl; Eickhoff, Simon B; Freund, Hans-Joachim; Rizzolatti, Giacomo; Fink, Gereon R

2007-10-01

In this event-related fMRI study, we demonstrate the effects of a single session of practising configural hand actions (guitar chords) on cortical activations during observation, motor preparation and imitative execution. During the observation of non-practised actions, the mirror neuron system (MNS), consisting of inferior parietal and ventral premotor areas, was more strongly activated than for the practised actions. This finding indicates a strong role of the MNS in the early stages of imitation learning. In addition, the left dorsolateral prefrontal cortex (DLPFC) was selectively involved during observation and motor preparation of the non-practised chords. This finding confirms Buccino et al.'s [Buccino, G., Vogt, S., Ritzl, A., Fink, G.R., Zilles, K., Freund, H.-J., Rizzolatti, G., 2004a. Neural circuits underlying imitation learning of hand actions: an event-related fMRI study. Neuron 42, 323-334] model of imitation learning: for actions that are not yet part of the observer's motor repertoire, DLPFC engages in operations of selection and combination of existing, elementary representations in the MNS. The pattern of prefrontal activations further supports Shallice's [Shallice, T., 2004. The fractionation of supervisory control. In: Gazzaniga, M.S. (Ed.), The Cognitive Neurosciences, Third edition. MIT Press, Cambridge, MA, pp. 943-956] proposal of a dominant role of the left DLPFC in modulating lower level systems and of a dominant role of the right DLPFC in monitoring operations.

Physical and sporting activities improve vestibular afferent usage and balance in elderly human subjects.

PubMed

Gauchard, G C; Jeandel, C; Perrin, P P

2001-01-01

Ageing is associated with a reduction in balance, in particular through dysfunction of each level of postural control, which results in an increased risk of falling. Conversely, the practice of physical activities has been shown to modulate postural control in elderly people. This study examined the potential positive effects of two types of regular physical and sporting activities on vestibular information and their relation to posture. Gaze and postural stabilisation was evaluated by caloric and rotational vestibular tests on 18 healthy subjects over the age of 60 who regularly practised low-energy or bioenergetic physical activities and on 18 controls of a similar age who only walked on a regular basis. These subjects were also submitted to static and dynamic posturographic tests. The control group displayed less balance control, with a lower vestibular sensitivity and a relatively high dependency on vision compared to the group practising low-energy physical activities, which had better postural control with good vestibular sensitivity and less dependency on vision. The postural control and vestibular sensitivity of subjects practising bioenergetic activities was average, and required higher visual afferent contribution. Low-energy exercises, already shown to have the most positive impact on balance control by relying more on proprioception, also appear to develop or maintain a high level of vestibular sensitivity allowing elderly people practising such exercises to reduce the weight of vision. Copyright 2001 S. Karger AG, Basel

The advancement of probiotics research and its application in fish farming industries.

PubMed

Banerjee, Goutam; Ray, Arun Kumar

2017-12-01

Fish are always susceptible to a variety of lethal diseases caused by different types of bacterial, fungal, viral and parasitic agents. The unscientific management practises such as, over feeding, high stock densities and destructive fishing techniques increase the probability of disease symptoms in aquaculture industries. According to Food and Agriculture Association (FAO), each and every year several countries such as China, India, Norway, Indonesia, etc. face a huge loss in aquaculture production due to mainly bacterial and viral diseases. The use of antibiotics is a common practise in fish farming sectors to control the disease outbreak. However, the antibiotics are not long term friend because it creates selective pressure for emergence of drug resistant bacteria. Probiotics are live microorganisms that confer several beneficial effects to host (enhances immunity, helps in digestion, protects from pathogens, improves water quality, promotes growth and reproduction) and can be used as an alternative of antibiotics. In recent year, a wide range of bacteria have reported as potential probiotics candidates in fish farming sectors, however, Lactobacillus sp. and Bacillus sp. gain special attention due to their high antagonistic activities, extracellular enzyme production and availability. In this present review, we have summarized the recent advancement in aquaculture probiotics research and its impact on fish health, nutrition, immunity, reproduction and water quality. Copyright © 2017 Elsevier Ltd. All rights reserved.

Validation of the updated ArthroS simulator: face and construct validity of a passive haptic virtual reality simulator with novel performance metrics.

PubMed

Garfjeld Roberts, Patrick; Guyver, Paul; Baldwin, Mathew; Akhtar, Kash; Alvand, Abtin; Price, Andrew J; Rees, Jonathan L

2017-02-01

To assess the construct and face validity of ArthroS, a passive haptic VR simulator. A secondary aim was to evaluate the novel performance metrics produced by this simulator. Two groups of 30 participants, each divided into novice, intermediate or expert based on arthroscopic experience, completed three separate tasks on either the knee or shoulder module of the simulator. Performance was recorded using 12 automatically generated performance metrics and video footage of the arthroscopic procedures. The videos were blindly assessed using a validated global rating scale (GRS). Participants completed a survey about the simulator's realism and training utility. This new simulator demonstrated construct validity of its tasks when evaluated against a GRS (p ≤ 0.003 in all cases). Regarding it's automatically generated performance metrics, established outputs such as time taken (p ≤ 0.001) and instrument path length (p ≤ 0.007) also demonstrated good construct validity. However, two-thirds of the proposed 'novel metrics' the simulator reports could not distinguish participants based on arthroscopic experience. Face validity assessment rated the simulator as a realistic and useful tool for trainees, but the passive haptic feedback (a key feature of this simulator) is rated as less realistic. The ArthroS simulator has good task construct validity based on established objective outputs, but some of the novel performance metrics could not distinguish between surgical experience. The passive haptic feedback of the simulator also needs improvement. If simulators could offer automated and validated performance feedback, this would facilitate improvements in the delivery of training by allowing trainees to practise and self-assess.

Framework for incorporating simulation into urology training.

PubMed

Arora, Sonal; Lamb, Benjamin; Undre, Shabnam; Kneebone, Roger; Darzi, Ara; Sevdalis, Nick

2011-03-01

• Changes to working hours, new technologies and increased accountability have rendered the need for alternative training environments for urologists. • Simulation offers a promising arena for learning to take place in a safe, realistic setting. • Despite its benefits, the incorporation of simulation into urological training programmes remains minimal. • The current status and future directions of simulation for training in technical and non-technical skills are reviewed as they pertain to urology. • A framework is presented for how simulation-based training could be incorporated into the entire urological curriculum. • The literature on simulation in technical and non-technical skills training is reviewed, with a specific focus upon urology. • To fully integrate simulation into a training curriculum, its possibilities for addressing all the competencies required by a urologist must be realized. • At an early stage of training, simulation has been used to develop basic technical skills and cognitive skills, such as decision-making and communication. • At an intermediate stage, the studies focus upon more advanced technical skills learnt with virtual reality simulators. • Non-technical skills training would include leadership and could be delivered with in situ models. • At the final stage, experienced trainees can practise technical and non-technical skills in full crisis simulations situated within a fully-simulated operating rooms. • Simulation can provide training in the technical and non-technical skills required to be a competent urologist. • The framework presented may guide how best to incorporate simulation into training curricula. • Future work should determine whether acquired skills transfer to clinical practice and improve patient care. © 2010 THE AUTHORS. BJU INTERNATIONAL © 2010 BJU INTERNATIONAL.

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

Bridge, Pete, E-mail: pete.bridge@qut.edu.au; Gunn, Therese; Kastanis, Lazaros

A novel realistic 3D virtual reality (VR) application has been developed to allow medical imaging students at Queensland University of Technology to practice radiographic techniques independently outside the usual radiography laboratory. A flexible agile development methodology was used to create the software rapidly and effectively. A 3D gaming environment and realistic models were used to engender presence in the software while tutor-determined gold standards enabled students to compare their performance and learn in a problem-based learning pedagogy. Students reported high levels of satisfaction and perceived value and the software enabled up to 40 concurrent users to prepare for clinical practice.more » Student feedback also indicated that they found 3D to be of limited value in the desktop version compared to the usual 2D approach. A randomised comparison between groups receiving software-based and traditional practice measured performance in a formative role play with real equipment. The results of this work indicated superior performance with the equipment for the VR trained students (P = 0.0366) and confirmed the value of VR for enhancing 3D equipment-based problem-solving skills. Students practising projection techniques virtually performed better at role play assessments than students practising in a traditional radiography laboratory only. The application particularly helped with 3D equipment configuration, suggesting that teaching 3D problem solving is an ideal use of such medical equipment simulators. Ongoing development work aims to establish the role of VR software in preparing students for clinical practice with a range of medical imaging equipment.« less

Development of a Tablet-based symbol digit modalities test for reliably assessing information processing speed in patients with stroke.

PubMed

Tung, Li-Chen; Yu, Wan-Hui; Lin, Gong-Hong; Yu, Tzu-Ying; Wu, Chien-Te; Tsai, Chia-Yin; Chou, Willy; Chen, Mei-Hsiang; Hsieh, Ching-Lin

2016-09-01

To develop a Tablet-based Symbol Digit Modalities Test (T-SDMT) and to examine the test-retest reliability and concurrent validity of the T-SDMT in patients with stroke. The study had two phases. In the first phase, six experts, nine college students and five outpatients participated in the development and testing of the T-SDMT. In the second phase, 52 outpatients were evaluated twice (2 weeks apart) with the T-SDMT and SDMT to examine the test-retest reliability and concurrent validity of the T-SDMT. The T-SDMT was developed via expert input and college student/patient feedback. Regarding test-retest reliability, the practise effects of the T-SDMT and SDMT were both trivial (d=0.12) but significant (p≦0.015). The improvement in the T-SDMT (4.7%) was smaller than that in the SDMT (5.6%). The minimal detectable changes (MDC%) of the T-SDMT and SDMT were 6.7 (22.8%) and 10.3 (32.8%), respectively. The T-SDMT and SDMT were highly correlated with each other at the two time points (Pearson's r=0.90-0.91). The T-SDMT demonstrated good concurrent validity with the SDMT. Because the T-SDMT had a smaller practise effect and less random measurement error (superior test-retest reliability), it is recommended over the SDMT for assessing information processing speed in patients with stroke. Implications for Rehabilitation The Symbol Digit Modalities Test (SDMT), a common measure of information processing speed, showed a substantial practise effect and considerable random measurement error in patients with stroke. The Tablet-based SDMT (T-SDMT) has been developed to reduce the practise effect and random measurement error of the SDMT in patients with stroke. The T-SDMT had smaller practise effect and random measurement error than the SDMT, which can provide more reliable assessments of information processing speed.

Problematising risk in stroke rehabilitation.

PubMed

Egan, Mary Y; Kessler, Dorothy; Ceci, Christine; Laliberté-Rudman, Debbie; McGrath, Colleen; Sikora, Lindsey; Gardner, Paula

2016-11-01

Following stroke, re-engagement in personally valued activities requires some experience of risk. Risk, therefore, must be seen as having positive as well as negative aspects in rehabilitation. Our aim was to identify the dominant understanding of risk in stroke rehabilitation and the assumptions underpinning these understandings, determine how these understandings affect research and practise, and if necessary, propose alternate ways to conceptualise risk in research and practise. Alvesson and Sandberg's method of problematisation was used. We began with a historical overview of stroke rehabilitation, and proceeded through five steps undertaken in an iterative fashion: literature search and selection; data extraction; syntheses across texts; identification of assumptions informing the literature and; generation of alternatives. Discussion of risk in stroke rehabilitation is largely implicit. However, two prominent conceptualisations of risk underpin both knowledge development and clinical practise: the risk to the individual stroke survivor of remaining dependent in activities of daily living and the risk that the health care system will be overwhelmed by the costs of providing stroke rehabilitation. Conceptualisation of risk in stroke rehabilitation, while implicit, drives both research and practise in ways that reinforce a focus on impairment and a generic, decontextualised approach to rehabilitation. Implications for rehabilitation Much of stroke rehabilitation practise and research seems to centre implicitly on two risks: risk to the patient of remaining dependent in ADL and risk to the health care system of bankruptcy due to the provision of stroke rehabilitation. The implicit focus on ADL dependence limits the ability of clinicians and researchers to address other goals supportive of a good life following stroke. The implicit focus on financial risk to the health care system may limit access to rehabilitation for people who have experienced either milder or more severe stroke. Viewing individuals affected by stroke as possessing a range of independence and diverse personally valued activities that exist within a network of relations offers wider possibilities for action in rehabilitation.

Unsafe sexual behaviour in domestic and foreign migrant male workers in multinational workplaces in Jordan: occupational-based and behavioural assessment survey

PubMed Central

Al Rifai, Rami; Nakamura, Keiko; Seino, Kaoruko; Kizuki, Masashi; Morita, Ayako

2015-01-01

Objectives To examine the prevalence of unsafe sexual behaviour, sexually transmitted infection (STI)-related knowledge, health and work-related conditions, and correlates of practising unsafe sex among domestic and foreign male workers in multinational workplaces in Jordan. Design Cross-sectional behavioural assessment survey. Setting Multinational workplaces in Jordan. Participants 230 Jordanian and 480 foreign male workers aged ≥18 years who had worked in a Qualified Industrial Zone (QIZ) for 12 months or more. Outcomes The primary outcome was the prevalence of practising unsafe sex. ‘Unsafe sex’ was defined as sex with a non-regular sexual partner with inconsistent condom usage. Results Overall, 74.3% of workers reported lifetime sexual experience. The proportion of lifetime unsafe sex was similar among domestic (31.8%) and foreign (35.6%) workers. Of those, 59.2% of domestic and 68.1% of foreign workers started practising unsafe sex after joining the QIZ. Rates of lifetime unsafe sex were significantly higher among those who had their sexual debut after joining the QIZ in domestic (aOR, 2.2, 95% CI 1.1 to 4.4) and foreign workers (aOR, 2.4, 95% CI 1.4 to 4.1). Among the domestic workers, being 18–24 years old (aOR, 4.9), unmarried (aOR, 4.8), working in the QIZ for 5–8 years (aOR, 5.0), sometimes/frequently shopped with foreign workers (aOR, 2.1) or were current/ex-alcohol drinkers (aORs, 3.4) were independently significantly associated with higher odds of practising unsafe sex. Conclusions A significant proportion of domestic and foreign male workers had been practising unsafe sex. The findings indicated that not only foreigners but also domestic male workers associating with foreign workers are at high risk of unsafe sex. Tailored interventions to promote safer sex in multinational workplaces in Jordan are needed. PMID:26068511

Vibration control in smart coupled beams subjected to pulse excitations

NASA Astrophysics Data System (ADS)

Pisarski, Dominik; Bajer, Czesław I.; Dyniewicz, Bartłomiej; Bajkowski, Jacek M.

2016-10-01

In this paper, a control method to stabilize the vibration of adjacent structures is presented. The control is realized by changes of the stiffness parameters of the structure's couplers. A pulse excitation applied to the coupled adjacent beams is imposed as the kinematic excitation. For such a representation, the designed control law provides the best rate of energy dissipation. By means of a stability analysis, the performance in different structural settings is studied. The efficiency of the proposed strategy is examined via numerical simulations. In terms of the assumed energy metric, the controlled structure outperforms its passively damped equivalent by over 50 percent. The functionality of the proposed control strategy should attract the attention of practising engineers who seek solutions to upgrade existing damping systems.

Cost Structure and Life Cycle Costs for Military Systems

DTIC Science & Technology

2003-09-01

LCC 1-1 Chapter 2 – Scope of the Study 2-1 2.1 Contribution of other NATO Entities 2-1 2.2 Review of National Practises and CBS 2-1 2.3 Development...Office – NCO) gave a positive answer and designated a representative in the working group. 2.2 REVIEW OF NATIONAL PRACTISES AND CBS The two first...time preference when spending money obtained through taxation ) with the effectiveness of alternate ways of meeting an objective. By combining the

Health care managers learning by listening to subordinates' dialogue training.

PubMed

Grill, C; Ahlborg, G; Wikström, E

2014-01-01

Middle managers in health care today are expected to continuously and efficiently decide and act in administration, finance, care quality, and work environment, and strategic communication has become paramount. Since dialogical communication is considered to promote a healthy work environment, the purpose of this paper is to investigate the ways in which health care managers experienced observing subordinates' dialogue training. A qualitative study using semi-structured interviews and documents from eight middle managers in a dialogue programme intervention conducted by dialogue trainers. Focus was on fostering and assisting workplace dialogue. Conventional qualitative content analysis was used. Managers' experiences were both enriching and demanding, and consisted of becoming aware of communication, meaning perceiving interaction between subordinates as well as own silent interaction with subordinates and trainer; Discovering communicative actions for leadership, by gaining self-knowledge and recognizing relational leadership models from trainers--such as acting democratically and pedagogically--and converting theory into practice, signifying practising dialogue-promoting conversation behaviour with subordinates, peers, and superiors. Only eight managers participated in the intervention, but data afforded a basis for further research. Findings stressed the importance of listening, and of support from superiors, for well-functioning leadership communication at work. Studies focusing on health care managers' communication and dialogue are few. This study contributes to knowledge about these activities in managerial leadership.

Type 2 diabetes: how do Thai Buddhist people with diabetes practise self-management?

PubMed

Lundberg, Pranee C; Thrakul, Supunnee

2012-03-01

This paper is a report of a study of how Thai Buddhist people with type 2 diabetes practice self-management. The importance of diabetes self-management is recognized in the literature. However, research on self-care management in Thailand, in particular concerning Buddhist people with type 2 diabetes, is scarce. A descriptive qualitative study was conducted. Purposive convenience sampling was used, and thirty men and women with diabetes, aged 28-79 years, participated. Data were collected from June to August 2009 and analysed by use of manifest and latent content analysis. Five themes of self-management among Thai Buddhist people with type 2 diabetes were identified: cultural influence on disease control, Buddhism and Thai culture, struggle for disease control, family support and economy a high priority. Even though the Buddhist people with diabetes had certain self-management capabilities, many had poor control of their blood sugar levels and needed assistance. Reference to Buddhist moderation can be an effective means of helping the people with diabetes better manage their disease and change their lifestyles. In addition to cultural and religious traditions, family, economy and social environment should be taken into account both in the care and in interventions aimed at helping people with diabetes cope and empowering them to control their disease. © 2011 Blackwell Publishing Ltd.

Migration of the CERN IT Data Centre Support System to ServiceNow

NASA Astrophysics Data System (ADS)

Alvarez Alonso, R.; Arneodo, G.; Barring, O.; Bonfillou, E.; Coelho dos Santos, M.; Dore, V.; Lefebure, V.; Fedorko, I.; Grossir, A.; Hefferman, J.; Mendez Lorenzo, P.; Moller, M.; Pera Mira, O.; Salter, W.; Trevisani, F.; Toteva, Z.

2014-06-01

The large potential and flexibility of the ServiceNow infrastructure based on "best practises" methods is allowing the migration of some of the ticketing systems traditionally used for the monitoring of the servers and services available at the CERN IT Computer Centre. This migration enables the standardization and globalization of the ticketing and control systems implementing a generic system extensible to other departments and users. One of the activities of the Service Management project together with the Computing Facilities group has been the migration of the ITCM structure based on Remedy to ServiceNow within the context of one of the ITIL processes called Event Management. The experience gained during the first months of operation has been instrumental towards the migration to ServiceNow of other service monitoring systems and databases. The usage of this structure is also extended to the service tracking at the Wigner Centre in Budapest.

Impressions of defensive medical practice and medical litigation among South African neurosurgeons.

PubMed

Roytowski, D; Smith, T R; Fieggen, A G; Taylor, A

2014-11-01

From a litigation perspective, neurosurgery is considered a 'super high-risk' field, and this has been associated with rapidly increasing malpractice cover costs. In 2013 the annual Medical Protection Society fee for cover was R250,900. We wished to determine whether high malpractice cover was influencing how neurosurgeons managed patients. A 40-question online survey asking questions on defensive medicine was distributed to determine perceptions around liability risk and whether these influenced how patients were managed. Eighty-four per cent of respondents agreed that a medicolegal crisis existed, and over half (53.8%) had been sued for malpractice during their career. Altering practice behaviour to minimise the risk of a lawsuit is common. The increasing number of legal claims against respondents in this survey has resulted in most neurosurgeons practising defensive medicine. Arguably this will result in increased healthcare costs, inferior patient care and decreased access to skilled surgeons.

How engineers perceive the importance of ethics in Finland

NASA Astrophysics Data System (ADS)

Taajamaa, Ville; Majanoja, Anne-Maarit; Bairaktarova, Diana; Airola, Antti; Pahikkala, Tapio; Sutinen, Erkki

2018-01-01

Success in complex and holistic engineering practices requires more than problem-solving abilities and technical competencies. Engineering education must offer proficient technical competences and also train engineers to think and act ethically. A technical 'engineering-like' focus and demand have made educators and students overlook the importance of ethical awareness and transversal competences. Using two Finnish surveys, conducted in 2014 and 2016, we examine how engineers perceive working life needs regarding ethics. The data consider different age groups. We research whether an engineer's age affects their perception of the importance of ethics in their work and if there are differences between young experts and young managers in their use of ethics within work. The results indicate that practising engineers do not consider ethical issues important in their work. This especially applies to younger engineers; the older an engineer, the more important they consider ethics. No statistically significant difference was found between young engineering experts and managers.

Organisational effectiveness within National Health Service (NHS) Trusts.

PubMed

Jackson, S

1998-01-01

In view of the dearth of information relating to organisational effectiveness of NHS Trusts in comparison with clinical effectiveness, a complex study was undertaken to determine whether overall effectiveness was a result of management processes, people, or a combination of both. The study incorporated two phases involving the distribution of a comprehensive questionnaire to identify the "whats" of organisational effectiveness, and a bench-marking exercise aimed at identifying the "hows". In the main, the better performing trusts were found to be subscribing to the concepts of "keeping it simple", innovation and attainment of highly efficient processes. A number of examples of better/best practices were observed which included visible leadership, a commitment towards stakeholder involvement and the practice of teamworking. Given the complexity of the study area, the findings were deemed valuable to managers practising within all areas of healthcare. However, a need for further research was identified in order to substantiate the results.

Management of orthodontic emergencies in primary care - self-reported confidence of general dental practitioners.

PubMed

Popat, H; Thomas, K; Farnell, D J J

2016-07-08

Objective To determine general dental practitioners' (GDPs) confidence in managing orthodontic emergencies.Design Cross-sectional study.Setting Primary dental care.Subjects and methods An online survey was distributed to dentists practicing in Wales. The survey collected basic demographic information and included descriptions of ten common orthodontic emergency scenarios.Main outcome measure Respondents' self-reported confidence in managing the orthodontic emergency scenarios on a 5-point Likert scale. Differences between the Likert responses and the demographic variables were investigated using chi-squared tests.Results The median number of orthodontic emergencies encountered by respondents over the previous six months was 1. Overall, the self-reported confidence of respondents was high with 7 of the 10 scenarios presented scoring a median of 4 indicating that GDPs were 'confident' in their management. Statistical analysis revealed that GDPs who saw more orthodontic emergencies in the previous six months were more confident when managing the presented scenarios. Other variables such as age, gender, geographic location of practice and number of years practising dentistry were not associated with self-reported confidence.Conclusions Despite GDPs encountering very few orthodontic emergencies in primary care, they appear to be confident in dealing with commonly arising orthodontic emergency situations.

May we practise endotracheal intubation on the newly dead?

PubMed Central

Ardagh, M

1997-01-01

Endotracheal intubation (ETI) is a valuable procedure which must be learnt and practised, and performing ETI on cadavers is probably the best way to do this, although lesser alternatives do exist. Performing ETI on a cadaver is viewed with a real and reasonable repugnance and if it is done without proper authorisation it might be illegal. Some form of consent is required. Presumed consent would preferably be governed by statute and should only occur if the community is well informed and therefore in a position of being able to decline. Currently neither statute nor adequate informing exists. Endotracheal intubation on the newly dead may be justifiable according to a Guttman scale if the patient has already consented to organ donation and if further research supports the relevance of the Guttman scale to this question. A "mandated choice" with prior individual consent as a matter of public policy is the best of these solutions, however until such a solution is in place we may not practise endotracheal intubation on the newly dead. PMID:9358348

Tai Chi and older people in the community: a preliminary study.

PubMed

Morris Docker, Sara

2006-05-01

This paper outlines a qualitative exploratory study of the individual experiences of older people who practise Tai Chi for health. The study aimed to identify factors that influence the attraction of Tai Chi for older people. Participants were recruited from a selection of Tai Chi clubs in the north of England. Participant and non-participant observation of a selection of Tai Chi practice sessions was undertaken along with interviews with 7 older people. Findings show that individuals who practice Tai Chi report a variety of immediate and lasting physical and mental benefits. Being part of a group that both learns and practises Tai Chi together appears to be important to the experience and awareness of the spiritual nature of Tai Chi was also reported. It is argued that older people who practise Tai Chi may have a particular view on ageing, health and well-being that the activity of Tai Chi allows them to express and future study intends to investigate this in more detail.

UK-trained junior doctors' intentions to work in UK medicine: questionnaire surveys, three years after graduation

PubMed Central

Surman, Geraldine; Goldacre, Michael J

2017-01-01

Objective To report on the career intentions, three years after qualification, of 12 national cohorts of UK-trained doctors who qualified between 1974 and 2012, and, specifically, to compare recent UK medical graduates’ intentions to work in medicine in the UK with earlier graduates. Design Questionnaire surveys of cohorts of UK medical graduates defined by year of graduation. Setting UK. Participants 30,272 UK medical graduates. Main outcome measures Stated level of intention to pursue a long-term career in medicine in the UK. Results The response rate was 62% (30,272/48,927). We examined responses to the question ‘Apart from temporary visits abroad, do you intend to practise medicine in the United Kingdom for the foreseeable future?' Of doctors from UK homes, 90% had specified that they would ‘definitely or probably’ practise medicine in the UK in the surveys of 1977–1986, 81% in 1996–2011 and 64% in 2015. Those who said that they would probably or definitely not practise medicine in the UK comprised 5% in 1977–1986, 8% in 1996–2011 and 15% in 2015. Most who were not definite about a future career in UK medicine indicated that they would wish to practise medicine outside the UK rather than to leave medicine. Conclusions The wish to remain in UK medical practice in the 2015 survey was unprecedentedly low in this unique series of 40 years of surveys. PMID:29116902

Psychosocial determinants of nurses' intention to practise euthanasia in palliative care.

PubMed

Lavoie, Mireille; Godin, Gaston; Vézina-Im, Lydi-Anne; Blondeau, Danielle; Martineau, Isabelle; Roy, Louis

2016-02-01

Most studies on euthanasia fail to explain the intentions of health professionals when faced with performing euthanasia and are atheoretical. The purpose of this study was to identify the psychosocial determinants of nurses' intention to practise euthanasia in palliative care if it were legalised. A cross-sectional study using a validated anonymous questionnaire based on an extended version of the Theory of Planned Behaviour. A random sample of 445 nurses from the province of Quebec, Canada, was selected for participation in the study. The study was reviewed and approved by the Ethics Committee of the Centre hospitalier universitaire de Québec. The response rate was 44.2% and the mean score for intention was 4.61 ± 1.90 (range: 1-7). The determinants of intention were the subjective (odds ratio = 3.08; 95% confidence interval: 1.50-6.35) and moral (odds ratio = 2.95; 95% confidence interval: 1.58-5.49) norms. Specific beliefs which could discriminate nurses according to their level of intention were identified. Overall, nurses have a slightly positive intention to practise euthanasia. Their family approval seems particularly important and also the approval of their medical colleagues. Nurses' moral norm was related to beneficence, an ethical principle. To our knowledge, this is the first study to identify nurses' motivations to practise euthanasia in palliative care using a validated psychosocial theory. It also has the distinction of identifying the ethical principles underlying nurses' moral norm and intention. © The Author(s) 2014.

Practice and payment preferences of newly practising family physicians in British Columbia

PubMed Central

Brcic, Vanessa; McGregor, Margaret J.; Kaczorowski, Janusz; Dharamsi, Shafik; Verma, Serena

2012-01-01

Abstract Objective To examine the remuneration model preferences of newly practising family physicians. Design Mixed-methods study comprising a cross-sectional, Web-based survey, as well as qualitative content analysis of answers to open-ended questions. Setting British Columbia. Participants University of British Columbia family practice residents who graduated between 2000 and 2009. Main outcome measures Preferred remuneration models of newly practising physicians. Results The survey response rate was 31% (133 of 430). Of respondents, 71% (93 of 132) preferred non–fee-for-service practice models and 86% (110 of 132) identified the payment model as very or somewhat important in their choice of future practice. Three principal themes were identified from content analysis of respondents’ open-ended comments: frustrations with fee-for-service billing, which encompassed issues related to aggravations with “the business side of things” and was seen as impeding “the freedom to focus on medicine”; quality of patient care, which embraced the importance of a payment model that supported “comprehensive patient care” and “quality rather than quantity”; and freedom to choose, which supported the plurality of practice preferences among providers who strived to provide quality care for patients, “whatever model you happen to be working in.” Conclusion Newly practising physicians in British Columbia preferred alternatives to fee-for-service payment models, which were perceived as contributing to fewer frustrations with billing systems, improved quality of work life, and better quality of patient care. PMID:22586205

Factors influencing palliative care. Qualitative study of family physicians' practices.

PubMed Central

Brown, J. B.; Sangster, M.; Swift, J.

1998-01-01

OBJECTIVE: To examine factors that influence family physicians' decisions to practise palliative care. DESIGN: Qualitative method of in-depth interviews. SETTING: Southwestern Ontario. PARTICIPANTS: Family physicians who practise palliative care on a full-time basis, who practise on a part-time basis, or who have retired from active involvement in palliative care. METHOD: Eleven in-depth interviews were conducted to explore factors that influence family physicians' decisions to practise palliative care and factors that sustain their interest in palliative care. All interviews were audiotaped and transcribed verbatim. The analysis strategy used a phenomenological approach and occurred concurrently rather than sequentially. All interview transcriptions were read independently by the researchers, who then compared and combined their analyses. Final analysis involved examining all interviews collectively, thus permitting relationships between and among central themes to emerge. MAIN OUTCOME FINDINGS: The overriding theme was a common philosophy of palliative care focusing on acceptance of death, whole person care, compassion, communication, and teamwork. Participants' philosophies were shaped by their education and by professional and personal experiences. In addition, participants articulated personal and systemic factors currently affecting their practice of palliative care. CONCLUSIONS: Participants observed that primary care physicians should be responsible for their patients' palliative care within the context of interdisciplinary teams. For medical students to be knowledgeable and sensitive to the needs of dying patients, palliative care should be given higher priority in the curriculum. Finally, participants argued compellingly for transferring the philosophy of palliative care to the overall practice of medicine. PMID:9612588

UK-trained junior doctors' intentions to work in UK medicine: questionnaire surveys, three years after graduation.

PubMed

Surman, Geraldine; Goldacre, Michael J; Lambert, Trevor W

2017-12-01

Objective To report on the career intentions, three years after qualification, of 12 national cohorts of UK-trained doctors who qualified between 1974 and 2012, and, specifically, to compare recent UK medical graduates' intentions to work in medicine in the UK with earlier graduates. Design Questionnaire surveys of cohorts of UK medical graduates defined by year of graduation. Setting UK. Participants 30,272 UK medical graduates. Main outcome measures Stated level of intention to pursue a long-term career in medicine in the UK. Results The response rate was 62% (30,272/48,927). We examined responses to the question ' Apart from temporary visits abroad, do you intend to practise medicine in the United Kingdom for the foreseeable future?' Of doctors from UK homes, 90% had specified that they would 'definitely or probably' practise medicine in the UK in the surveys of 1977-1986, 81% in 1996-2011 and 64% in 2015. Those who said that they would probably or definitely not practise medicine in the UK comprised 5% in 1977-1986, 8% in 1996-2011 and 15% in 2015. Most who were not definite about a future career in UK medicine indicated that they would wish to practise medicine outside the UK rather than to leave medicine. Conclusions The wish to remain in UK medical practice in the 2015 survey was unprecedentedly low in this unique series of 40 years of surveys.

Nursing work in NHS Direct: constructing a nursing identity in the call-centre environment.

PubMed

Snelgrove, Sherrill Ray

2009-12-01

The introduction of nurse-led telephone helplines for patients to have access to information and advice has led to the development of a new kind of practise for nurses. This study focuses on the ways NHS Direct (NHSD) nurses construct a nursing identity and shape their work in a call-centre environment. The empirical findings are drawn from a study investigating the impact of NHSD on professional nursing issues that was part of a wider evaluation of the service in South Wales, UK. Data were gathered from responses to free text questions included in a questionnaire sent to nurses in three NHSD sites. Further data were collected from focus groups held with NHSD nurses. The nurses defend their identity as nurses rather than call-centre workers. The discourses of the nurses show a strong alignment with the traditional values of nursing, encompassing holistic and empathetic practise that has moved with the nurses across locales. We argue that the nurses frame a nursing identity in NHSD around the importance of previous experience and claim to practise holistic nursing. However, the development of new skills and adaptation of old skills in response to the demand of NHSD work challenges normative notions of traditional 'hands-on' models of practise and indicates a possible movement towards a cognitive model of nursing based upon knowledge, analytical and communication skills that reflects the transformative and dynamic nature of professional identity and boundaries.

Nurse leaders as stewards at the point of service.

PubMed

Murphy, Norma; Roberts, Deborah

2008-03-01

Nurse leaders, including clinical nurse educators, who exercise stewardship at the point of service, may facilitate practising nurses' articulation of their shared value priorities, including respect for persons' dignity and self-determination, as well as equity and fairness. A steward preserves and promotes what is intrinsically valuable in an experience. Theories of virtue ethics and discourse ethics supply contexts for clinical nurse educators to clarify how they may facilitate nurses' articulation of their shared value priorities through particularism and universalism, as well as how they may safeguard nurses' self-interpretation and discursive reasoning. Together, clinical nurse educators and nurses may contribute to management decisions that affect the point of service, and thus the health care organization.

Quality improvement with the new general practitioner contract - myth or reality?

PubMed

Lovett, John; Curry, Adrienne

2007-05-01

The introduction of the new general practitioner (GP) contract has been a significant development in the management of primary care and requires a number of changes to be made to the way things are done. This paper provides an initial evaluation of the impacts of the new contract from the perspective of practising GPs in the Greater Glasgow area of Scotland. Its impact is assessed using Ovretveit's three dimensions of quality: professional, client and managerial quality. Some of the changes have proved so far to have positive effects and some may prove to be increasingly negative if appropriate amendments to the contract are not realized. There are some noteworthy implications for policy here.

A virtual reality based simulator for learning nasogastric tube placement.

PubMed

Choi, Kup-Sze; He, Xuejian; Chiang, Vico Chung-Lim; Deng, Zhaohong

2015-02-01

Nasogastric tube (NGT) placement is a common clinical procedure where a plastic tube is inserted into the stomach through the nostril for feeding or drainage. However, the placement is a blind process in which the tube may be mistakenly inserted into other locations, leading to unexpected complications or fatal incidents. The placement techniques are conventionally acquired by practising on unrealistic rubber mannequins or on humans. In this paper, a virtual reality based training simulation system is proposed to facilitate the training of NGT placement. It focuses on the simulation of tube insertion and the rendering of the feedback forces with a haptic device. A hybrid force model is developed to compute the forces analytically or numerically under different conditions, including the situations when the patient is swallowing or when the tube is buckled at the nostril. To ensure real-time interactive simulations, an offline simulation approach is adopted to obtain the relationship between the insertion depth and insertion force using a non-linear finite element method. The offline dataset is then used to generate real-time feedback forces by interpolation. The virtual training process is logged quantitatively with metrics that can be used for assessing objective performance and tracking progress. The system has been evaluated by nursing professionals. They found that the haptic feeling produced by the simulated forces is similar to their experience during real NGT insertion. The proposed system provides a new educational tool to enhance conventional training in NGT placement. Copyright © 2014 Elsevier Ltd. All rights reserved.

The perils of working abroad.

PubMed

Lockhart-Mirams, A R

1991-05-25

There may come a time in a dentist's life when thoughts turn to the possibility of working abroad. We have all heard of those who have successfully practised abroad, with large financial incomes and spectacular lifestyles. But are these stories accurate, and what is it really like to work and live abroad? This article will endeavour to reveal some of the realities, and to examine the position of a dentist who wants to practise abroad using Germany as a particular example, on the basis that Germany is the most common target country for emigration.

Pharmacists' self-perceptions in relation to the 'Advanced Pharmacy Practice Framework'.

PubMed

Ali, A S; Fejzic, J; Grant, G D; Nissen, L M

2016-01-01

The Australian Pharmacy Practice Framework was developed by the Advanced Pharmacy Practice Steering Committee and endorsed by the Pharmacy Board of Australia in October 2012. The Steering Committee conducted a study that found practice portfolios to be the preferred method to assess and credential Advanced Pharmacy Practitioner, which is currently being piloted by the Australian Pharmacy Council. Credentialing is predicted to open to all pharmacists practising in Australia by November 2015. To explore how Australian pharmacists self-perceived being advanced in practice and how they related their level of practice to the Australian Advanced Pharmacy Practice Framework. This was an explorative, cross-sectional study with mixed methods analysis. Advanced Pharmacy Practice Framework, a review of the recent explorative study on Advanced Practice conducted by the Advanced Pharmacy Practice Framework Steering Committee and semi-structured interviews (n = 10) were utilized to create, refine and pilot the questionnaire. The questionnaire was advertised across pharmacy-organizational websites via a purposive sampling method. The target population were pharmacists currently registered in Australia. Seventy-two participants responded to the questionnaire. The participants were mostly female (56.9%) and in the 30-40 age group (26.4%). The pharmacists self-perceived their levels of practice as either entry, transition, consolidation or advanced, with the majority selecting the consolidation level (38.9%). Although nearly half (43.1%) of the participants had not seen the Framework beforehand, they defined Advanced Pharmacy Practice similarly to the definition outlined in the Framework, but also added specialization as a requirement. Pharmacists explained why they were practising at their level of practice, stating that not having more years of practice, lacking experience, or postgraduate/post-registration qualifications, and more involvement and recognition in practice were the main reasons for not considering themselves as an Advanced Pharmacy Practitioner. To be considered advanced by the Framework, pharmacists would need to fulfill at least 70% of the Advanced Practice competency standards at an advanced level. More than half of the pharmacists (64.7%) that self-perceived as being advanced managed to fulfill 70% or more of these Advanced Practice competency standards at the advanced level. However, none of the self-perceived entry level pharmacists managed to match at least 70% of the competencies at the entry level. Participants' self-perception of the term Advanced Practice was similar to the definition in the Advanced Pharmacy Practice Framework. Pharmacists working at an advanced level were largely able to demonstrate and justify their reasons for being advanced practitioners. However, pharmacists practising at the other levels of practice (entry, transition, consolidation) require further guidance regarding their advancement in practice. Copyright © 2016 Elsevier Inc. All rights reserved.

Inappropriate sexual behaviours of patients towards practising physiotherapists: a study using qualitative methods.

PubMed

O'Sullivan, V; Weerakoon, P

1999-01-01

Recent research recognizes the occurrence of inappropriate sexual behaviour (ISB) by patients towards health professionals. The objective of this study was to explore in-depth the clinical context and effect of incidents of ISB towards practising physiotherapists. In-depth interviews were conducted with a sub-sample of nine physiotherapists who were part of a larger survey on ISB. Quantitative analyses of the survey responses are reported elsewhere. Interview participants were asked to describe an incident of ISB by a patient that was either perceived to be the worst or was the most recent. They were asked questions on a variety of themes, such as their relationship with the patient prior to incident, the effects of the incident, the strategies used to deal with the incident, and changes in practice as a result of the incident. All interview participants reported encountering some level of ISB from patients. Although the overall frequency of these behaviours was relatively low, the range of behaviours was diverse. Regardless of the perceived severity of the incident, only four participants labelled their experience as 'sexual harassment'. Many reported negative effects on work performance. Participants mainly used physical measures to prevent further incidents, rather than confronting the perpetrator or reporting the incident. The findings are discussed in the context of theory pertaining to boundaries and issues of transference and counter-transference. This emphasized the need for effective communication skills training of both undergraduate and graduate physiotherapists in the prevention and management of ISB from patients.

Lay and health care professional understandings of self-management: A systematic review and narrative synthesis

PubMed Central

Wolfe, Charles DA; McKevitt, Christopher

2014-01-01

Objectives: Self-management is widely promoted but evidence of effectiveness is limited. Policy encourages health care professionals to support people with long-term conditions to learn self-management skills, yet little is known about the extent to which both parties share a common understanding of self-management. Thus, we compared health care professional and lay understandings of self-management of long-term conditions. Methods: Systematic review and narrative synthesis of qualitative studies identified from relevant electronic databases, hand-searching of references lists, citation tracking and recommendations by experts. Results: In total, 55 studies were included and quality was assessed using a brief quality assessment tool. Three conceptual themes, each with two subthemes were generated: traditional and shifting models of the professional–patient relationship (self-management as a tool to promote compliance; different expectations of responsibility); quality of relationship between health care professional and lay person (self-management as a collaborative partnership; self-management as tailored support) and putting self-management into everyday practice (the lived experience of self-management; self-management as a social practice). Conclusion: Self-management was conceptualised by health care professionals as incorporating both a biomedical model of compliance and individual responsibility. Lay people understood self-management in wider terms, reflecting biomedical, psychological and social domains and different expectations of responsibility. In different ways, both deviated from the dominant model of self-management underpinned by the concept of self-efficacy. Different understandings help to explain how self-management is practised and may help to account for limited evidence of effectiveness of self-management interventions. PMID:26770733

The development and evaluation of a medical imaging training immersive environment

PubMed Central

Bridge, Pete; Gunn, Therese; Kastanis, Lazaros; Pack, Darren; Rowntree, Pamela; Starkey, Debbie; Mahoney, Gaynor; Berry, Clare; Braithwaite, Vicki; Wilson-Stewart, Kelly

2014-01-01

Introduction A novel realistic 3D virtual reality (VR) application has been developed to allow medical imaging students at Queensland University of Technology to practice radiographic techniques independently outside the usual radiography laboratory. Methods A flexible agile development methodology was used to create the software rapidly and effectively. A 3D gaming environment and realistic models were used to engender presence in the software while tutor-determined gold standards enabled students to compare their performance and learn in a problem-based learning pedagogy. Results Students reported high levels of satisfaction and perceived value and the software enabled up to 40 concurrent users to prepare for clinical practice. Student feedback also indicated that they found 3D to be of limited value in the desktop version compared to the usual 2D approach. A randomised comparison between groups receiving software-based and traditional practice measured performance in a formative role play with real equipment. The results of this work indicated superior performance with the equipment for the VR trained students (P = 0.0366) and confirmed the value of VR for enhancing 3D equipment-based problem-solving skills. Conclusions Students practising projection techniques virtually performed better at role play assessments than students practising in a traditional radiography laboratory only. The application particularly helped with 3D equipment configuration, suggesting that teaching 3D problem solving is an ideal use of such medical equipment simulators. Ongoing development work aims to establish the role of VR software in preparing students for clinical practice with a range of medical imaging equipment. PMID:26229652

The nature and structure of supervision in health visiting with victims of child sexual abuse.

PubMed

Scott, L

1999-03-01

Part of a higher research degree to explore professional practice. To explore how health visitors work with victims of child sexual abuse and the supervision systems to support them. To seek the views and experiences of practising health visitors relating to complex care in order to consider the nature and structure of supervision. The research reported in this paper used a qualitative method of research and semi-structured interviews with practising health visitors of varying levels of experience in venues around England. Qualitative research enabled the exploration of experiences. Identification of the need for regular, structured, accountable opportunities in a 'private setting' to discuss whole caseload work and current practice issues. Supervision requires a structured, formalized process, in both regularity and content, as a means to explore and acknowledge work with increasingly complex care, to enable full discussion of whole caseloads. Supervision is demonstrated as a vehicle to enable the sharing of good practices and for weak practices to be identified and managed appropriately. Supervision seeks to fulfil the above whilst promoting a stimulating, learning experience, accommodating the notion that individuals learn at their own pace and bring a wealth of human experience to the service. The size of the study was dictated by the amount of time available within which to complete a research master's degree course primarily in the author's own time, over a 2-year period. The majority of participants volunteered their accounts in their own time. For others I obtained permission from their employers for them to participate once they approached me with an interest in being interviewed. This research provides a model of supervision based on practitioner views and experiences. The article highlights the value of research and evidence-based information to enhance practice accountability and the quality of care. Proactive risk management can safeguard the health and safety of the public, the practitioner and the organization.

Doctors' experiences and their perception of the most stressful aspects of complaints processes in the UK: an analysis of qualitative survey data

PubMed Central

Bourne, Tom; Vanderhaegen, Joke; Vranken, Renilt; Wynants, Laure; De Cock, Bavo; Peters, Mike; Timmerman, Dirk; Van Calster, Ben; Jalmbrant, Maria; Van Audenhove, Chantal

2016-01-01

Objectives To examine doctors' experiences of complaints, including which aspects are most stressful. We also investigated how doctors felt complaints processes could be improved. Design and methods A qualitative study based on a cross-sectional survey of members of the British Medical Association (BMA). We asked the following: (1) Try to summarise as best as you can your experience of the complaints process and how it made you feel. (2) What were the most stressful aspects of the complaint? (3) What would you improve in the complaints system? Participants We sent the survey to 95 636 doctors, and received 10 930 (11.4%) responses. Of these, 6146 had a previous, recent or current complaint and 3417 (31.3%) of these respondents answered questions 1 and 2. We randomly selected 1000 answers for analysis, and included 100 using the saturation principle. Of this cohort, 93 responses for question 3 were available. Main results Doctors frequently reported feeling powerless, emotionally distressed, and experiencing negative feelings towards both those managing complaints and the complainants themselves. Many felt unsupported, fearful of the consequences and that the complaint was unfair. The most stressful aspects were the prolonged duration and unpredictability of procedures, managerial incompetence, poor communication and perceiving that processes are biased in favour of complainants. Many reported practising defensively or considering changing career after a complaint, and few found any positive outcomes from complaints investigations. Physicians suggested procedures should be more transparent, competently managed, time limited, and that there should be an open dialogue with complainants and policies for dealing with vexatious complaints. Some felt more support for doctors was needed. Conclusions Complaints seriously impact on doctors' psychological wellbeing, and are associated with defensive practise. This is not beneficial to patient care. To improve procedures, doctors propose they are simplified, time limited and more transparent. PMID:27377638

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

Morgan, Richard K., E-mail: rkm@geography.otago.ac.nz; Hart, Andrew; Freeman, Claire, E-mail: cf@geography.otago.ac.nz

The very nature of impact assessment (IA) means that it often involves practitioners from a very wide range of disciplinary and professional backgrounds, which open the possibility that how IA is perceived and practised may vary according to the professional background of the practitioner. The purpose of this study is to investigate the extent to which a practitioner's professional background influences their perceptions of the adequacy of impact assessment in New Zealand under the Resource Management Act (RMA). Information gathered concerned professional affiliations, training, understanding of impact assessment practise, and perceptions of adequacy in relation to impact assessment. The resultsmore » showed a dominance of a legalistic, operational perspective of impact assessment under the Resource Management Act, across all the main professions represented in the study. However, among preparers of impact assessments there was clear evidence of differences between the four main professional groups - surveyors, planners, engineers and natural scientists - in the way they see the nature and purpose of impact assessment, the practical steps involved, and what constitutes adequacy. Similarly, impact assessment reviewers - predominantly planners and lawyers - showed variations in their expectations of impact assessment depending on their respective professional affiliation. Although in many cases the differences seem to be more of a matter of emphasis, rather than major disputes on what constitutes a good process, even those differences can add up to rather distinct professional cultures of impact assessment. The following factors are seen as leading to the emergence of such professional cultures: different professions often contribute in different ways to an impact assessment, affecting their perception of the nature and purpose of the process; impact assessment training will usually be a secondary concern, compared with the core professional training, which will be reflected in the depth and length of such training; and any impact assessment training provided within a profession will often have the 'cultural' imprint of that profession.« less

Unsafe sexual behaviour in domestic and foreign migrant male workers in multinational workplaces in Jordan: occupational-based and behavioural assessment survey.

PubMed

Al Rifai, Rami; Nakamura, Keiko; Seino, Kaoruko; Kizuki, Masashi; Morita, Ayako

2015-06-11

To examine the prevalence of unsafe sexual behaviour, sexually transmitted infection (STI)-related knowledge, health and work-related conditions, and correlates of practising unsafe sex among domestic and foreign male workers in multinational workplaces in Jordan. Cross-sectional behavioural assessment survey. Multinational workplaces in Jordan. 230 Jordanian and 480 foreign male workers aged ≥ 18 years who had worked in a Qualified Industrial Zone (QIZ) for 12 months or more. The primary outcome was the prevalence of practising unsafe sex. 'Unsafe sex' was defined as sex with a non-regular sexual partner with inconsistent condom usage. Overall, 74.3% of workers reported lifetime sexual experience. The proportion of lifetime unsafe sex was similar among domestic (31.8%) and foreign (35.6%) workers. Of those, 59.2% of domestic and 68.1% of foreign workers started practising unsafe sex after joining the QIZ. Rates of lifetime unsafe sex were significantly higher among those who had their sexual debut after joining the QIZ in domestic (aOR, 2.2, 95% CI 1.1 to 4.4) and foreign workers (aOR, 2.4, 95% CI 1.4 to 4.1). Among the domestic workers, being 18-24 years old (aOR, 4.9), unmarried (aOR, 4.8), working in the QIZ for 5-8 years (aOR, 5.0), sometimes/frequently shopped with foreign workers (aOR, 2.1) or were current/ex-alcohol drinkers (aORs, 3.4) were independently significantly associated with higher odds of practising unsafe sex. A significant proportion of domestic and foreign male workers had been practising unsafe sex. The findings indicated that not only foreigners but also domestic male workers associating with foreign workers are at high risk of unsafe sex. Tailored interventions to promote safer sex in multinational workplaces in Jordan are needed. 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.

The interaction between research and practice: a pan-European approach to managing H.pylori infection in primary care.

PubMed

Hungin, A P

2000-08-01

The transposition of evidence into clinical care presents many challenges. New knowledge may be immediately translatable to the practice setting, with barriers to be overcome before implementation. The early guidelines on Helicobacter pylori management presented an overview but were not able to take into account local factors and health care traditions, such as the non-availability of tests and established primary-secondary care relationships. Primary care is a specific specialty across most of Europe, existing within different health care systems and clinical traditions. The creation of H. pylori management guidelines, aimed at European primary care but adaptable to local national circumstances, presented a challenge in methodology and formulation. The process exposed similarities but also tensions between differing health care systems, as well as variations in the conditions in which GPs practise. Clinical differences, such as varying ulcer prevalence and drug resistance rates, highlighted the importance of guidelines being adaptable. This paper analyses the European Society for Primary Care Gastroenterology process of pan-European primary care agreement towards H.pylori management and how diverse views, traditions and national settings were reconciled through an evidence-based approach.

Equine metabolic syndrome

PubMed Central

Morgan, R.; Keen, J.; McGowan, C.

2015-01-01

Laminitis is one of the most common and frustrating clinical presentations in equine practice. While the principles of treatment for laminitis have not changed for several decades, there have been some important paradigm shifts in our understanding of laminitis. Most importantly, it is essential to consider laminitis as a clinical sign of disease and not as a disease in its own right. Once this shift in thinking has occurred, it is logical to then question what disease caused the laminitis. More than 90 per cent of horses presented with laminitis as their primary clinical sign will have developed it as a consequence of endocrine disease; most commonly equine metabolic syndrome (EMS). Given the fact that many horses will have painful protracted and/or chronic recurrent disease, a good understanding of the predisposing factors and how to diagnose and manage them is crucial. Current evidence suggests that early diagnosis and effective management of EMS should be a key aim for practising veterinary surgeons to prevent the devastating consequences of laminitis. This review will focus on EMS, its diagnosis and management. PMID:26273009

Aged over 50 years and practising: separation and changes in nursing practice among New Zealand's older Registered Nurses.

PubMed

North, Nicola; Leung, William; Lee, Rochelle

2014-12-01

To describe temporary and permanent separation patterns and changes in nursing practice over 5 years, for the 2006 cohort of nurses aged ≥50 years in New Zealand. As ageing populations increase demand on nursing services, workforce projections need better information on work and retirement decision-making of large 'baby-boomer' cohorts. Retrospective cohort analysis using the Nursing Council of New Zealand administrative dataset. A cohort of all nurses aged ≥50 years on the register and practising in 2006 (n = 12,606) was tracked until 2011. After 5 years, a quarter (n = 3161) of the cohort (equivalent to 8·4% of all 2006 practising nurses) was no longer practising. There were no significant differences in permanent separation rates between the ages of 50-58; between 18-54% of annual separations re-entered the workforce. On re-entry, 56% returned to the same clinical area. Annual separations from the workforce declined sharply during the global financial crisis and more of those leaving re-entered the workforce. In 2006, half the cohort worked in hospitals. After 5 years, the number of cohort nurses working in hospitals fell by 45%, while those in community settings increased by 12%. Over 5 years, weekly nursing practice hours declined significantly for every age-band. To retain the experience of older nurses for longer, workforce strategies need to take account of patterns of leaving and re-entering the workforce, preferences for work hours and the differences between the sub-groups across employment settings and practice areas. © 2014 John Wiley & Sons Ltd.

Current practice patterns and training status of selected graduates at the King Abdulaziz University College of Medicine, Saudi Arabia.

PubMed

Mira, S A; Fatani, H H; Abduljabbar, H S; Scott, C S; Strand, D A

1991-01-01

Graduate doctors are the primary output of medical education programmes. It is important for institutions to identify systematically the types of medical activities in which their former students are involved in order to determine the effectiveness of the curriculum, assessing academic standards and reviewing admissions policies. Information was obtained from a survey of men and women graduates from three of the early graduation classes of King Abdulaziz University College of Medicine in Saudi Arabia about postgraduate medical training, certification, practice patterns, and other curriculum issues. Information collected from 151 graduates (90%) indicated that 96% were practising medicine in a variety of medical specialties and subspecialties. Six were not practising at the time of the study. Significant differences were found in the specialties being practised when men and women were compared. Men tended to practise in medicine, surgery, dermatology, urology, ENT, ophthalmology and orthopaedics, while women concentrated in obstetrics and gynaecology and paediatrics. Certification beyond medical school was earned by 49% with no significant difference being found comparing men to women. Men earned the majority of their postgraduate certifications outside Saudi Arabia while most women earned theirs in Saudi Arabia. Graduates indicated that departments in the basic sciences were least helpful in preparing them as doctors, while selected clinical departments were most helpful. It was concluded from the study that the curriculum goals of the College of Medicine, namely a curriculum of international standards producing graduates to take leadership roles in both teaching and medical practice, were realized in part by the graduates surveyed.

Medical practice in rural Saskatchewan: factors in physician recruitment and retention.

PubMed

Wasko, Kevin; Jenkins, Jacqueline; Meili, Ryan

2014-01-01

The recruitment and retention of physicians in rural communities is a challenge throughout Canada and across the globe. In 1976, a group of medical students profiled rural communities with medical practices and produced a summary report entitled Medical Practice in Saskatchewan. Our objective was to repeat the 1976 study and to identify factors that motivate physicians to select rural locations for practice. Physicians practising in rural Saskatchewan were interviewed in 2011 and 2012. Through qualitative, inductive analysis, we identified themes that drove the recruitment and retention of physicians. Sixty-two physicians were interviewed and 105 communities profiled. Of the physicians interviewed, 21 noted that the ability to practise full-scope family medicine and having the freedom to practise as they desire was important for recruitment, and 43 reported that these factors influenced their decision to remain in a community. Attraction to a rural lifestyle (cited by 17 physicians), having a rural background (13) and having ties to a specific community (12) were important for recruitment. Feeling appreciated by patients (45), one's spouse and/or family enjoying the community (41), and integration into the community (38) were important factors for retention. The decision to practise in a rural location correlates with a desire for a broad and varied scope of practice, being attracted to a rural lifestyle and having rural roots. Once physicians establish a rural practice, they are more likely to stay if they can continue a broad scope of practice, if they feel appreciated by their patients, and if their spouses and family are happy in the community.

Exploring family physicians' reasons to continue or discontinue providing intrapartum care: Qualitative descriptive study.

PubMed

Dove, Marion; Dogba, Maman Joyce; Rodríguez, Charo

2017-08-01

To examine the reasons why family physicians continue or discontinue providing intrapartum care in their clinical practice. Qualitative descriptive study. Two hospitals located in a multicultural area of Montreal, Que, in November 2011 to June 2012. Sixteen family physicians who were current or former providers of obstetric care. Data were collected using semistructured qualitative interviews. Thematic analysis was used to analyze the interview transcripts. Three overarching themes that help create understanding of why family doctors continue to provide obstetric care were identified: their attraction, often initiated by role models early in their careers, to practising complete continuity of care and accompanying patients in a special moment in their lives; the personal, family, and organizational pressures experienced while pursuing a family medicine career that includes obstetrics; and their ongoing reflection about continuing to practise obstetrics. The practice of obstetrics was very attractive to family physician participants whether they provided intrapartum care or decided to stop. More professional support and incentives might help keep family doctors practising obstetrics. Copyright© the College of Family Physicians of Canada.

Factors Related to Continuation of Health Behaviours among Stroke Survivors

PubMed Central

Kudo, Makoto

2011-01-01

Abstract Purpose: This study investigated stroke survivors' perspectives of health behaviours after stroke. We aimed to explore the actual process by which stroke survivors changed their health behaviours. Method: Semi-structured interviews were conducted with 40 people in a 1-year prospective study in the regional city of Chiba, Japan. Interviews covered views of health behaviours in order to explore why patients change their risk factors. Data were analysed using the principles of modified grounded theory. Results: Six categories related to practising health behaviours were identified: cause of stroke, antithetic thinking, awareness of the body, fear of disease progression, view of health, and psychological meaning of practise. Stroke survivors constructed a meaning of practise for each health behaviour. The recognition of previous lifestyle as cause of stroke, hope for recovery, and fear of future progression influenced health behaviours. Conclusions: The key finding of this study is that when cognitive behavioural therapy principles are enforced, an important aspect is that stroke survivors recognize the possibility that previous lifestyle was a cause of stroke and appreciate the necessity of preventing a new stroke. PMID:25792892

Editor's Choice-The role of the emergency department in the management of acute heart failure: An international perspective on education and research.

PubMed

Pang, Peter S; Collins, Sean P; Miró, Òscar; Bueno, Hector; Diercks, Deborah B; Di Somma, Salvatore; Gray, Alasdair; Harjola, Veli-Pekka; Hollander, Judd E; Lambrinou, Ekaterini; Levy, Phillip D; Papa, AnnMarie; Möckel, Martin

2017-08-01

Emergency departments are a major entry point for the initial management of acute heart failure (AHF) patients throughout the world. The initial diagnosis, management and disposition - the decision to admit or discharge - of AHF patients in the emergency department has significant downstream implications. Misdiagnosis, under or overtreatment, or inappropriate admission may place patients at increased risk for adverse events, and add costs to the healthcare system. Despite the critical importance of initial management, data are sparse regarding the impact of early AHF treatment delivered in the emergency department compared to inpatient or chronic heart failure management. Unfortunately, outcomes remain poor, with nearly a third of patients dying or re-hospitalised within 3 months post-discharge. In the absence of robust research evidence, consensus is an important source of guidance for AHF care. Thus, we convened an international group of practising emergency physicians, cardiologists and advanced practice nurses with the following goals to improve outcomes for AHF patients who present to the emergency department or other acute care setting through: (a) a better understanding of the pathophysiology, presentation and management of the initial phase of AHF care; (b) improving initial management by addressing knowledge gaps between best practices and current practice through education and research; and (c) to establish a framework for future emergency department-based international education and research.

Are satisfaction with and self-management of personal assistance services associated with the life satisfaction of persons with physical disabilities?

PubMed

Fleming-Castaldy, Rita P

2011-01-01

To examine the relationships between satisfaction with and self-management of personal assistance services (PAS) and the quality of life (QoL) of persons with disabilities. To test the postulate that consumer-directed PAS can fulfil the human need for control and contribute to a satisfactory life. A survey compared the perspectives of persons using consumer-directed PAS versus those using agency-directed. A Personal Data Form obtained demographics and PAS characteristics. The Quality of Life Inventory measured life satisfaction. A PAS questionnaire measured perceptions about the management of, desire for control of, and satisfaction with PAS. Data were analysed using SPSS®- 14. Significant relationships were found between QoL and satisfaction with PAS (p < 0.001) and between perceived control of PAS and satisfaction with PAS (p < 0.001). Significant group differences were also found. Consumer-directed participants reported higher satisfaction with their PAS (p < 0.01), greater control over services (p < 0.001) and greater QoL than agency-directed participants, (p = 0.001). The relationships found between self-management, PAS satisfaction, and QoL support the value of consumer-directed programmes. Rehabilitation professionals can use this knowledge to develop, implement and research practises that enable self-management.

Leadership behaviours, organizational culture and intention to stay amongst Jordanian nurses.

PubMed

AbuAlRub, R F; Nasrallah, M A

2017-12-01

To investigate the impact of leadership behaviours of nurse managers and organizational culture on Jordanian nurses' intention to stay at work in public, private and university hospitals. Leadership behaviours of nurses and organizational culture are considered important factors in enhancing retention of nurses. A correlational design was used in the study. A sample of 285 Jordanian nurses was conveniently selected to complete a self-administered questionnaire that consisted of three measures; Kouzes and Posner's Leadership Practise Inventory, Professional Organizational Culture questionnaire and McCain's Intent to Stay Scale. Nurse managers' leadership behaviours and organizational culture were positively associated with the level of intention to stay at work. The study variables explained almost 43% of the variance in nurses' intention to stay at work. The limitation of the study was the use of convenience sampling method. The results asserted that transformational leadership styles of nurse managers enhance positive hospitals' culture as well as the intention of nurses to stay at work. Nurse executives should promote leadership behaviours of nurse managers through training. The regulatory bodies of nursing profession in collaboration with nurse educators and administrators should help in developing competencies for nurse managers that are based on transformational leadership and incorporate such competencies in nursing education programs as well as continuous education programs. © 2017 International Council of Nurses.

An experimental investigation into the extent social evaluation anxiety impairs performance in simulation-based learning environments amongst final-year undergraduate nursing students.

PubMed

Mills, Brennen; Carter, Owen; Rudd, Cobie; Claxton, Louise; O'Brien, Robert

2016-10-01

While numerous theoretical and conceptual models suggest social evaluation anxiety would likely influence performance in simulation-based learning environments, there has been surprisingly little research to investigate the extent to which this is true. Final-year Bachelor of Science (Nursing) students (N=70) were randomly assigned to complete one of three clinically identical simulation-based scenarios designed to elicit varying levels of social evaluation anxiety by manipulating the number of other people present with the student during the simulation (1, 2 or 3 others). Rises in acute stress were measured via continuous heart-rate and salivary cortisol. Performance scores were derived from the average of two independent raters' using a structured clinical checklist (/16). Statistically different increases were found within the first minute of the simulation between those students with one versus three other people in the room (+4.13 vs. +14.01beats-per-minute respectively, p=0.01) and salivary cortisol measures suggested significantly different changes in anxiety between these groups (-0.05 vs. +0.11μg/dL respectively, p=0.02). Independent assessments suggested students with only one other person accompanying them in the simulation significantly outperformed those accompanied by three others (12.95 vs. 10.67 respectively, p=0.03). Students accompanied by greater numbers during simulations experienced measurably greater anxiety and measurably poorer performances. These results demonstrate the ability to manipulate social evaluation anxiety within high-fidelity simulation training of undergraduates in order to help students better acclimatise to stressful events prior to practising in real clinical settings. Copyright © 2016 Elsevier Ltd. All rights reserved.

Using simulation to prepare for clinical practice.

PubMed

Morgan, James; Green, Victoria; Blair, John

2018-02-01

A significant proportion of medical students feel underprepared for clinical practice, especially in skills such as decision making, prioritisation and prescribing. Changes to medical curricula, including assistantships and shadowing, provide supervised practise, but students remain unable to fully take responsibility for patient care. Simulation may assist in addressing this deficit. A simulation course entitled 'Simulated ward round and professional skills' (SWAPS) was developed to improve student preparation for clinical practice. Preliminary work surveyed 22 foundation doctors to identify perceived areas of weakness and to guide the learning outcomes of the course. Following the design and development of the course, 133 final-year medical students were observed completing a 60-minute simulation scenario aimed at providing experiential learning in a ward environment, reflecting professional practice. Students received structured feedback and completed pre- and post-course questionnaires to evaluate changes in confidence over the learning domains. Qualitative feedback was also collected. A significant proportion of medical students feel underprepared for clinical practice RESULTS: The p values were significant in all assessed domains, indicating a perceived improvement in confidence following the SWAPS course. Qualitative feedback highlighted the perceived utility of the course in exposing students to clinical ward-based scenarios infrequently encountered in their medical curriculum. Students praised the personal feedback received and realism of the simulation. This paper contributes to the growing body of literature supporting the use of simulation to replicate a ward round and the daily roles of a junior doctor. The SWAPS course seems to empower students to take responsibility for clinical decision making and experience some of the realities of foundation training in a simulated setting. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Simulation and mitigation of higher-order ionospheric errors in PPP

NASA Astrophysics Data System (ADS)

Zus, Florian; Deng, Zhiguo; Wickert, Jens

2017-04-01

We developed a rapid and precise algorithm to compute ionospheric phase advances in a realistic electron density field. The electron density field is derived from a plasmaspheric extension of the International Reference Ionosphere (Gulyaeva and Bilitza, 2012) and the magnetic field stems from the International Geomagnetic Reference Field. For specific station locations, elevation and azimuth angles the ionospheric phase advances are stored in a look-up table. The higher-order ionospheric residuals are computed by forming the standard linear combination of the ionospheric phase advances. In a simulation study we examine how the higher-order ionospheric residuals leak into estimated station coordinates, clocks, zenith delays and tropospheric gradients in precise point positioning. The simulation study includes a few hundred globally distributed stations and covers the time period 1990-2015. We take a close look on the estimated zenith delays and tropospheric gradients as they are considered a data source for meteorological and climate related research. We also show how the by product of this simulation study, the look-up tables, can be used to mitigate higher-order ionospheric errors in practise. Gulyaeva, T.L., and Bilitza, D. Towards ISO Standard Earth Ionosphere and Plasmasphere Model. In: New Developments in the Standard Model, edited by R.J. Larsen, pp. 1-39, NOVA, Hauppauge, New York, 2012, available at https://www.novapublishers.com/catalog/product_info.php?products_id=35812

Educating about female genital mutilation.

PubMed

Holmes, Victoria; Farrington, Rebecca; Mulongo, Peggy

2017-01-01

Female genital mutilation (FGM) is illegal in the UK but nevertheless practised in some immigrant communities. Effective educational approaches are required to inform policy and to direct resources, often in the voluntary sector. The opinions in this article arise from discussions with professionals and members of FGM-practising communities. We highlight the importance of sharing experiences and expertise across health and social care professionals as well as working in partnership with culturally sensitive Non-Governmental Organisations. Enlisting the support of men and religious leaders is crucial to breaking down barriers in male-dominated communities and dispelling myths about FGM being a 'requirement' of faith.

[The changing picture of practicing dentistry].

PubMed

Hokwerda, O

2006-03-01

Originally, dentists were particularly technical and curative practitioners. Nowadays, patient care is brought into focus, directed at maintaining oral health permanently by prevention and necessary curative treatments as a contribution to general health and well-being. The changing picture of praccising does not develop as a matter-of-course since many factors have an effect on dental practice. Effecting factors are: content concerning developments, technological advancements, legislation, government policies, organizational aspects, and typical characteristics of dental practitioners. The changing picture of practising dentistry is connected with uncertainty, proves to be hard to control, and some adjustments occur around practising.

Torsion of Abdominal Organs in Sows: A Report of 36 Cases

PubMed Central

Morin, M.; Sauvageau, R.; Phaneuf, J.-B.; Teuscher, E.; Beauregard, M.; Lagacé, A.

1984-01-01

Necropsy records of 36 sows with torsion of abdominal organs involving individually the stomach, the spleen, a liver lobe or the intestine were reviewed for the years 1970 to 1983, and the age, the clinical signs and the gross lesions were recorded. These acute abdominal accidents were characterized clinically by sudden death. Dry sows from large breeding units were affected. Twenty-six cases were diagnosed between January 1981 and December 1983 while only ten cases had been seen between 1970 and 1980. Gastric torsion was the most common condition (40% of the cases) and the other three conditions were equally represented (20% each). Management practises that could be responsible for the apparent increase in occurrence of this problem are discussed. PMID:17422483

Maritime Archaeology in Uruguay: Towards a Manifesto

NASA Astrophysics Data System (ADS)

Herrera, Jorge Manuel; Buffa, Valerio; Cordero, Alejo; Francia, Gabriel; Adams, Jonathan

2010-10-01

We report a collaborative maritime archaeological project in Uruguay, one of several Latin American countries where the subject is undergoing review in terms of the ways it is practised and managed. Uruguay is typical of many states where there has been a tension between a heritage-based approach in which the results of investigations are viewed as publicly owned, as opposed to the profit motive in which commercial and personal gain is the underlying ethic. This project was conceived both as a way of assisting the Uruguayan Heritage Commission in promoting the former approach as well as advancing a programme of research into the age of global exploration. This paper sets out the rationale of the initial field season and reflects on subsequent developments.

Modelling the future distribution of ammonium nitrate concentrations in The Netherlands for 2020: The sensitivity to meteorological parameters

NASA Astrophysics Data System (ADS)

Williams, J. E.; van der Swaluw, E.; de Vries, W. J.; Sauter, F. J.; van Pul, W. A. J.; Hoogerbrugge, R.

2015-08-01

We present a parameterization developed to simulate Ammonium particle (NH4+) concentrations in the Operational Priority Substances (OPS) source-receptor model, without the necessity of using a detailed chemical scheme. By using the ratios of the main pre-cursor gases SO2, NO2 and NH3, and utilising calculations performed using a chemical box-model, we show that the parameterization can simulate annual mean NH4+ concentration fields to within ∼15% of measured values at locations throughout the Netherlands. Performing simulations for different decades, we find a strong correlation of simulated NH4+ distributions for both past (1993-1995) and present (2009-2012) time periods. Although the total concentration of NH4+ has decreased over the period, we find that the fraction of NH4+ transported into the Netherlands has increased from around 40% in the past to 50% for present-day. This is due to the variable efficiency of mitigation practises across economic sectors. Performing simulations for the year 2020 using associated emission estimates, we show that there are generally decreases of ∼8-25% compared to present day concentrations. By altering the meteorological fields applied in the future simulations, we show that a significant uncertainty of between ∼50 and 100% exists on this estimated NH4+ distribution as a result of variability in the temperature dependent emission terms and relative humidity. Therefore, any projections of future NH4+ distributions should be performed using well chosen meteorological fields representing recent meteorological situations.

Bilateral blindness following anterior nasal packing in a case of nasopharyngeal angiofibroma.

PubMed

Sahoo, A K; Preetam, C; Kumar, R; Samal, D K

2016-11-01

Epistaxis is the most common ENT emergency encountered in the Emergency Department. Most cases can be managed by simple anterior nasal packing. This is usually a safe and very effective option in an emergency situation, requiring minimal expertise and infrastructure. This paper describes a rare instance of a serious complication following anterior nasal packing in a case of nasopharyngeal angiofibroma. A 27-year-old man diagnosed with nasopharyngeal angiofibroma presented to the Emergency Department with bilateral epistaxis. The patient was stabilised and anterior nasal packing was performed, which controlled the bleeding. Three hours later, the patient developed complete blindness in both eyes. Aggressive medical management was initiated immediately, but failed to restore the patient's vision. Anterior nasal packing is a simple and minimally invasive procedure practised regularly in an Emergency Department setting. However, it can occasionally lead to serious complications such as blindness. Thus, obtaining informed consent is essential to avoid medico-legal consequences in high-risk cases.

Strawberries from integrated pest management and organic farming: phenolic composition and antioxidant properties.

PubMed

Fernandes, Virgínia C; Domingues, Valentina F; de Freitas, Victor; Delerue-Matos, Cristina; Mateus, Nuno

2012-10-15

Consumer awareness, pesticide and fertilizer contaminations and environmental concerns have resulted in significant demand for organically grown farm produce. Consumption of berries has become popular among health-conscious consumers due to the high levels of valuable antioxidants, such as anthocyanins and other phenolic compounds. The present study evaluated the influence that organic farming (OF) and integrated pest management (IPM) practise exert on the total phenolic content in 22 strawberry samples from four varieties. Postharvest performance of OF and IPM strawberries grown in the same area in the centre of Portugal and harvested at the same maturity stage were compared. Chemical profiles (phenolic compounds) were determined with the aid of HPLC-DAD/MS. Total phenolic content was higher for OF strawberry extracts. This study showed that the main differences in bioactive phytochemicals between organically and IPM grown strawberries concerned their anthocyanin levels. Organically grown strawberries were significantly higher in antioxidant activity than were the IPM strawberries, as measured by DPPH and FRAP assays. Copyright © 2012 Elsevier Ltd. All rights reserved.

A Short History of Sonography in Obstetrics and Gynaecology

PubMed Central

Campbell, S.

2013-01-01

The history of sonography in Obstetrics and Gynaecology dates from the classic 1958 Lancet paper of Ian Donald and his team from Glasgow. Fifty years on it is impossible to conceive of practising Obstetrics and Gynaecology without one of the many forms of ultrasound available today. Technological developments such as solid state circuitry, real time imaging, colour and power Doppler, transvaginal sonography and 3/4D imaging have been seized by clinical researchers to enhance the investigation and management of patients in areas as diverse as assessment of fetal growth and wellbeing, screening for fetal anomalies, prediction of pre-eclampsia and preterm birth, detection of ectopic gestation, evaluation of pelvic masses, screening for ovarian cancer and fertility management. Ultrasound guided procedures are now essential components of fetal therapy and IVF treatment. This concise history is written by someone who has witnessed each of these advances throughout the ultrasound era and is able to give perspective to these momentous happenings. PMID:24753947

LGBTQ+ Latinx young adults' health autonomy in resisting cultural stigma.

PubMed

Schmitz, Rachel M; Sanchez, Julissa; Lopez, Bianca

2018-03-20

Lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ+) young people of colour are exposed to intersecting dynamics of social prejudice and discrimination related to sexuality and gender as well as race/ethnicity. In particular, Latinx-identifying LGBTQ+ young people face unique challenges in their lives, due to cultural stressors that stigmatise expansive gender and sexual identities. While it is crucial to examine the effects of multiple stressors on the well-being of LGBTQ+ young people of colour, this risk-based focus can overshadow the resilient capacities of multiply marginalised groups. Guided by an intersectional minority stress resilience framework, we asked: how do self-identified LGBTQ+ Latinx young adults manage cultural messages of prejudice and discrimination in relation to their health? Findings underscore how LGBTQ+ Latinx young adults established a strong sense of health autonomy to resist cultural stigma related to their intersecting identities. Young people actively educated themselves on health-related concerns, engaged in health-promoting tactics, and practised cultural negativity management to effectively navigate exposure to prejudice and discrimination.

Current state of knowledge on Takotsubo syndrome: a Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology.

PubMed

Lyon, Alexander R; Bossone, Eduardo; Schneider, Birke; Sechtem, Udo; Citro, Rodolfo; Underwood, S Richard; Sheppard, Mary N; Figtree, Gemma A; Parodi, Guido; Akashi, Yoshihiro J; Ruschitzka, Frank; Filippatos, Gerasimos; Mebazaa, Alexandre; Omerovic, Elmir

2016-01-01

Takotsubo syndrome is an acute reversible heart failure syndrome that is increasingly recognized in modern cardiology practice. This Position Statement from the European Society of Cardiology Heart Failure Association provides a comprehensive review of the various clinical and pathophysiological facets of Takotsubo syndrome, including nomenclature, definition, and diagnosis, primary and secondary clinical subtypes, anatomical variants, triggers, epidemiology, pathophysiology, clinical presentation, complications, prognosis, clinical investigations, and treatment approaches. Novel structured approaches to diagnosis, risk stratification, and management are presented, with new algorithms to aid decision-making by practising clinicians. These also cover more complex areas (e.g. uncertain diagnosis and delayed presentation) and the management of complex cases with ongoing symptoms after recovery, recurrent episodes, or spontaneous presentation. The unmet needs and future directions for research in this syndrome are also discussed. © 2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology.

Diagnosis and management of hymenoptera venom allergy: British Society for Allergy and Clinical Immunology (BSACI) guidelines.

PubMed

Krishna, M T; Ewan, P W; Diwakar, L; Durham, S R; Frew, A J; Leech, S C; Nasser, S M

2011-09-01

This guidance for the management of patients with hymenoptera venom allergy has been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI). The guideline is based on evidence as well as on expert opinion and is for use by both adult physicians and pediatricians practising allergy. During the development of these guidelines, all BSACI members were included in the consultation process using a web-based system. Their comments and suggestions were carefully considered by the SOCC. Where evidence was lacking, consensus was reached by the experts on the committee. Included in this guideline are epidemiology, risk factors, clinical features, diagnostic tests, natural history of hymenoptera venom allergy and guidance on undertaking venom immunotherapy (VIT). There are also separate sections on children, elevated baseline tryptase and mastocytosis and mechanisms underlying VIT. Finally, we have made recommendations for potential areas of future research. © 2011 Blackwell Publishing Ltd.

Formula student as part of a mechanical engineering curriculum

NASA Astrophysics Data System (ADS)

Davies, Huw Charles

2013-10-01

Formula Student (FS) is a multi-university student design competition managed by the UK Institution of Mechanical Engineers. Students are required to demonstrate and prove their creativity and engineering skills through the design, manufacture and financing of a small formula style race car. This paper seeks to explore the educational value that derives from the FS activity through a series of semi-structured interviews with key stakeholders. Through the analysis of the interview data, it was found that the FS activity supported development of student skills and competencies in the following areas: use of engineering knowledge to support the application of existing and emerging technology; application of theoretical and practical knowledge to the solution of engineering problems; development of technical and commercial management skills; development of effective interpersonal skills, including communication skills; and demonstration of personal commitment to professional development. In addition, a number of areas for implementing 'good practise' have been identified. The information herein supports educators in their responsibility to help meet the needs of the engineering industry for high quality graduates.

Participants' sports characteristics related to heavy episodic drinking among French students.

PubMed

Martha, C; Grélot, L; Peretti-Watel, P

2009-03-01

The relationships between involvement in sports and alcohol consumption appear to be complex in the alcohol literature. In this study we aimed to examine this link among French students, taking into account their sports characteristics. We also examined variations in alcohol use among sport sciences students between 2002 and 2006, and the difference in alcohol use and heavy episodic drinking among sport sciences, law and pharmacy students. repeated survey; cross-sectional study; self-questionnaire survey; French (south-east France) sport sciences (n=693), law (n=325) and pharmacy (n=338) students (females=58%). In 2002, 38% of the male sport sciences students reported repeated heavy episodic drinking, and this proportion has risen to 48% in 2006 (p<0.05). When compared to law and pharmacy students, female and male sport sciences students were less likely to report repeated heavy episodic drinking (p<0.05). Engaging in physical activity (whether or not it takes place within an institution) and practising martial art were negatively related to heavy episodic drinking (p<0.05). Other factors related to heavy episodic drinking were gender-specific: among males, practising sport in a formal context, team sports, and competitive participation at a departmental or regional level represented risk factors (p<0.05), while practising an individual sport was a protective factor among females (p<0.05). This study corroborated the importance to take into account the context of practice and the type of sport practised to examine the link between sport participation and alcohol consumption. The normative context of peer socialization among competitive and team sports participants seemed to play a role in alcohol use. Further studies are needed to confirm the role of this putative factor.

Vaccination and blood sampling acceptability during Ramadan fasting month: A cross-sectional study in Conakry, Guinea.

PubMed

Peiffer-Smadja, Nathan; Ouedraogo, Ramatou; D'Ortenzio, Eric; Cissé, Papa Ndiaga; Zeggani, Zahra; Beavogui, Abdoul Habib; Faye, Sylvain Landry; Le Marcis, Frédéric; Yazdanpanah, Yazdan; Nguyen, Vinh-Kim

2017-05-02

There are few data on the acceptability of vaccination or blood sampling during Ramadan fasting month in Muslim countries. This could impact vaccination campaigns, clinical trials or healthcare during Ramadan. Using a semi-structured questionnaire, we conducted a cross-sectional study on 201 practising Muslims and 10 religious leaders in Conakry, Guinea in the wake of the recent epidemic Ebola epidemic. Acceptability of vaccination and blood sampling during Ramadan were investigated as well as reasons for refusal. Vaccination was judged acceptable during Ramadan by 46% (93/201, 95% CI 0.40-0.53) of practising Muslims versus 80% (8/10, 95% CI 0.49-0.94) of religious leaders (p=0.11). Blood sampling was judged acceptable during Ramadan by 54% (108/201, 95% CI 0.47-0.60) of practising Muslims versus 80% (8/10, 95% CI 0.49-0.94) of religious leaders (p=0.19). The percentage of participants that judged both blood sampling and vaccination acceptable during Ramadan was 40% (81/201, 95% CI 0.34-0.47) for practising Muslims versus 80% (8/10, 95% CI 0.49-0.94) for religious leaders (p=0.048). The most common reasons for refusal of vaccination or blood sampling were that nothing should enter or leave the body during Ramadan (43%), that adverse events could lead to breaking the fast (32%), that blood should not be seen during Ramadan (9%) and that the Quran explicitly forbids it (9%). Although most Muslims leaders and scientists consider that injections including immunization and blood sampling should be authorized during Ramadan, many Muslims in our study judged vaccination or blood sampling unacceptable when fasting. Widely available recommendations on healthcare during Ramadan would be useful to inform Muslims. Copyright © 2017. Published by Elsevier Ltd.

Shadow of Buddhism and Shintoism in neurosurgical practice in Japan.

PubMed

Ohta, T

2006-01-01

In Japan, almost all culture and civilization were introduced from abroad; in the past from China and now from U.S. and European countries, owing to her geographical features circumscribed by oceans and separated from the continents. Neurosurgical science and practice have been received in the same way as other activities. However, there are some exceptions such as organ transplantation from the brain dead and brain-dock, which means a brain check-up system of asymptomatic brain diseases. Reasons why these are practised or not in Japan are considered from the viewpoint of Buddhism and Shintoism. If our special practises could appeal to people in other countries, our neurosurgical philosophy might become widespread and welcome worldwide. Organ transplantations from brain dead have routinely been performed in many countries, while only 37 cases have been executed in Japan, after the Japanese government accepted its application in 1997. In contrast, brain-dock is widely practised without any national insurance systems, while this is rarely practised in other countries. It seems to me that Buddhism and Shintoism have influenced on these special situations, due to extreme fear and impurity of the dead body and a way of comprehending the oneness of body and mind, and also deep concern for the impact of their diseases to their families rather than for themselves. We neurosurgeons should realize that our profession is directly related to ultimate human sufferings such as aging, disease, and death, as pointed out by Gautama Buddha. We are in fact in a position to study the real way for resolution of the human sufferings, mentally and physically. Based on our experiences, the foundation of a new academic discipline like "cultural medical science" should urgently be considered in all parts of the world and in light of individual cultural, economical, geographical, and population problems.

Proposals for the mitigation of the environmental impact of clinical laboratories.

PubMed

Lopez, Joseph B; Badrick, Tony

2012-03-24

Laboratories should be aware of the carbon footprint resulting from their activities and take steps to mitigate it as part of their societal responsibilities. Once committed to a mitigation programme, they should announce an environmental policy, secure the support of senior management, initiate documentation, institute a staff training programme, schedule environmental audits and appoint an environmental manager. Laboratories may aspire to be accredited to one of the standards for environmental management, such as the ISO 14000. As environmental and quality issues are linked, the improvement in the environmental management of an organisation will ultimately lead to improved quality system performance. Indeed, environmental management could conceivably come under overall quality management. Although there will be initial costs, good environmental practices can bring savings. Environmental improvement should be based on the 3R concept to reduce, reuse and recycle. Several policy initiatives may be introduced. These include a green purchasing policy for equipment, laboratory furniture and reagents as well as the management of packaging wastes. There are several ways to reduce energy, water usage and wastage. A reduction of test numbers and collection tubes should be attempted. Paper management involves all aspects of 3R. The recycling of solvents and general wastes should be practised where feasible. The construction new laboratories or renovations to existing ones are opportunities to make them more environmentally-friendly. The advocacy of policies to associates and the inclusion of environmentally-friendly conditions on contractors are integral parts of the programme.

Comparing self-guided learning and educator-guided learning formats for simulation-based clinical training.

PubMed

Brydges, Ryan; Carnahan, Heather; Rose, Don; Dubrowski, Adam

2010-08-01

In this paper, we tested the over-arching hypothesis that progressive self-guided learning offers equivalent learning benefit vs. proficiency-based training while limiting the need to set proficiency standards. We have shown that self-guided learning is enhanced when students learn on simulators that progressively increase in fidelity during practice. Proficiency-based training, a current gold-standard training approach, requires achievement of a criterion score before students advance to the next learning level. Baccalaureate nursing students (n = 15/group) practised intravenous catheterization using simulators that differed in fidelity (i.e. students' perceived realism). Data were collected in 2008. Proficiency-based students advanced from low- to mid- to high-fidelity after achieving a proficiency criterion at each level. Progressive students self-guided their progression from low- to mid- to high-fidelity. Yoked control students followed an experimenter-defined progressive practice schedule. Open-ended students moved freely between the simulators. One week after practice, blinded experts evaluated students' skill transfer on a standardized patient simulation. Group differences were examined using analyses of variance. Proficiency-based students scored highest on the high-fidelity post-test (effect size = 1.22). An interaction effect showed that the Progressive and Open-ended groups maintained their performance from post-test to transfer test, whereas the Proficiency-based and Yoked control groups experienced a significant decrease (P < 0.05). Surprisingly, most Open-ended students (73%) chose the progressive practice schedule. Progressive training and proficiency-based training resulted in equivalent transfer test performance, suggesting that progressive students effectively self-guided when to transition between simulators. Students' preference for the progressive practice schedule indicates that educators should consider this sequence for simulation-based training.

Changes in sexual behaviour and the fall in incidence of HIV infection among homosexual men.

PubMed Central

van Griensven, G. J.; de Vroome, E. M.; Goudsmit, J.; Coutinho, R. A.

1989-01-01

To investigate the epidemiology and normal course of infection with HIV the prevalence and incidence of the infection were studied among two cohorts of homosexual men in Amsterdam in 1980-7. The cumulative incidence of infection increased from a weighted 2.2% in 1980 to 39.0% in 1987. The estimated yearly incidence of HIV was 3.0% in 1981, rose to 8.8% in 1984, and fell gradually to 0% in 1987. During the study the sexual behaviour of the cohorts was examined. The number of men with whom anopenetrative intercourse was practised fell from a mean of 10.6 to 1.4 for those positive for HIV antibody, whereas the number with whom anoreceptive intercourse was practised fell from a mean of 3.7 to 0.5 for those negative for the antibody. In addition, there was a reduction in the number of cases of hepatitis B and syphilis among men in general. The decline in infection with HIV was assumed to be linked to changes in sexual behaviour. Such changes practised early in the course of the epidemic probably had a strong effect on the number of cases of AIDS among homosexual men in Amsterdam. PMID:2493866

The fitness to practise hearing. 1. Where's your evidence? Keeping good records.

PubMed

Solon, Mark

2011-04-01

To some midwives, record keeping may be a chore. However, getting your records right will provide you with the best possible defence if you have the misfortune to be called to a 'Fitness to Practise Hearing'. In this article I shall consider what makes good records and next month, examine the hearing itself. It is important to note that if called to a hearing, it may be several years after the event in question and you must be able to verify what actually happened and why. Considering that a midwife delivers hundreds of babies each year, it would be very difficult to prove your fitness to practise from memory alone; in cross-examination you will need some concrete evidence of what actually happened. You should keep your notes for at least six years as breach of contract cases can be brought for up to six years after the breach is discovered (whereas negligence cases need to be brought by three years after the negligent act). In the case of a minor, a case can be brought three years after a child reaches adulthood and may therefore be up to 21 years after the event.

The impact of complaints procedures on the welfare, health and clinical practise of 7926 doctors in the UK: a cross-sectional survey

PubMed Central

Bourne, Tom; Wynants, Laure; Peters, Mike; Van Audenhove, Chantal; Timmerman, Dirk; Van Calster, Ben; Jalmbrant, Maria

2015-01-01

Objectives The primary aim was to investigate the impact of complaints on doctors’ psychological welfare and health. The secondary aim was to assess whether doctors report exposure to a complaints process is associated with defensive medical practise. Design This was a cross-sectional anonymous survey study. Participants were stratified into recent/current, past, no complaints. Each group completed tailored versions of the survey. Participants 95 636 doctors were invited to participate. A total of 10 930(11.4%) responded, 7926 (8.3%) completed the full survey and were included in the complete analysis. Main outcome measures Anxiety and depression were assessed using the standardised Generalised Anxiety Disorder scale and Physical Health Questionnaire. Defensive practise was evaluated using a new measure. Single-item questions measured stress-related illnesses, complaints-related experience, attitudes towards complaints and views on improving complaints processes. Results 16.9% of doctors with current/recent complaints reported moderate/severe depression (relative risk (RR) 1.77 (95% CI 1.48 to 2.13) compared to doctors with no complaints (9.5%)). Fifteen per cent reported moderate/severe anxiety (RR=2.08 (95% CI 1.61 to 2.68) compared to doctors with no complaints (7.3%)). Distress increased with complaint severity, with highest levels after General Medical Council (GMC) referral (26.3% depression, 22.3% anxiety). Doctors with current/recent complaints were 2.08 (95% CI 1.61 to 2.68) times more likely to report thoughts of self-harm or suicidal ideation. Most doctors reported defensive practise: 82–89% hedging and 46–50% avoidance. Twenty per cent felt victimised after whistleblowing, 38% felt bullied, 27% spent over 1 month off work. Over 80% felt processes would improve with transparency, managerial competence, capacity to claim lost earnings and action against vexatious complainants. Conclusions Doctors with recent/current complaints have significant risks of moderate/severe depression, anxiety and suicidal ideation. Morbidity was greatest in cases involving the GMC. Most doctors reported practising defensively, including avoidance of procedures and high-risk patients. Many felt victimised as whistleblowers or reported bullying. Suggestions to improve complaints processes included transparency and managerial competence. PMID:25592686

A Daily Diary Approach to the Examination of Chronic Stress, Daily Hassles and Safety Perceptions in Hospital Nursing.

PubMed

Louch, Gemma; O'Hara, Jane; Gardner, Peter; O'Connor, Daryl B

2017-12-01

Stress is a significant concern for individuals and organisations. Few studies have explored stress, burnout and patient safety in hospital nursing on a daily basis at the individual level. This study aimed to examine the effects of chronic stress and daily hassles on safety perceptions, the effect of chronic stress on daily hassles experienced and chronic stress as a potential moderator. Utilising a daily diary design, 83 UK hospital nurses completed three end-of-shift diaries, yielding 324 person days. Hassles, safety perceptions and workplace cognitive failure were measured daily, and a baseline questionnaire included a measure of chronic stress. Hierarchical multivariate linear modelling was used to analyse the data. Higher chronic stress was associated with more daily hassles, poorer perceptions of safety and being less able to practise safely, but not more workplace cognitive failure. Reporting more daily hassles was associated with poorer perceptions of safety, being less able to practise safely and more workplace cognitive failure. Chronic stress did not moderate daily associations. The hassles reported illustrate the wide-ranging hassles nurses experienced. The findings demonstrate, in addition to chronic stress, the importance of daily hassles for nurses' perceptions of safety and the hassles experienced by hospital nurses on a daily basis. Nurses perceive chronic stress and daily hassles to contribute to their perceptions of safety. Measuring the number of daily hassles experienced could proactively highlight when patient safety threats may arise, and as a result, interventions could usefully focus on the management of daily hassles.

Mental health education in occupational therapy professional preparation programs: Alignment between clinician priorities and coverage in university curricula.

PubMed

Scanlan, Justin Newton; Meredith, Pamela J; Haracz, Kirsti; Ennals, Priscilla; Pépin, Geneviève; Webster, Jayne S; Arblaster, Karen; Wright, Shelley

2017-12-01

Occupational therapy programs must prepare graduates for work in mental health. However, this area of practice is complex and rapidly changing. This study explored the alignment between educational priorities identified by occupational therapists practising in mental health and level of coverage of these topics in occupational therapy programs in Australia and New Zealand. Surveys were distributed to heads of all occupational therapy programs across Australia and New Zealand. The survey included educational priorities identified by occupational therapists in mental health from a previous study. Respondents were requested to identify the level of coverage given to each of these priorities within their curriculum. These data were analysed to determine a ranking of educational topics in terms of level of coverage in university programs. Responses were received for 19 programs from 16 universities. Thirty-four topics were given 'High-level coverage' in university programs, and these were compared against the 29 topics classified as 'Essential priorities' by clinicians. Twenty topics were included in both the 'Essential priorities' and 'High-level coverage' categories. Topics considered to be 'Essential priorities' by clinicians which were not given 'High-level coverage' in university programs included the following: mental health fieldwork experiences; risk assessment and management; professional self-care resilience and sensory approaches. While there appears to be overall good alignment between mental health curricula and priorities identified by practising occupational therapists, there are some discrepancies. These discrepancies are described and establish a strong foundation for further discussion between clinicians, academics and university administration to support curriculum review and revision. © 2017 Occupational Therapy Australia.

Nature and incidence of severe limbal stem cell deficiency in Australia and New Zealand.

PubMed

Bobba, Samantha; Di Girolamo, Nick; Mills, Richard; Daniell, Mark; Chan, Elsie; Harkin, Damien G; Cronin, Brendan G; Crawford, Geoffrey; McGhee, Charles; Watson, Stephanie

2017-03-01

This study aimed to determine the nature and incidence of severe limbal stem cell deficiency (LSCD) in Australia and New Zealand. A 1-year pilot surveillance study with a 1-year follow-up period was conducted in association with the Australian and New Zealand Ophthalmic Surveillance Unit. The study included patients reported by practising ophthalmologists on the Surveillance Unit's database. Ophthalmologists were provided with a definition of severe limbal stem cell deficiency, contacted on a monthly basis by the Unit and asked to report newly diagnosed cases. Severe LSCD was defined as at least 6 clock hours of whorl-like epitheliopathy, an opaque epithelium arising from the limbus, late fluorescein staining of the involved epithelium and superficial corneal neovascularization or conjunctivalization. On average, 286 report cards were sent by the Surveillance Unit to practising ophthalmologists each month (total 3429 over 12 months) and the Unit received an average of 176 responses per month (total 2111; 62% response rate). During the 1-year study period from April 2013 to March 2014, 14 positive cases were reported to the Unit. A range of underlying aetiologies were implicated, with contact lens over-wear and cicatrizing conjunctivitis being the most common (n = 3). This surveillance study is the first worldwide to document the incidence of limbal stem cell deficiency; however, because of study design limitations, it is likely to have been under-reported. It provides novel data on the demographics, clinical conditions and management of patients with limbal stem cell deficiency as reported by treating ophthalmologists. © 2016 Royal Australian and New Zealand College of Ophthalmologists.

EQUAL Candida Score: An ECMM score derived from current guidelines to measure QUAlity of Clinical Candidaemia Management.

PubMed

Mellinghoff, Sibylle C; Hoenigl, Martin; Koehler, Philipp; Kumar, Anil; Lagrou, Katrien; Lass-Flörl, Cornelia; Meis, Jacques F; Menon, Vidya; Rautemaa-Richardson, Riina; Cornely, Oliver A

2018-05-01

Candida species frequently cause blood stream infections and are reported to be the third to tenth most commonly isolated pathogens. Guidelines and standardised treatment algorithms provided by professional organisations aim to facilitate decision-making regarding diagnosis, management and treatment of candidaemia. In routine clinical practise, however, it may be challenging to comply with these guidelines. The reasons include lack of familiarity or feasibility to adherence, but also their length and complexity. There is no tool to measure guideline adherence currently. To provide such a tool, we reviewed the current guidelines provided by the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) and by the Infectious Diseases Society of America (IDSA), and selected the strongest recommendations for management quality as the bases for our scoring tool. Factors incorporated were diagnostic (blood cultures, echocardiography, ophthalmoscopy, species identification) and follow-up procedures (repeat blood cultures until negative result) as well as key treatment parameters (echinocandin treatment, step down to fluconazole depending on susceptibility result, CVC removal). The EQUAL Candida Score weighs and aggregates factors recommended for the ideal management of candidaemia and provides a tool for antifungal stewardship as well as for measuring guideline adherence. © 2018 Blackwell Verlag GmbH.

Interaction of penetrating missiles with tissues: some common misapprehensions and implications for wound management.

PubMed

Cooper, G J; Ryan, J M

1990-06-01

It is apparent from review of published papers and books that misunderstanding and confusion exists in the minds of many authors describing the interaction of penetrating missiles with tissues. These misapprehensions may influence the management of wounds by suggesting didactic approaches based upon a preconceived notion of the nature and severity of the wound for different types of projectiles. This review considers the biophysics of penetrating missile wounds, highlights some of the more common misconceptions and seeks to reconcile the conflicting and confusing management doctrines that are promulgated in the literature-differences that arise not only from two scenarios, peace and war, but also from misapprehensions of the wounding process. Wounds of war and of peacetime differ both in the nature of the wound and in the propensity for wound infection. Additionally, the limitations imposed by war dictate the type of management that may be practised and result in procedures that would be considered inappropriate by some in civilian clinical practice. Many of the procedures described in civilian peacetime settings, such as reliance on antibiotics alone for the control of infection in penetrating wounds, or minimal excision and debridement, can yield good results but would herald disaster if transposed to a war setting.

Staff perceptions of leadership during implementation of task-shifting in three surgical units.

PubMed

Henderson, Amanda; Paterson, Karyn; Burmeister, Liz; Thomson, Bernadette; Young, Louise

2013-03-01

Registered nurses are difficult to recruit and retain. Task shifting, which involves reallocation of delegation, can reduce demand for registered nurses. Effective leadership is needed for successful task shifting. This study explored leadership styles of three surgical nurse unit managers. Staff completed surveys before and after the implementation of task shifting. Task shifting involved the introduction of endorsed enrolled nurses (licensed nurses who must practise under registered nurse supervision) to better utilize registered nurses. Implementation of task shifting occurred over 4 months in a 700-bed tertiary hospital, in southeast Queensland, Australia. A facilitator assisted nurse unit managers during implementation. The impact was assessed by comparison of data before (n = 49) and after (n = 72) task shifting from registered nurses and endorsed enrolled nurses (n = 121) who completed the Ward Organization Features Survey. Significant differences in leadership and staff organization subscales across the settings suggest that how change involving task shifting is implemented influences nurses' opinions of leadership. Leadership behaviours of nurse unit managers is a key consideration in managing change such as task shifting. Consistent and clear messages from leaders about practice change are viewed positively by nursing staff. In the short term, incremental change possibly results in staff maintaining confidence in leadership. © 2012 Blackwell Publishing Ltd.

Difficulties encountered at the beginning of professional life: results of a 2003 pilot survey among undergraduate students in Paris Rene Descartes University (France).

PubMed

Benbelaïd, R; Dot, D; Levy, G; Eid, N

2006-11-01

In addition to dental hospital clinical activity, dental students at Paris Rene Descartes University have the opportunity in their final year of study to practise clinically in a dental office, as associates. This paper outlines a pilot, experimental study designed to assess student reaction to this Vocational Clinical Activity (VCA) in order to identify relevant weaknesses of the undergraduate programme. Using questionnaires, data were collected for each of the following clinical or management skills: clinical difficulty, therapeutic decision-making, patient/practitioner relationship, time management, administrative matters and technical problems. Students were asked to rank each item in order of difficulty (1, high level to 6, low level). A high response rate was observed (90%) among the 50 undergraduate VCA students. The results pointed out three main difficulties encountered by undergraduate students during the VCA: time management (90% of the students), administrative matters (85% of the students) and clinical decision-making (80% of the students). These preliminary results need further investigation. However, they give us the incentive to carry on with this type of assessment and to extend it to young, qualified colleagues' perceptions and to other French Universities.

Randomised controlled trial of oxytocin alone versus oxytocin and ergometrine in active management of third stage of labour.

PubMed Central

McDonald, S J; Prendiville, W J; Blair, E

1993-01-01

OBJECTIVE--To compare intramuscular oxytocin alone and intramuscular oxytocin with ergometrine (Syntometrine) for their effect in reducing the risk of postpartum haemorrhage when both are used as part of the active management of the third stage of labour. DESIGN--Double blind, randomised controlled trial. SETTING--Two metropolitan teaching hospitals in Perth, Western Australia. SUBJECTS--All women who expected a vaginal birth during the period of the trial. Informed consent was obtained. MAIN OUTCOME MEASURES--Postpartum haemorrhage, nausea, vomiting, and increased blood pressure. RESULTS--3497 women were randomly allocated to receive oxytocin-ergometrine (n = 1730) or oxytocin (n = 1753). Rates of postpartum haemorrhage (> or = 500 ml or > or = 1000 ml) were similar in both arms (odds ratio 0.90 (0.82); 95% confidence interval 0.75 to 1.07 (0.59 to 1.14) at 500 ml (1000 ml) threshold). The use of oxytocin-ergometrine was associated with nausea, vomiting, and increased blood pressure. CONCLUSIONS--There are few advantages but several disadvantages for the routine use of oxytoxinergometrine when prophylactic active management of the third stage of labour is practised. Further investigation of dose-response for oxytocin may be warranted. PMID:8251842

Modular workcells: modern methods for laboratory automation.

PubMed

Felder, R A

1998-12-01

Laboratory automation is beginning to become an indispensable survival tool for laboratories facing difficult market competition. However, estimates suggest that only 8% of laboratories will be able to afford total laboratory automation systems. Therefore, automation vendors have developed alternative hardware configurations called 'modular automation', to fit the smaller laboratory. Modular automation consists of consolidated analyzers, integrated analyzers, modular workcells, and pre- and post-analytical automation. These terms will be defined in this paper. Using a modular automation model, the automated core laboratory will become a site where laboratory data is evaluated by trained professionals to provide diagnostic information to practising physicians. Modem software information management and process control tools will complement modular hardware. Proper standardization that will allow vendor-independent modular configurations will assure success of this revolutionary new technology.

Old age psychiatrists: what do they find stressful?

PubMed

Benbow, S M; Jolley, D

1997-09-01

To examine the main sources of stress for practising old age psychiatrists. Postal survey. Old age psychiatry services in England and Wales. Old age psychiatrists on the list held by the Section of Old Age Psychiatry, Royal College of Psychiatrists. Number and nature of stresses identified by respondents. One hundred and thirty-eight old age psychiatrists identified a mean of 5.1 stresses per respondent, which fell into seven broad categories: changes within the health service, community care changes, personal, management-related, resource-related, related to time pressures, overwork and others. Unavoidable stresses were rarely listed. Most were related to work overload and organizational structure and climate. More research is needed on stress in other areas of psychiatry, ways to minimize/prevent stress and how to optimize the balance between work and home life.

Resource protection and resource management of drinking water-reservoirs in Thuringia--a prerequisite for high drinking-water quality.

PubMed

Willmitzer, H

2000-01-01

In face of widespread pollution of surface waters, strategies must be developed for the use of surface waters which protect the high quality standards of drinking water, starting with the catchment area via the reservoir to the consumer. As a rule, priority is given to the avoidance of contaminants directly at their point of origin. Water protection is always cheaper than expensive water-body restoration and water treatment. Complementary to the generally practised technical methods of raw water treatment with all their associated problems of energy input requirements, costs, and waste products, there is an increasing number of environmentally sound treatment technologies which use ecological principles as a basis to support the self-cleaning properties of flowing and dammed waters.

Survey of management of acute, traumatic compartment syndrome of the leg in Australia.

PubMed

Wall, Christopher J; Richardson, Martin D; Lowe, Adrian J; Brand, Caroline; Lynch, Joan; de Steiger, Richard N

2007-09-01

Acute compartment syndrome is a serious and not uncommon complication of limb trauma. The condition is a surgical emergency and is associated with significant morbidity if not diagnosed promptly and treated effectively. Despite the urgency of effective management to minimize the risk of adverse outcomes, there is currently little consensus in the published reports as to what constitutes best practice in the management of acute limb compartment syndrome. A structured survey was sent to all currently practising orthopaedic surgeons and accredited orthopaedic registrars in Australia to assess their current practice in the management of acute, traumatic compartment syndrome of the leg. Questions were related to key decision nodes in the management process, as identified in a literature review. These included identification of patients at high risk, diagnosis of the condition in alert and unconscious patients, optimal timeframe and technique for carrying out a fasciotomy and management of fasciotomy wounds. A total of 264 valid responses were received, a response rate of 29% of all eligible respondents. The results indicated considerable variation in management of acute compartment syndrome of the leg, in particular in the utilization of compartment pressure measurement and the appropriate pressure threshold for fasciotomy. Of the 78% of respondents who regularly measured compartment pressure, 33% used an absolute pressure threshold, 28% used a differential pressure threshold and 39% took both into consideration. There is variation in the management of acute, traumatic compartment syndrome of the leg in Australia. The development of evidence-based clinical practice guidelines may be beneficial.

How to report and monitor the performance of waiting list management.

PubMed

Torkki, Markus; Linna, Miika; Seitsalo, Seppo; Paavolainen, Pekka

2002-01-01

Potential problems concerning waiting list management are often monitored using mean waiting times based on empirical samples. However, the appropriateness of mean waiting time as an indicator of access can be questioned if a waiting list is not managed well, e.g., if the queue discipline is violated. This study was performed to find out about the queue discipline in waiting lists for elective surgery to reveal potential discrepancies in waiting list management. There were 1,774 waiting list patients for hallux valgus or varicose vein surgery or sterilization. The waiting time distributions of patients receiving surgery and of patients still waiting for an operation are presented in column charts. The charts are compared with two model charts. One model chart presents a high queue discipline (first in-first out) and another a poor queue discipline (random) queue. There were significant differences in waiting list management across hospitals and patient categories. Examples of a poor queue discipline were found in queues for hallux valgus and varicose vein operations. A routine waiting list reporting should be used to guarantee the quality of waiting list management and to pinpoint potential problems in access. It is important to monitor not only the number of patients in the waiting list but also the queue discipline and the balance between demand and supply of surgical services. The purpose for this type of reporting is to ensure that the priority setting made at health policy level also works in practise.

Doctors' experiences and their perception of the most stressful aspects of complaints processes in the UK: an analysis of qualitative survey data.

PubMed

Bourne, Tom; Vanderhaegen, Joke; Vranken, Renilt; Wynants, Laure; De Cock, Bavo; Peters, Mike; Timmerman, Dirk; Van Calster, Ben; Jalmbrant, Maria; Van Audenhove, Chantal

2016-07-04

To examine doctors' experiences of complaints, including which aspects are most stressful. We also investigated how doctors felt complaints processes could be improved. A qualitative study based on a cross-sectional survey of members of the British Medical Association (BMA). We asked the following: (1) Try to summarise as best as you can your experience of the complaints process and how it made you feel. (2) What were the most stressful aspects of the complaint? (3) What would you improve in the complaints system? We sent the survey to 95 636 doctors, and received 10 930 (11.4%) responses. Of these, 6146 had a previous, recent or current complaint and 3417 (31.3%) of these respondents answered questions 1 and 2. We randomly selected 1000 answers for analysis, and included 100 using the saturation principle. Of this cohort, 93 responses for question 3 were available. Doctors frequently reported feeling powerless, emotionally distressed, and experiencing negative feelings towards both those managing complaints and the complainants themselves. Many felt unsupported, fearful of the consequences and that the complaint was unfair. The most stressful aspects were the prolonged duration and unpredictability of procedures, managerial incompetence, poor communication and perceiving that processes are biased in favour of complainants. Many reported practising defensively or considering changing career after a complaint, and few found any positive outcomes from complaints investigations. Physicians suggested procedures should be more transparent, competently managed, time limited, and that there should be an open dialogue with complainants and policies for dealing with vexatious complaints. Some felt more support for doctors was needed. Complaints seriously impact on doctors' psychological wellbeing, and are associated with defensive practise. This is not beneficial to patient care. To improve procedures, doctors propose they are simplified, time limited and more transparent. 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/

Medical student career intentions at the Christchurch School of Medicine. The New Zealand Wellbeing, Intentions, Debt and Experiences (WIDE) survey of medical students pilot study. Results part II.

PubMed

Gill, D; Palmer, C; Mulder, R; Wilkinson, T

2001-10-26

To record career preferences for medical students at the Christchurch School of Medicine and Health Sciences and investigate factors, including student debt, that might influence career decisions. A questionnaire, The New Zealand Wellbeing, Intentions, Debt, and Experiences (WIDE) Survey of Medical Students, was developed and administered to all 204 medical students at the Christchurch School of Medicine and Health Sciences. The survey included questions relating to preferred career intentions and factors influencing career decisions, including the decision to leave New Zealand to practise medicine. The response rate was 88%. 80% intend to practise medicine in New Zealand immediately after graduation, however 82% indicated that they would leave within two years of graduation. Financial opportunities overseas and level of debt were the strongest motivating factors to leave. Repayments towards student loans and increased salaries were factors that might retain people in New Zealand. Medical and surgical specialities were the most popular career choices. Personal interest was the strongest motivator for career choice. Practising in a rural community was not popular. Debt is one of a number of important factors influencing medical student career decisions including the decision to leave New Zealand. Initiatives addressing debt may be useful in retaining medical graduates in this country.

Leading the rebirth of the rural obstetrician.

PubMed

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

2014-12-11

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

A continuing education programme for general practitioners. Status report after 5 years of function.

PubMed

Wiskott, H W; Borgis, S; Simoness, M

2000-05-01

In 1992, following newly issued university regulations, the board of the School of Dental Medicine of the University of Geneva decided to establish a structured continuing education course programme for practising dentists in an effort to better meet the school's continuing education mandate. The programme started in January 1994 and was structured so that regular courses would be offered in each discipline of dentistry. The course contents were aimed at satisfying the demands of practising dentists, but it was also established that basic science issues and theoretical concepts should be included. Possible course formats were "conference", "hands-on", "clinical" and "seminar". The courses were meant as a form of knowledge transfer from the school to the practising community, but also as a means to generate revenue for research and teaching programmes. Operative aspects were supervised by a small staff which was assisted by computer software designed to handle all procedural steps of course administration, participant registration, accounting, communication. The dentists' responses were rewarding in that attendance was very satisfactory. Closer scrutiny of our data, however, indicates that our impact is still low since at best only 20% of the course-hours required by the Swiss dental association are actually taken. Both course and programme evaluations were satisfactory and are discussed using the Harden and Laidlaw CRISIS criteria.

Development of functional requirements for electronic health communication: preliminary results from the ELIN project.

PubMed

Christensen, Tom; Grimsmo, Anders

2005-01-01

User participation is important for developing a functional requirements specification for electronic communication. General practitioners and practising specialists, however, often work in small practices without the resources to develop and present their requirements. It was necessary to find a method that could engage practising doctors in order to promote their needs related to electronic communication. Qualitative research methods were used, starting a process to develop and study documents and collect data from meetings in project groups. Triangulation was used, in that the participants were organised into a panel of experts, a user group, a supplier group and an editorial committee. The panel of experts created a list of functional requirements for electronic communication in health care, consisting of 197 requirements, in addition to 67 requirements selected from an existing Norwegian standard for electronic patient records (EPRs). Elimination of paper copies sent in parallel with electronic messages, optimal workflow, a common electronic 'envelope' with directory services for units and end-users, and defined requirements for content with the possibility of decision support were the most important requirements. The results indicate that we have found a method of developing functional requirements which provides valid results both for practising doctors and for suppliers of EPR systems.

Cases relating to anaesthetists handled by the UK General Medical Council in 2009: methodological approach and patterns of referral.

PubMed

Campbell, G; Rollin, A M; Smith, A F

2013-05-01

The General Medical Council is the regulatory body charged with maintaining standards in the medical profession in the UK. We analysed cases relating to anaesthetists handled in 2009 using fitness-to-practise data, comparing them with the profession as a whole and examining patterns of referral. Complaints were made about 105 doctors practising in anaesthesia. The 81 anaesthetists who were investigated further were subject to a total of 225 separate allegations, median (IQR [range]) of 2 (1-3 ) allegations per anaesthetist. Anaesthetists had a lower rate of referral compared with doctors in general (0.095% vs 0.20%, respectively, p = 0.0001). They were less likely than doctors in general to be referred by an individual member of the public (27% vs 64%, respectively, p = 0.0001). As with other specialties, allegations were most commonly made about clinical care, probity and relationships with patients. On the basis of 2009 data, we calculated that a mean (95% CI) of 1 in 120 (1 in 100-145) doctors practising in anaesthesia in the UK will be referred to the General Medical Council every year. We have provided examples of allegations and made recommendations for maintaining good practice in anaesthesia. © 2013 The Association of Anaesthetists of Great Britain and Ireland.

Impact of cancer on Moslem patients in Morocco.

PubMed

Errihani, Hassan; Mrabti, Hind; Boutayeb, Saber; El Ghissassi, Ibrahim; El Mesbahi, Omar; Hammoudi, Mohamed; Chergui, Hanaa; Riadi, Ahmed

2008-01-01

The study aims to determine the impact of cancer on Moroccan patients of Moslem faith. Patients included a convenience sample with histological confirmed cancer. Cases with cerebral metastasis or lacking capacity were excluded. Participants were assessed prospectively using a questionnaire covering epidemiological and socio-economic characteristics, religious affiliation, repercussions of disease on religious beliefs and practices. One thousand and six hundred patients (median age 49 years) were approached; 41% females and 74% from rural areas. There was a high rate of illiteracy (38%) and only 7% had higher education. Seventeen per cent were divorced, among whom 41% were divorced after diagnosis of cancer. Eighty-seven per cent had no medical insurance. All were Muslims; 49% practising believers and 51% non-practising. In the first group cancer represented a divine test that permitted acceptance of the disease. In the second group of 'non-practising believers', patients reported a feeling of culpability and 95% of them started taking up religious practices, often with extremism and sometimes in contradiction of medical advice. In both groups new behaviours were noticed; 450 women now wore the 'Hijab' (scarf), 19% used popular medicine and plants in their diet recommended by the Koran. While these results require replication they indicate changes in behaviour by those within the Moslem faith following a cancer diagnosis.

Settlement analysis of fresh and partially stabilised municipal solid waste in simulated controlled dumps and bioreactor landfills.

PubMed

Swati, M; Joseph, Kurian

2008-01-01

The patterns of settlement of fresh as well as partially stabilised municipal solid waste (MSW), undergoing degradation in five different landfill lysimeters, were studied elaborately. The first two lysimeters, R1 and R2, contained fresh MSW while the other three lysimeters, R3, R4 and R5, contained partially stabilised MSW. R1 and R3 simulated conventional controlled dumps with fortnightly disposal of drained leachate. R2 and R4 simulated bioreactor landfills with leachate recirculation. Fortnightly water flushing was done in R5. Settlement of MSW, monitored over a period of 58 weeks, was correlated with the organic carbon content of leachate and residual volatile matter in the MSW to establish the relationship between settlement and organic destruction. Compressibility parameters such as modulus of elasticity and compression indices were determined and empirical equations were applied for the settlement data. Overall settlements up to 49% were observed in the case of landfill lysimeters, filled with fresh MSW. Landfill lysimeters with liquid addition, in the form of leachate or water, experienced lower primary settlements and higher secondary settlements than conventional fills, where no liquid addition was practised. Modified secondary compression indices for MSW in lysimeters with leachate recirculation and flushing were 30%-44% higher than that for lysimeters where no liquid addition was done. Secondary settlements in bioreactor landfills were found to vary exponentially with time.

Graphic and haptic simulation system for virtual laparoscopic rectum surgery.

PubMed

Pan, Jun J; Chang, Jian; Yang, Xiaosong; Zhang, Jian J; Qureshi, Tahseen; Howell, Robert; Hickish, Tamas

2011-09-01

Medical simulators with vision and haptic feedback techniques offer a cost-effective and efficient alternative to the traditional medical trainings. They have been used to train doctors in many specialties of medicine, allowing tasks to be practised in a safe and repetitive manner. This paper describes a virtual-reality (VR) system which will help to influence surgeons' learning curves in the technically challenging field of laparoscopic surgery of the rectum. Data from MRI of the rectum and real operation videos are used to construct the virtual models. A haptic force filter based on radial basis functions is designed to offer realistic and smooth force feedback. To handle collision detection efficiently, a hybrid model is presented to compute the deformation of intestines. Finally, a real-time cutting technique based on mesh is employed to represent the incision operation. Despite numerous research efforts, fast and realistic solutions of soft tissues with large deformation, such as intestines, prove extremely challenging. This paper introduces our latest contribution to this endeavour. With this system, the user can haptically operate with the virtual rectum and simultaneously watch the soft tissue deformation. Our system has been tested by colorectal surgeons who believe that the simulated tactile and visual feedbacks are realistic. It could replace the traditional training process and effectively transfer surgical skills to novices. Copyright © 2011 John Wiley & Sons, Ltd.

"Working towards being ready": A grounded theory study of how practising midwives maintain their ongoing competence to practise their profession.

PubMed

Calvert, Susan; Smythe, Elizabeth; McKenzie-Green, Barbara

2017-07-01

to present a grounded theory research study explaining how New Zealand midwives maintain their ongoing competence to practise their profession. grounded theory, an interpretive emergent research methodology was used to examine the process of maintaining competence in midwifery practice. New Zealand urban and rural practice settings. twenty-six midwives from across New Zealand were interviewed and asked about maintaining their competence to practise. Five midwives were interviewed twice, to explore the emerging findings and as one method of member checking. the grounded theory of 'working towards being ready' describes a continuous process in which midwives engage as they work to maintain practice competence. The component parts comprise professional positioning, identifying needs, strategizing solutions and reflecting on practice. The process is contextual, diverse and is influenced by the practice setting where the salient conditions of resourcing, availability and opportunity for engagement in activities are significant. across the midwifery profession, midwives in New Zealand are currently working under the generic umbrella of midwifery practice. Midwives work across a range of practice arenas in diverse ways focussed on providing safe care and require a range of professional development activities germane to their area of practice. When the midwife has access to professional development pertinent to their practice, women and the profession benefit. As there is diversity of practice, then mandated processes for ongoing competence need to have flexibility to reflect that diversity. midwives engage in development that allows them to remain current in practice and that enables them to provide appropriate care to women and their babies. As a consequence they can develop expertise in certain aspects of midwifery. Mandated processes that require engagement in activities aimed at demonstration of competence should be evaluated and tailored to ensure they meet the needs of the developing profession. Copyright © 2017 Elsevier Ltd. All rights reserved.

Young Athletes’ Motivational Profiles

PubMed Central

Murcia, Juan Antonio Moreno; Gimeno, Eduardo Cervelló; Coll, David González-Cutre

2007-01-01

The aim of this study was to examine the relationship between motivational characteristics and dispositional flow. In order to accomplish this goal, motivational profiles emerging from key constructs within Achievement Goal Theory and Self-Determination Theory were related to the dispositional flow measures. A sample of 413 young athletes (Age range 12 to 16 years) completed the PMCSQ-2, POSQ, SMS and DFS measures. Cluster analysis results revealed three profiles: a “self-determined profile ”characterised by higher scores on the task-involving climate perception and on the task orientation; a “non-self-determined profile”, characterised by higher scores on ego-involving climate perception and ego orientation; and a “low self-determined and low non-self-determined profile ”which had the lowest dispositional flow. No meaningful differences were found between the “self-determined profile ”and the “non-self-determined profile ”in dispositional flow. The “self-determined profile ”was more commonly associated with females, athletes practising individual sports and those training more than three days a week. The “non-self-determined profile ”was more customary of males and athletes practising team sports as well as those training just two or three days a week. Key pointsThe “self-determined profile ”was characterized by high task orientation, high task-involving climate perception and was more commonly associated with females, athletes practising individual sports and those training more than three days a week.The “non-self-determined profile ”was characterized by high ego orientation, high ego-involving climate perception and was more customary of males and athletes practising team sports as well as those training two or three days a week.Both profiles revealed a moderate tendency toward dispositional flow, with no significant differences between the two profiles.The “low self-determined and low non-self-determined profile ”had low scores on all of the variables in the study. PMID:24149326

Development of the KOSMS management simulation training system and its application

NASA Astrophysics Data System (ADS)

Takatsu, Yoshiki

The use of games which simulate actual corporate management has recently become more common and is now utilized in various ways for in-house corporate training courses. KOSMS (Kobe Steel Management Simulation System), a training system designed to help improve the management skills of senior management staff, is a unique management simulation training system in which the participants, using personal computers, must make decisions concerning a variety of management activities, in simulated competition with other corporations. This report outlines the KOSMS system, and describes the basic structure and detailed contents of the management simulation models, and actual application of the KOSMS management simulation training.

Assessment study of insight ARTHRO VR (®) arthroscopy virtual training simulator: face, content, and construct validities.

PubMed

Bayona, Sofía; Fernández-Arroyo, José Manuel; Martín, Isaac; Bayona, Pilar

2008-09-01

The aims of this study were to test the face, content, and construct validities of a virtual-reality haptic arthroscopy simulator and to validate four assessment hypothesis. The participants in our study were 94 arthroscopists attending an international conference on arthroscopy. The interviewed surgeons had been performing arthroscopies for a mean of 8.71 years (σ = 6.94 years). We explained the operation, functionality, instructions for use, and the exercises provided by the simulator. They performed a trial exercise and then an exercise in which performance was recorded. After having using it, the arthroscopists answered a questionnaire. The simulator was classified as one of the best training methods (over phantoms), and obtained a mark of 7.10 out of 10 as an evaluation tool. The simulator was considered more useful for inexperienced surgeons than for surgeons with experience (mean difference 1.88 out of 10, P value < 0.001). The participants valued the simulator at 8.24 as a tool for learning skills, its fidelity at 7.41, the quality of the platform at 7.54, and the content of the exercises at 7.09. It obtained a global score of 7.82. Of the subjects, 30.8% said they would practise with the simulator more than 6 h per week. Of the surgeons, 89.4% affirmed that they would recommend the simulator to their colleagues. The data gathered support the first three hypotheses, as well as face and content validities. Results show statistically significant differences between experts and novices, thus supporting the construct validity, but studies with a larger sample must be carried out to verify this. We propose concrete solutions and an equation to calculate economy of movement. Analogously, we analyze competence measurements and propose an equation to provide a single measurement that contains them all and that, according to the surgeons' criteria, is as reliable as the judgment of experts observing the performance of an apprentice.

The evolving role of data scientist during 20 years of the British Atmospheric Data Centre (Invited)

NASA Astrophysics Data System (ADS)

Pascoe, S.; Parton, G.; Pascoe, C.; Guillory, A.; da Costa, E. D.

2013-12-01

In 2014 The British Atmospheric Data Centre (BADC), now part of the Centre of Environmental Data Archival (CEDA), will celebrate its 20th anniversary. During its lifetime, most BADC staff have defined themselves as data scientists by virtue of being scientists by background and "data workers" by practice. However, the definition of data scientist has been ill defined until recently. As the term has become popularised in the world of business and general information technology, we ask ourselves to what extent the popular definition fits our profession. We observe that data science, as practised at CEDA, encompasses several roles which overlap and compliment each other as we strive to be enablers of data exploitation. For us a data scientist's skills include elements of data curation, software engineering, data infrastructure management and data-intensive research. As data science has evolved the balance between these roles has shifted in response to changes in technology, demands of the research community and funding drivers. We have had to balance our role as enablers of data exploitation, by providing services and infrastructure to the geo-science community, with our role as pioneers of data exploitation itself. By telling the story of how these roles have evolved during the 20 year history of the BADC, we aim to explore the maturing role of data scientist as practised within the geo-sciences and contrast that role with its recently popularised usage. Looking forward we will address questions about how centres of expertise, such as CEDA, can best increase the data capabilities of geo-science research as a whole in order to facilitate the transition to data-intensive science.

'It's showed me the skills that he has': pharmacists' and mentors' views on pharmacist supplementary prescribing.

PubMed

Lloyd, Fran; Parsons, Carole; Hughes, Carmel M

2010-02-01

Supplementary prescribing has seen pharmacists assume greater responsibility for prescribing in collaboration with doctors. This study explored the context and experiences, in relation to the practice of supplementary prescribing, of pharmacists and physicians (who acted as their training mentors) at least 12 months after pharmacists had qualified as supplementary prescribers. The setting was primary and secondary healthcare sectors in Northern Ireland. Pharmacists and mentors who had participated in a pre-training study were invited to take part. All pharmacists (n = 47) were invited to participate in focus groups, while mentors (n = 35) were asked to participate in face-to-face semi-structured interviews. The research took place between May 2005 and September 2007. All discussions and interviews were audiotaped, transcribed and analysed using constant comparison. Nine pharmacist focus groups were convened (number per group ranging from three to six; total n = 40) and 31 semi-structured interviews with mentors were conducted. The six main themes that emerged were optimal practice setting, professional progression for prescribing pharmacists, outcomes for prescribing pharmacists, mentors and patients, relationships, barriers to implementation and the future of pharmacist prescribing. Where practised, pharmacist prescribing had been accepted, worked best for chronic disease management, was perceived to have reduced doctors' workload and improved continuity of care for patients. However, three-quarters of pharmacists qualified to practise as supplementary prescribers were not actively prescribing, largely due to logistical and organisational barriers rather than inter-professional tensions. Independent prescribing was seen as contentious by mentors, particularly because of the diagnostic element. Supplementary prescribing has been successful where it has been implemented but a number of barriers remain which are preventing the wider acceptance of this practice innovation.

Random matrix theory and fund of funds portfolio optimisation

NASA Astrophysics Data System (ADS)

Conlon, T.; Ruskin, H. J.; Crane, M.

2007-08-01

The proprietary nature of Hedge Fund investing means that it is common practise for managers to release minimal information about their returns. The construction of a fund of hedge funds portfolio requires a correlation matrix which often has to be estimated using a relatively small sample of monthly returns data which induces noise. In this paper, random matrix theory (RMT) is applied to a cross-correlation matrix C, constructed using hedge fund returns data. The analysis reveals a number of eigenvalues that deviate from the spectrum suggested by RMT. The components of the deviating eigenvectors are found to correspond to distinct groups of strategies that are applied by hedge fund managers. The inverse participation ratio is used to quantify the number of components that participate in each eigenvector. Finally, the correlation matrix is cleaned by separating the noisy part from the non-noisy part of C. This technique is found to greatly reduce the difference between the predicted and realised risk of a portfolio, leading to an improved risk profile for a fund of hedge funds.

How family influences practice of obstetrics. Do married women family physicians make different choices?

PubMed

Brown, J B; Carroll, J; Reid, A

1996-07-01

To examine the influence of family, past and current, on married women family physicians' and to understand why and how some women continue to practise obstetrics. Purposive sample of nine married women family physicians who currently practise obstetrics. Qualitative in-depth interviews. Analysis identified four main influences of family on participants' practice of obstetrics: family of origin, transitions in the life cycle, children, and the marital relationship. These women described how they combined the roles of wife, mother, daughter, sister, and doctor. Family was a powerful influence throughout their practice lives. Finding a balance between the demands of practice, particularly obstetrics, and family relationships was an ongoing process. The process was also influenced by transitions in the life cycle.

The challenges and effects of globalisation on forensic dentistry.

PubMed

Bernitz, Herman

2009-08-01

This paper deals with the challenges faced by forensic dentists in a world in which globalisation has become a reality. People travelling across the globe on a daily basis become victims of violent crime, terrorist attacks, human displacement, natural and man made disasters. This has forced colleagues in the profession to participate in joint operations exposing inadequacies which need urgent attention. Forensic dentists practise in isolation creating their own rules and regulations oblivious to the greater global community. No international protocols exist for the many procedures practised by the profession. Possible solutions to the complex problems are offered. These include co-operation with colleagues around the globe while striving for the highest levels of quality control, standardisation, reliability, impartiality, reproducibility and ethical accountability.

3D Digital Surveying and Modelling of Cave Geometry: Application to Paleolithic Rock Art.

PubMed

González-Aguilera, Diego; Muñoz-Nieto, Angel; Gómez-Lahoz, Javier; Herrero-Pascual, Jesus; Gutierrez-Alonso, Gabriel

2009-01-01

3D digital surveying and modelling of cave geometry represents a relevant approach for research, management and preservation of our cultural and geological legacy. In this paper, a multi-sensor approach based on a terrestrial laser scanner, a high-resolution digital camera and a total station is presented. Two emblematic caves of Paleolithic human occupation and situated in northern Spain, "Las Caldas" and "Peña de Candamo", have been chosen to put in practise this approach. As a result, an integral and multi-scalable 3D model is generated which may allow other scientists, pre-historians, geologists…, to work on two different levels, integrating different Paleolithic Art datasets: (1) a basic level based on the accurate and metric support provided by the laser scanner; and (2) a advanced level using the range and image-based modelling.

Dental fear in children and adolescents: a comparison of forms of anxiety management practised by general and paediatric dentists.

PubMed

Diercke, Katja; Ollinger, Isabelle; Bermejo, Justo Lorenzo; Stucke, Kathrin; Lux, Christopher J; Brunner, Monika

2012-01-01

BACKGROUND. About 11% of children and adolescents suffer from dental fear. These young people run an increasing risk of undergoing more invasive treatments. AIM. We researched the management of dental anxiety in young patients by general and paediatric dentists as well as by trained and untrained dentists. DESIGN. Eight hundred dentists in Germany were interviewed via e-mail regarding their experience, treatment techniques, information material and complications during the treatment of fearful children. We also examined how difficult dentists judge the treatment of anxious children and how often they participate in continuing education courses. RESULTS. Paediatric dentists applied a greater spectrum of management techniques than general dentists. They used more often psychotherapeutic interventions and anxiety assessment questionnaires. Dentists who frequently attend in continuing education courses judged the treatment to be less difficult and also used psychotherapeutic interventions more often. CONCLUSIONS. German paediatric dentists and dentists who take continuing education courses utilise a broader range of techniques to manage dental anxiety. They may be eminently suited to treat children with severe forms of anxiety. Therefore, dentists who treat young patients should participate in education programmes so as to reduce both the anxiety of their patients and their own anxiety. © 2011 The Authors. International Journal of Paediatric Dentistry © 2011 BSPD, IAPD and Blackwell Publishing Ltd.

Healthcare providers' attitudes and behaviours related to paediatric mild traumatic brain injury: results from the 2014 DocStyles survey.

PubMed

Sarmiento, Kelly; Donnell, Zoe; Hoffman, Rosanne; Tennant, Bethany

2018-04-23

Explore healthcare providers' experiences managing mTBI and better understand their use of mTBI assessment tools and guidelines. Cross-sectional Methods: A random sample of 1,760 healthcare providers responded to the web-based DocStyles survey between June 18 and 30, 2014. The sample included family/general practitioners, internists, pediatricians, and nurse practitioners who reported seeing pediatric patients. We examined their experiences with mTBI to identify opportunities to increase preparedness and improve management of mTBI. Fifty-nine percent of healthcare providers reported that they diagnosed or managed pediatric patients with mTBI within the last 12 months. Of those, 44.4% felt 'very prepared' to make decisions about when pediatric patients can safety return to activities, such as school and sports after a mTBI. When asked how often they use screening or assessment tools to assess pediatric patients with mTBI, almost half reported that they 'seldom' or 'never' use those resources (24.6% and 22.0%, respectively). Most healthcare providers reported seeing pediatric patients with mTBI, yet most feel only somewhat prepared to manage this injury in their practise. Broader use of screening tools and guidelines, that include clinical decision support tools, may be useful for healthcare providers who care for pediatric patients with mTBI.

Infant gastro-oesophageal reflux disease (GORD): Australian GP attitudes and practices.

PubMed

Kirby, Catherine N; Segal, Ahuva Y; Hinds, Rupert; Jones, Kay M; Piterman, Leon

2016-01-01

The aim of this study was to evaluate the attitudes and practices of Australian general practitioners (GPs) regarding infant gastro-oesophageal reflux disease (GORD) diagnosis and management. A national cross-sectional survey, involving a random sample of currently practising Australian GPs (n = 2319) was undertaken between July and September 2011. GPs attitudes and management of infant GORD were surveyed via an online and paper-based 41-item questionnaire. In total, 400 responses were analysed (17.24% response rate). The majority of GPs employed empirical trials of acid-suppression medication and/or lifestyle modifications to diagnose infant GORD. GPs frequently recommended dietary modification despite the belief that they were only moderately effective at best. In addition, GPs frequently prescribed acid-suppression medication, despite concerns regarding their safety in the infant population. Other GP concerns included the lack of clinical guidelines and education for GPs about infant GORD, as well as the level of evidence available for the safety and efficacy of diagnostic tests and treatments. Despite the important role Australian GPs play in the diagnosis and management of infant GORD, high-level evidence-based guidelines for GPs are lacking. Consequently, GPs engage in diagnostic and management practices despite their concerns regarding the safety and effectiveness. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Comparison of Australian and American orthodontic clinical approaches towards root resorption.

PubMed

Lim, Elaine; Sameshima, Glenn; Petocz, Peter; Darendeliler, Ali

2012-11-01

As part of The Rocky Mountain Travelling Fellowship, a pilot survey was conducted to assess current diagnostic and clinical approaches to the management of orthodontic patients in relation to root resorption. Groups comprising Australians (Sydney, New South Wales) and North Americans (Los Angeles, California), in two stages of their orthodontic careers (post-graduate orthodontic students from the University of Sydney and University of Southern California and qualified practising orthodontists) were asked to complete a questionnaire. The questions examined diagnosis and management approaches related to root resorption used in their clinical practice. Replies demonstrated that there were differences in management depending on operator experience and the country of clinical practice. However, a summarised common approach to orthodontic root resorption comprised (1) the use of an orthopantomogram as a screening diagnostic tool, followed by periapical radiographs for those perceived as 'higher risk' patients, particularly individuals with a history of root resorption; (2) a six monthly radiographic review during treatment; (3) the use of light forces and/or rest periods (discontinuous forces) every two to three months; (4) the extraction of deciduous teeth if permanent successors were erupting ectopically and causing damage to adjacent root structures; and (5) the use of fixed retention after treatment. This project was intended to initiate discussion and form a basis for further investigation into the clinical management of orthodontic root resorption.

Simulated consultations: a sociolinguistic perspective.

PubMed

Atkins, Sarah; Roberts, Celia; Hawthorne, Kamila; Greenhalgh, Trisha

2016-01-15

Assessment of consulting skills using simulated patients is widespread in medical education. Most research into such assessment is sited in a statistical paradigm that focuses on psychometric properties or replicability of such tests. Equally important, but less researched, is the question of how far consultations with simulated patients reflect real clinical encounters--for which sociolinguistics, defined as the study of language in its socio-cultural context, provides a helpful analytic lens. In this debate article, we draw on a detailed empirical study of assessed role-plays, involving sociolinguistic analysis of talk in OSCE interactions. We consider critically the evidence for the simulated consultation (a) as a proxy for the real; (b) as performance; (c) as a context for assessing talk; and (d) as potentially disadvantaging candidates trained overseas. Talk is always a performance in context, especially in professional situations (such as the consultation) and institutional ones (the assessment of professional skills and competence). Candidates who can handle the social and linguistic complexities of the artificial context of assessed role-plays score highly--yet what is being assessed is not real professional communication, but the ability to voice a credible appearance of such communication. Fidelity may not be the primary objective of simulation for medical training, where it enables the practising of skills. However the linguistic problems and differences that arise from interacting in artificial settings are of considerable importance in assessment, where we must be sure that the exam construct adequately embodies the skills expected for real-life practice. The reproducibility of assessed simulations should not be confused with their validity. Sociolinguistic analysis of simulations in various professional contexts has identified evidence for the gap between real interactions and assessed role-plays. The contextual conditions of the simulated consultation both expect and reward a particular interactional style. Whilst simulation undoubtedly has a place in formative learning for professional communication, the simulated consultation may distort assessment of professional communication These sociolinguistic findings contribute to the on-going critique of simulations in high-stakes assessments and indicate that further research, which steps outside psychometric approaches, is necessary.

Configuration Management File Manager Developed for Numerical Propulsion System Simulation

NASA Technical Reports Server (NTRS)

Follen, Gregory J.

1997-01-01

One of the objectives of the High Performance Computing and Communication Project's (HPCCP) Numerical Propulsion System Simulation (NPSS) is to provide a common and consistent way to manage applications, data, and engine simulations. The NPSS Configuration Management (CM) File Manager integrated with the Common Desktop Environment (CDE) window management system provides a common look and feel for the configuration management of data, applications, and engine simulations for U.S. engine companies. In addition, CM File Manager provides tools to manage a simulation. Features include managing input files, output files, textual notes, and any other material normally associated with simulation. The CM File Manager includes a generic configuration management Application Program Interface (API) that can be adapted for the configuration management repositories of any U.S. engine company.

'Thinking on my feet': an improvisation course to enhance students' confidence and responsiveness in the medical interview.

PubMed

Shochet, Robert; King, Julie; Levine, Rachel; Clever, Sarah; Wright, Scott

2013-02-01

Effective patient-centred communication requires physicians to respond 'in the moment' to comments and questions. It is a valuable skill to be able to react to unexpected patient utterances with empathy and support, and these surprises may be most common in general practice where patients are encouraged to speak to their doctor about anything. We developed an elective for medical students to learn and practise improvisational skills that would optimise their communications with patients during medical encounters. Nineteen second-year medical students during two consecutive years (n =38) participated in a four-session elective that introduced and allowed them to practise the principles and skills of improvisation, and reflect on the role of those skills in their communication with patients. Specific skills that were practised and emphasised included listening, affirmation, vocal tone modulation, nonverbal communication, agreement, collaboration, acceptance and validation. In addition to previously developed 'Improv' exercises, students created their own improvisation exercises targeted at specific communication skills. Twenty-seven (71%) of all participating students completed the post-curriculum assessment survey. Twenty-two (81%) rated their enjoyment as 'tremendous'. The desire to experience something new and different from the standard medical curriculum served as the motivation for many of the students (67%) to sign up for the course. Most students (23/27; 85%) thought that the concepts that were addressed were either 'very much' or 'tremendously' relevant to the care of patients. We have found that an improvisational workshop geared towards enhancing medical student communication skills has the potential to impart valuable skills that are essential to providing empathic, supportive patient-centred care. Communication skills training programmes have become a cornerstone in medical student and postgraduate medical education over the past 20 years. Both national accreditation and expert panel consensus guidelines have stressed the importance and framed the structure for best communication practices. Exemplary curricula for teaching medical trainees in core communication strategies to use with patients have been published; many emphasise patient-centred and/or relationshipcentred strategies. Simulated patient technologies with video review can allow learners to practise their skills through both self-assessment and feedback from others. However, despite these newer learning resources, frameworks and behavioural checklists, learners naïve to clinical patient encounters must still learn how to function and adapt within the interpersonal communicative space that is created by the learner and patient. At its core, this is an iterative, spontaneous process created by the dyad and yielding, from moment to moment, to unique and unanticipated outcomes. Thus, repetitive practice will improve confidence but may miss the mark in learning the essential skills of intuitive and improvised interpersonal responsiveness. One could argue that existing approaches in teaching medical learners communication skills may promote rigid and stereotyped responses. Haidet proposes that there are significant parallels between the patient-physician dialogue (when a physician attempts to learn details about a patient and their illness) and improvisational jazz. 11 He contends that effective clinicians who are committed to relationship-centred practice depart from overarching principles of biomedical inquiry when necessary to respond spontaneously and without script to the particular circumstances of each encounter. It is believed that successful doctor-patient relationships are founded upon trusting and open communication, as well as genuine respect that can be shown by a willingness to listen or respond to the issues raised by patients. 12 The nature of the comprehensive care in family medicine makes it likely that GPs will regularly be surprised by concerns raised by patients such that they must be adept at improvising. Because of the gap that currently exists in interview skills training programmes, we hypothesised that the field of improvisational theatre would effectively supplement the traditional curriculum. Improvisation relies on listening, confidence and responding instinctively and spontaneously. 13,14 In this paper, we describe our efforts to develop a brief curriculum for medical students providing training in the art of theatre improvisation, with the goal of enhancing students' confidence and performance in clinical encounters. We hoped that this innovative curricular experience would establish a venue where secondyear medical students could learn and practise improvisational skills that might prove helpful in their communications with patients during medical encounters.

Soil erosion under climate change in Great Britain: long-term simulations using high-resolution regional models

NASA Astrophysics Data System (ADS)

Ciampalini, Rossano; Kendon, Elizabeth; Constantine, José Antonio; Schindewolf, Marcus; Hall, Ian

2016-04-01

Twenty-first century climate change simulations for Great Britain reveal an increase in heavy precipitation that may lead to widespread soil loss and reduced soil carbon stores by increasing the likelihood of surface runoff. We find the quality and resolution of the simulated rainfall used to drive soil loss variation can widely influence the results. Hourly high definition rainfall simulations from a 1.5km resolution regional climate model are used to examine the soil erosion response in two UK catchments. The catchments have different sensitivity to soil erosion. "Rother" in West Sussex, England, reports some of the most erosive events that have been observed during the last 50 years in the UK. "Conwy" in North Wales, is resilient to soil erosion because of the abundant natural vegetation cover and very limited agricultural practises. We modelled with Erosion3D to check variations in soil erosion as influenced by climate variations for the periods 1996-2009 and 2086-2099. Our results indicate the Rother catchment is the most erosive, while the Conwy catchment is confirmed as the more resilient to soil erosion. The values of the reference-base period are consistent with the values of those locally observed in the previous decades. A soil erosion comparison for the two periods shows an increasing of sediment production (off-site erosion) for the end of the century at about 27% in the Rother catchment and about 50% for the Conwy catchment. The results, thanks to high-definition rainfall predictions, throw some light on the effect of climatic change effects in Great Britain.

What happens to health professionals when the ill patient is the health care system? Understanding the experience of practising medicine in the Romanian socio-cultural context.

PubMed

Spânu, Florina; Băban, Adriana; Bria, Mara; Dumitrascu, Dan L

2013-09-01

Our aims were to investigate the sources of work strain and stress, and the way in which they are experienced by Romanian health professionals in a work context shaped by the ongoing 20 years long reform of the national health care system. An exploratory, qualitative design was used to investigate medical professionals' perceptions of stress and work strain. Twenty eight interviews and two focus groups were conducted with 38 physicians, residents and nurses, between the age of 26 and 53. A semi-structured interview guide was used for data gathering and the major themes were identified using thematic analysis of the transcripts. Three themes emerged in the analysis: governance and health system management, scarcity of resources, and health system reputation. Health professionals described the image of a suffering health system, exhausted by an inconsistent management plan, underfunded and understaffed; a system that is a constant source of discontent, bitterness and doubts for them and their patients. Romanian health professionals' experiences reveal a health care system which after 20 years of reform managed to shape a learned helplessness culture within the medical community and drive a large proportion of its workforce across the borders. © 2012 The British Psychological Society.

Provider perspectives on the enabling environment required for skilled birth attendance: a qualitative study in western Nepal.

PubMed

Morgan, Alison; Jimenez Soto, Eliana; Bhandari, Gajananda; Kermode, Michelle

2014-12-01

In Nepal, where difficult geography and an under-resourced health system contribute to poor health care access, the government has increased the number of trained skilled birth attendants (SBAs) and posted them in newly constructed birthing centres attached to peripheral health facilities that are available to women 24 h a day. This study describes their views on their enabling environment. Qualitative methods included semi-structured interviews with 22 SBAs within Palpa district, a hill district in the Western Region of Nepal; a focus group discussion with ten SBA trainees, and in-depth interviews with five key informants. Participants identified the essential components of an enabling environment as: relevant training; ongoing professional support; adequate infrastructure, equipment and drugs; and timely referral pathways. All SBAs who practised alone felt unable to manage obstetric complications because quality management of life-threatening complications requires the attention of more than one SBA. Maternal health guidelines should account for the provision of an enabling environment in addition to the deployment of SBAs. In Nepal, referral systems require strengthening, and the policy of posting SBAs alone, in remote clinics, needs to be reconsidered to achieve the goal of reducing maternal deaths through timely management of obstetric complications. © 2014 John Wiley & Sons Ltd.

The management of Graves' disease in New Zealand 2014.

PubMed

Cox, Stephanie C; Tamatea, Jade Au; Conaglen, John V; Elston, Marianne S

2016-06-10

Treatment options for Graves' disease (GD), namely anti-thyroid drugs (ATD), surgery or radioiodine (RAI), have not changed over the past two decades. There is no 'gold-standard' treatment for GD. To assess whether the management of GD in New Zealand has changed since the previous 1991 New Zealand survey and compare current management with that of contemporary international studies. We conducted an online survey of New Zealand physicians currently practising internal medicine, diabetes and/or endocrinology, using the cases and questions from the original European and 1991 New Zealand studies. The first-line use of RAI was 5.5%, compared to 41% in the 1991 New Zealand survey. This corresponded to an increase in ATD use, while the rates of surgery as a first-line treatment have remained static over time. New Zealand physicians use technetium scanning for diagnosis, whereas ultrasound and radioiodine uptake were the most commonly selected investigations by European and North American physicians, respectively. The pattern of ATD use in pregnancy was similar to international practice. Treatment of GD in New Zealand has shifted away from the use of RAI as first line treatment. There are significant differences in the investigation and treatment of Grave's disease between New Zealand, Europe and North America.

Dysmenorrhoea among Hong Kong university students: prevalence, impact, and management.

PubMed

Chia, C F; Lai, Joyce H Y; Cheung, P K; Kwong, L T; Lau, Fiona P M; Leung, K H; Leung, M T; Wong, Francis C H; Ngu, S F

2013-06-01

OBJECTIVE. To evaluate the prevalence of dysmenorrhoea, its impact, and management approaches in Hong Kong university students, and to compare between medical and non-medical students for any potential differences in coping strategies. DESIGN. Cross-sectional questionnaire survey. SETTING. The University of Hong Kong, Hong Kong. PARTICIPANTS. A total of 240 undergraduate (128 medical and 112 non-medical) students. MAIN OUTCOME MEASURES. Data on the presence and severity of dysmenorrhoea, its impact on daily life, management approaches, specific strategies, and their self-perceived effectiveness were obtained and analysed. RESULTS. In these subjects, the prevalence of dysmenorrhoea was 80% (95% confidence interval, 75-85%) with a mean (standard deviation) pain score of 5.0 (1.7). The most common impacts on daily life included reduced ability to concentrate and/or disturbance with study (75%) and changes in normal physical activity (60%). Only 6% sought medical advice, while 70% practised self-management. Pain scores and pain affecting normal physical activities were important predictive factors for self-management and for management based on pharmacological or non-pharmacological means. The commonest specific strategies used were a warm beverage (62%), paracetamol (57%), and sleeping (45%), while the most effective strategies were non-steroidal anti-inflammatory drugs (100%), traditional Chinese medicine (93%), and dietary/nutritional supplements (92%). Regarding the comparison of medical and non-medical students, the former used fewer pharmacological strategies among the various management approaches investigated. CONCLUSION. With data showing dysmenorrhoea as a very common condition having a significant impact in the Hong Kong community, primary care doctors should reassure young women with dysmenorrhoea that it is a common experience in the same age-group. Health education on the existence of effective treatment from medical practitioners could help women whose dysmenorrhoea was not controlled by self-management.

From Undang-undang Melaka to federal constitution: the dynamics of multicultural Malaysia.

PubMed

Nor, Mohd Roslan Mohd; Abdullah, Ahmad Termizi; Ali, Abdul Karim

2016-01-01

Malaysia is a multicultural state comprising three main races: Malays, Chinese and Indians. The three main religions are Islam, Buddhism and Hinduism. Other religions such as Sikhism and Christianity are also practised. Muslims are the majority comprising 67 % of the population. This paper is qualitative in nature. It applies historical comparative method in presenting its data. The Undang - undang Melaka (Malacca Laws) was obtained from the monograph available at National Library of Malaysia under the name of Hukum Kanun Melaka. Analysis was done on selected examples from this document. This paper highlights that had there been no introduction to a common law system, Malaysia would have remained with its traditional laws influenced by Islam and its local customs as evident from Undang - undang Melaka (Malacca laws). The Undang - undang Melaka was practised from 1422 to 1444 and the law of the country was developed to accommodate the introduction of civil law during the colonial period. One of the unique aspects of multicultural Malaysia is the fact that it has a parallel legal system: sharia and civil law. This paper examines histo-cultural development of the Islamic law as practised in pre-independent Malaysia, as well as the coexistence between these two laws after the independence of Malaya in 1957. This paper concludes that Islamic law in Malaysia is confined to Muslim family matters, while civil law covers all other matters.

Perceptions and practice of exclusive breastfeeding among Malay women in Kelantan, Malaysia: a qualitative approach.

PubMed

Tengku, Alina T I; Wan, Abdul Manan W M; Zaharah, S; Rohana, A J; Nik Normanieza, N M

2012-04-01

Despite evidence from various studies on exclusive breastfeeding (EBF) being best for infants, many women do not or are unable to practise EBF. This study aimed to examine perceptions on EBF and its influencing factors among a sample of Malay women in rural and urban areas in Kelantan, Malaysia. A qualitative study using in-depth interviews was conducted to examine respondents' views about EBF including their beliefs, experiences and feelings. The interviews were audio-recorded and transcribed verbatim, followed by discussion and identification of emergent concepts. Data saturation was achieved after interviewing a total of 30 women. The mean age of the women was about 30 years with most having at least secondary level schooling; the majority were working women. Thirteen of the 30 women practised EBF. They believed breastfeeding allowed them to fulfill their reproductive role and regarded it as a gift from God. The practice required sacrifice, and was therefore associated with a combination of positive and negative feelings. Differing opinions surfaced with regard to belief in the superiority of breastfeeding and feasibility of practice. Many women accepted breastfeeding practice but found it challenging to practise EBF especially when confronted with low milk production, perceived low nutritional quality breast milk, and work commitments. Women should be educated on the importance of EBF with regard to the nutritional adequacy of breast milk and long-term benefits for mother and children.

Spectators & spectacles: nurses, midwives and visuality.

PubMed

Barnard, Alan G; Sinclair, Marlene

2006-09-01

In this paper we reflect on how linear perspective vision influences the practice of nurses and midwives and to advance understanding of clinical practice in technologically intensive environments through examination of drawings by nurses and midwives and through critical analysis. There is increasing emphasis on vision in Western culture, and both nurses and midwives spend a great deal of time observing their clinical environment(s). Healthcare practitioners work increasingly in image-based realities and nurses rely on visual skills. Vision and visual representation are central to our practice and are important to examine because we look often at technology to assess people and care. The world in which we practise is one of meaning(s). Technological development is transformative in nature and produces changes that alter the way(s) we give care. Amongst all this change, it is unclear how we practise in environments characterized by increasing technology and it is unknown how nursing and midwifery practice alter as a result. Simple drawings included in this paper highlight an important and shared experience of clinical practice(s). They emphasize the importance and scope of the visual sense and expose practitioner behaviour that has enormous implications for current and future professional development and person-focussed care provision. Experiences described in this paper require further examination and highlight substantial changes to nurse-patient relationships, health care and the way we practise.

Conservative management of antenatally diagnosed cystic lung malformations.

PubMed

Ng, Christabella; Stanwell, Joanna; Burge, David M; Stanton, Michael P

2014-05-01

To review the outcome of all antenatally diagnosed conservatively managed congenital lung malformations (CLMs) managed at our centre. All patients diagnosed antenatally with cystic lung malformations from 2001 to 2011, at a tertiary referral paediatric surgical centre practising a policy of conservative management of asymptomatic cases, were retrospectively reviewed. Data were collected from medical case notes and radiology reports. Ethical approval was obtained from our institutional research and development department. The complete records of 74 fetuses antenatally diagnosed with CLM were reviewed. There were 72 live births, at a median gestation of 39.6 weeks. Emergency lobectomy was performed in one symptomatic neonate. Elective lobectomies were performed at parental request in three asymptomatic infants, one of whom had a family history of synovial sarcoma. Two patients developed pneumonia in the affected lobe during early childhood and proceeded to lobectomy at the age of 3 years. One patient with a bronchopulmonary sequestration required embolisation for cyanotic episodes. The remaining 65 patients have been conservatively managed to date, and none have required hospital admission. Less than a quarter report mild respiratory symptoms such as cough or wheeze. Median follow-up is 5 years. This retrospective cohort study of 74 consecutive CLMs diagnosed antenatally over a 10-year period demonstrates that most of these lesions will remain asymptomatic throughout childhood. Although the natural history of CLMs in later years remains to be elucidated, we hope that this report on medium-term outcomes will be useful to clinicians who undertake antenatal counselling and may inform the discussion on how best to manage these children.

Does the virtual refractor patient-simulator improve student competency when refracting in the consulting room?

PubMed

Alhazmi, Mohammed S; Butler, Craig W; Junghans, Barbara M

2018-06-12

The use of patient simulators in ophthalmic education appears limited. This study examines the effects of the addition of the 'Virtual Refractor' patient simulator learning activity into a short unit preparing students to determine the power of the spectacle lenses required by patients in a clinic. Twenty-four year one optometry students were randomly assigned to either the simulator-intervention group (n = 12) or the non-intervention group. All students attended tutorials on refraction and the use of a refractor-head. Simulator-intervention students additionally attended a tutorial on the Virtual Refractor. All answered a questionnaire concerning time spent studying, perceived knowledge and confidence. Twenty-four short-sighted patients were recruited. Two refractions per student were timed and the accuracy compared with that of an experienced optometrist. Ten students from each group completed the study. Students who used the simulator were significantly (p < 0.05) more accurate at a clinical level (within 0.22 ± 0.22 DS, 95 per cent CI 0.12-0.32) than those who did not (within 0.60 ± 0.67 DS, 95 per cent CI 0.29-0.92) and 13 per cent quicker (4.7 minutes, p < 0.05). Students who used the simulator felt more knowledgeable (p < 0.05) and confident (p < 0.05), but had spent more time reading about refraction and practised on the Virtual Refractor at home for 5.7 ± 1.3 hours. The Virtual Refractor has many features of high-fidelity medical simulation known to lead to effective learning and it also offers flexible independent learning without a concomitant increase in the student time-burden. The improved accuracy and speed on first patient encounters found in this study validates the use of this patient simulator as a useful bridge for students early in training to successfully transfer theoretical knowledge prior to entering the consulting room. The translational benefits resulting from compulsory learning activities on a patient simulator can lead to reduced demands on infrastructure and clinical supervision. © 2018 Optometry Australia.

Navigating in the landscape of care: a critical reflection on theory and practise of care and ethics.

PubMed

Skærbæk, Eva

2011-03-01

The theory and practise of care is defined and enacted differently in different national as well as cultural contexts, illuminating how differently constructed the personal and societal structures in Europe are. A common trait is however that care work paid or non-paid, private or public is identified with women. To navigate in the landscape of care and ethics requires taking into account the constitutive relation between one's identity, embodiment and position. The author suggests conceiving care as an existential condition of life demanded from all human beings. This will free care from the identification with women and pave a way towards a more gender equal and just society with less gender segregation in the labour market and at the arena of education.

[Providing successful education and further training: 10 tips].

PubMed

Brand, Paul L P; Boendermaker, Peter M; Venekamp, Ruud M

2014-01-01

Almost all physicians teach or provide postgraduate medical education from time to time. Although many people assume that there are 'born teachers' and 'those who will never learn to teach', teaching is an ability. The knowledge and skills required to teach well can be learned and practised. In this review article, we present 10 tips that will help the busy clinician to teach effectively. The 10 tips, which are based on the principles of adult learning, are: prepare your teaching session, involve the learners actively, connect to the learners' level of competence, define learning objectives, make the subject of your teaching relevant to the learners, use questions, be a good role model, vary your teaching methods, practise your teaching, and limit the amount of material you are teaching in each session.

Emerging issues and current trends in assistive technology use 2007-2010: practising, assisting and enabling learning for all.

PubMed

Abbott, Chris; Brown, David; Evett, Lindsay; Standen, Penny

2014-11-01

Following an earlier review in 2007, a further review of the academic literature relating to the uses of assistive technology (AT) by children and young people was completed, covering the period 2007-2011. As in the earlier review, a tripartite taxonomy: technology uses to train or practise, technology uses to assist learning and technology uses to enable learning, was used in order to structure the findings. The key markers for research in this field and during these three years were user involvement, AT on mobile mainstream devices, the visibility of AT, technology for interaction and collaboration, new and developing interfaces and inclusive design principles. The paper concludes by locating these developments within the broader framework of the Digital Divide.

NeuroManager: a workflow analysis based simulation management engine for computational neuroscience

PubMed Central

Stockton, David B.; Santamaria, Fidel

2015-01-01

We developed NeuroManager, an object-oriented simulation management software engine for computational neuroscience. NeuroManager automates the workflow of simulation job submissions when using heterogeneous computational resources, simulators, and simulation tasks. The object-oriented approach (1) provides flexibility to adapt to a variety of neuroscience simulators, (2) simplifies the use of heterogeneous computational resources, from desktops to super computer clusters, and (3) improves tracking of simulator/simulation evolution. We implemented NeuroManager in MATLAB, a widely used engineering and scientific language, for its signal and image processing tools, prevalence in electrophysiology analysis, and increasing use in college Biology education. To design and develop NeuroManager we analyzed the workflow of simulation submission for a variety of simulators, operating systems, and computational resources, including the handling of input parameters, data, models, results, and analyses. This resulted in 22 stages of simulation submission workflow. The software incorporates progress notification, automatic organization, labeling, and time-stamping of data and results, and integrated access to MATLAB's analysis and visualization tools. NeuroManager provides users with the tools to automate daily tasks, and assists principal investigators in tracking and recreating the evolution of research projects performed by multiple people. Overall, NeuroManager provides the infrastructure needed to improve workflow, manage multiple simultaneous simulations, and maintain provenance of the potentially large amounts of data produced during the course of a research project. PMID:26528175

NeuroManager: a workflow analysis based simulation management engine for computational neuroscience.

PubMed

Stockton, David B; Santamaria, Fidel

2015-01-01

We developed NeuroManager, an object-oriented simulation management software engine for computational neuroscience. NeuroManager automates the workflow of simulation job submissions when using heterogeneous computational resources, simulators, and simulation tasks. The object-oriented approach (1) provides flexibility to adapt to a variety of neuroscience simulators, (2) simplifies the use of heterogeneous computational resources, from desktops to super computer clusters, and (3) improves tracking of simulator/simulation evolution. We implemented NeuroManager in MATLAB, a widely used engineering and scientific language, for its signal and image processing tools, prevalence in electrophysiology analysis, and increasing use in college Biology education. To design and develop NeuroManager we analyzed the workflow of simulation submission for a variety of simulators, operating systems, and computational resources, including the handling of input parameters, data, models, results, and analyses. This resulted in 22 stages of simulation submission workflow. The software incorporates progress notification, automatic organization, labeling, and time-stamping of data and results, and integrated access to MATLAB's analysis and visualization tools. NeuroManager provides users with the tools to automate daily tasks, and assists principal investigators in tracking and recreating the evolution of research projects performed by multiple people. Overall, NeuroManager provides the infrastructure needed to improve workflow, manage multiple simultaneous simulations, and maintain provenance of the potentially large amounts of data produced during the course of a research project.

Gait rehabilitation machines based on programmable footplates.

PubMed

Schmidt, Henning; Werner, Cordula; Bernhardt, Rolf; Hesse, Stefan; Krüger, Jörg

2007-02-09

Gait restoration is an integral part of rehabilitation of brain lesioned patients. Modern concepts favour a task-specific repetitive approach, i.e. who wants to regain walking has to walk, while tone-inhibiting and gait preparatory manoeuvres had dominated therapy before. Following the first mobilization out of the bed, the wheelchair-bound patient should have the possibility to practise complex gait cycles as soon as possible. Steps in this direction were treadmill training with partial body weight support and most recently gait machines enabling the repetitive training of even surface gait and even of stair climbing. With treadmill training harness-secured and partially relieved wheelchair-mobilised patients could practise up to 1000 steps per session for the first time. Controlled trials in stroke and SCI patients, however, failed to show a superior result when compared to walking exercise on the floor. Most likely explanation was the effort for the therapists, e.g. manually setting the paretic limbs during the swing phase resulting in a too little gait intensity. The next steps were gait machines, either consisting of a powered exoskeleton and a treadmill (Lokomat, AutoAmbulator) or an electromechanical solution with the harness secured patient placed on movable foot plates (Gait Trainer GT I). For the latter, a large multi-centre trial with 155 non-ambulatory stroke patients (DEGAS) revealed a superior gait ability and competence in basic activities of living in the experimental group. The HapticWalker continued the end effector concept of movable foot plates, now fully programmable and equipped with 6 DOF force sensors. This device for the first time enables training of arbitrary walking situations, hence not only the simulation of floor walking but also for example of stair climbing and perturbations. Locomotor therapy is a fascinating new tool in rehabilitation, which is in line with modern principles of motor relearning promoting a task-specific repetitive approach. Sophisticated technical developments and positive randomized controlled trials form the basis of a growing acceptance worldwide to the benefits or our patients.

Basic statistics (the fundamental concepts).

PubMed

Lim, Eric

2014-12-01

An appreciation and understanding of statistics is import to all practising clinicians, not simply researchers. This is because mathematics is the fundamental basis to which we base clinical decisions, usually with reference to the benefit in relation to risk. Unless a clinician has a basic understanding of statistics, he or she will never be in a position to question healthcare management decisions that have been handed down from generation to generation, will not be able to conduct research effectively nor evaluate the validity of published evidence (usually making an assumption that most published work is either all good or all bad). This article provides a brief introduction to basic statistical methods and illustrates its use in common clinical scenarios. In addition, pitfalls of incorrect usage have been highlighted. However, it is not meant to be a substitute for formal training or consultation with a qualified and experienced medical statistician prior to starting any research project.

3D Digital Surveying and Modelling of Cave Geometry: Application to Paleolithic Rock Art

PubMed Central

González-Aguilera, Diego; Muñoz-Nieto, Angel; Gómez-Lahoz, Javier; Herrero-Pascual, Jesus; Gutierrez-Alonso, Gabriel

2009-01-01

3D digital surveying and modelling of cave geometry represents a relevant approach for research, management and preservation of our cultural and geological legacy. In this paper, a multi-sensor approach based on a terrestrial laser scanner, a high-resolution digital camera and a total station is presented. Two emblematic caves of Paleolithic human occupation and situated in northern Spain, “Las Caldas” and “Peña de Candamo”, have been chosen to put in practise this approach. As a result, an integral and multi-scalable 3D model is generated which may allow other scientists, pre-historians, geologists…, to work on two different levels, integrating different Paleolithic Art datasets: (1) a basic level based on the accurate and metric support provided by the laser scanner; and (2) a advanced level using the range and image-based modelling. PMID:22399958

A CMOS camera-based system for clinical photoplethysmographic applications

NASA Astrophysics Data System (ADS)

Humphreys, Kenneth; Markham, Charles; Ward, Tomas E.

2005-06-01

In this work an image-based photoplethysmography (PPG) system is developed and tested against a conventional finger-based system as commonly used in clinical practise. A PPG is essentially an optical instrument consisting of a near infrared (NIR) source and detector that is capable of tracking blood flow changes in body tissue. When used with a number of wavelengths in the NIR band blood oxygenation changes as well as other blood chemical signatures can be ascertained yielding a very useful device in the clinical realm. Conventionally such a device requires direct contact with the tissue under investigation which eliminates the possibility of its use for applications like wound management where the tissue oxygenation measurement could be extremely useful. To circumnavigate this shortcoming we have developed a CMOS camera-based system, which can successfully extract the PPG signal without contact with the tissue under investigation. A comparison of our results with conventional techniques has yielded excellent results.

Predictive systems ecology

PubMed Central

Evans, Matthew R.; Bithell, Mike; Cornell, Stephen J.; Dall, Sasha R. X.; Díaz, Sandra; Emmott, Stephen; Ernande, Bruno; Grimm, Volker; Hodgson, David J.; Lewis, Simon L.; Mace, Georgina M.; Morecroft, Michael; Moustakas, Aristides; Murphy, Eugene; Newbold, Tim; Norris, K. J.; Petchey, Owen; Smith, Matthew; Travis, Justin M. J.; Benton, Tim G.

2013-01-01

Human societies, and their well-being, depend to a significant extent on the state of the ecosystems that surround them. These ecosystems are changing rapidly usually in response to anthropogenic changes in the environment. To determine the likely impact of environmental change on ecosystems and the best ways to manage them, it would be desirable to be able to predict their future states. We present a proposal to develop the paradigm of predictive systems ecology, explicitly to understand and predict the properties and behaviour of ecological systems. We discuss the necessary and desirable features of predictive systems ecology models. There are places where predictive systems ecology is already being practised and we summarize a range of terrestrial and marine examples. Significant challenges remain but we suggest that ecology would benefit both as a scientific discipline and increase its impact in society if it were to embrace the need to become more predictive. PMID:24089332

Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice.

PubMed

Hajjaj, F M; Salek, M S; Basra, M K A; Finlay, A Y

2010-05-01

This article reviews an aspect of daily clinical practice which is of critical importance in virtually every clinical consultation, but which is seldom formally considered. Non-clinical influences on clinical decision-making profoundly affect medical decisions. These influences include patient-related factors such as socioeconomic status, quality of life and patient's expectations and wishes, physician-related factors such as personal characteristics and interaction with their professional community, and features of clinical practice such as private versus public practice as well as local management policies. This review brings together the different strands of knowledge concerning non-clinical influences on clinical decision-making. This aspect of decision-making may be the biggest obstacle to the reality of practising evidence-based medicine. It needs to be understood in order to develop clinical strategies that will facilitate the practice of evidence-based medicine.

Predictive systems ecology.

PubMed

Evans, Matthew R; Bithell, Mike; Cornell, Stephen J; Dall, Sasha R X; Díaz, Sandra; Emmott, Stephen; Ernande, Bruno; Grimm, Volker; Hodgson, David J; Lewis, Simon L; Mace, Georgina M; Morecroft, Michael; Moustakas, Aristides; Murphy, Eugene; Newbold, Tim; Norris, K J; Petchey, Owen; Smith, Matthew; Travis, Justin M J; Benton, Tim G

2013-11-22

Human societies, and their well-being, depend to a significant extent on the state of the ecosystems that surround them. These ecosystems are changing rapidly usually in response to anthropogenic changes in the environment. To determine the likely impact of environmental change on ecosystems and the best ways to manage them, it would be desirable to be able to predict their future states. We present a proposal to develop the paradigm of predictive systems ecology, explicitly to understand and predict the properties and behaviour of ecological systems. We discuss the necessary and desirable features of predictive systems ecology models. There are places where predictive systems ecology is already being practised and we summarize a range of terrestrial and marine examples. Significant challenges remain but we suggest that ecology would benefit both as a scientific discipline and increase its impact in society if it were to embrace the need to become more predictive.

High-altitude cerebral oedema mimicking stroke.

PubMed

Yanamandra, Uday; Gupta, Amul; Patyal, Sagarika; Varma, Prem Prakash

2014-03-26

High-altitude cerebral oedema (HACO) is the most fatal high-altitude illness seen by rural physicians practising in high-altitude areas. HACO presents clinically with cerebellar ataxia, features of raised intracranial pressure (ICP) and coma. Early identification is important as delay in diagnosis can be fatal. We present two cases of HACO presenting with focal deficits mimicking stroke. The first patient presented with left-sided hemiplegia associated with the rapid deterioration in the sensorium. Neuroimaging revealed features suggestive of vasogenic oedema. The second patient presented with monoplegia of the lower limb. Neuroimaging revealed perfusion deficit in anterior cerebral artery territory. Both patients were managed with dexamethasone and they improved dramatically. Clinical picture and neuroimaging closely resembled acute ischaemic stroke in both cases. Thrombolysis in these patients would have been disastrous. Recent travel to high altitude, young age, absence of atherosclerotic risk factors and features of raised ICP concomitantly directed the diagnosis to HACO.

Specificity revisited and updated.

PubMed

Paulley, J W

1991-01-01

Typicality is probably a better representation of Alexander, Dunbar and others' conclusions than specificity, which was always too absolute a term. As such it became a valid cause of objection by opponents. No genuine attempts to repeat the original studies have been made and most of the original opposition to the concept is now acknowledged as invalid. Typicality (specificity) in psychosomatic disorders appears to be conferred by coping mechanisms acquired through interaction with mother and early surrogates in infancy and childhood as a means of reducing tensions and restoration of homeostatic emotional equilibrium. Psychosomatic medicine patients share one such mechanism, notably superstability/alexythymia, but contained within it are coping mechanisms typical for differing disorders. Examples are listed, and also mention of typicality of recurrently provocative life events/situations. Until typicality is appreciated, taught, learned and practised, success in management of psychosomatic disorders will be limited. The current bio-psycho-social approach is too imprecise.

Promoting self-reflection in clinical practice among Chinese nursing undergraduates in Hong Kong.

PubMed

Ip, Wan Yim; Lui, May H; Chien, Wai Tong; Lee, Iris F; Lam, Lai Wah; Lee, Diana T

2012-06-01

This study evaluated the effect of a structured education programme on improving the self-reflection skills of Chinese nursing undergraduates in managing clinical situations. Johns' Structured Reflection Model was used as a framework for the development of the education programme. Thirty-eight nursing undergraduates attended a 3-hour interactive workshop on reflective skills and were encouraged to practise the skills learned under the guidance of a nurse instructor during their 4-week clinical practicum. The findings indicated that the programme was helpful in improving the undergraduates' reflective skills though only a few of them reached the highest level as critical reflectors. Some undergraduates identified time constraints and the lack of a trusting relationship with their nurse instructor as barriers to their reflective learning. The findings may help nurse educators develop education programmes with structured learning strategies to promote nursing undergraduates' self-refection in clinical practice.

Are the General Medical Council's Tests of Competence fair to long standing doctors? A retrospective cohort study.

PubMed

Mehdizadeh, Leila; Sturrock, Alison; Dacre, Jane

2015-04-21

The General Medical Council's Fitness to Practise investigations may involve a test of competence for doctors with performance concerns. Concern has been raised about the suitability of the test format for doctors who qualified before the introduction of Single Best Answer and Objective Structured Clinical Examination assessments, both of which form the test of competence. This study explored whether the examination formats used in the tests of competence are fair to long standing doctors who have undergone fitness to practise investigation. A retrospective cohort design was used to determine an association between year of primary medical qualification and doctors' test of competence performance. Performance of 95 general practitioners under investigation was compared with a group of 376 volunteer doctors. We analysed performance on knowledge test, OSCE overall, and three individual OSCE stations using Spearman's correlation and regression models. Doctors under investigation performed worse on all test outcomes compared to the comparison group. Qualification year correlated positively with performance on all outcomes except for physical examination (e.g. knowledge test r = 0.48, p < 0.001 and OSCE r = 0.37, p < 0.001). Qualification year was associated with test performance in doctors under investigation even when controlling for sex, ethnicity and qualification region. Regression analyses showed that qualification year was associated with knowledge test, OSCE and communication skills performance of doctors under investigation when other variables were controlled for. Among volunteer doctors this was not the case and their performance was more strongly related to where they qualified and their ethnic background. Furthermore, volunteer doctors who qualified before the introduction of Single Best Answer and OSCE assessments, still outperformed their peers under investigation. Earlier graduates under fitness to practise investigation performed less well on the test of competence than their more recently qualified peers under investigation. The performance of the comparator group tended to stay consistent irrespective of year qualified. Our results suggest that the test format does not disadvantage early qualified doctors. We discuss findings in relation to the GMC's fitness to practise procedures and suggest alternative explanations for the poorer performance of long standing doctors under investigation.

Application of the expanded Creme RIFM consumer exposure model to fragrance ingredients in cosmetic, personal care and air care products.

PubMed

Safford, B; Api, A M; Barratt, C; Comiskey, D; Ellis, G; McNamara, C; O'Mahony, C; Robison, S; Rose, J; Smith, B; Tozer, S

2017-06-01

As part of a joint project between the Research Institute for Fragrance Materials (RIFM) and Creme Global, a Monte Carlo model (here named the Creme RIFM model) has been developed to estimate consumer exposure to ingredients in personal care products. Details of the model produced in Phase 1 of the project have already been published. Further data on habits and practises have been collected which enable the model to estimate consumer exposure from dermal, oral and inhalation routes for 25 product types. . In addition, more accurate concentration data have been obtained which allow levels of fragrance ingredients in these product types to be modelled. Described is the use of this expanded model to estimate aggregate systemic exposure for eight fragrance ingredients. Results are shown for simulated systemic exposure (expressed as μg/kg bw/day) for each fragrance ingredient in each product type, along with simulated aggregate exposure. Highest fragrance exposure generally occurred from use of body lotions, body sprays and hydroalcoholic products. For the fragrances investigated, aggregate exposure calculated using this model was 11.5-25 fold lower than that calculated using deterministic methodology. The Creme RIFM model offers a very comprehensive and powerful tool for estimating aggregate exposure to fragrance ingredients. Copyright © 2017. Published by Elsevier Inc.

Virtual patient simulation in psychiatric care - A pilot study of digital support for collaborate learning.

PubMed

Sunnqvist, Charlotta; Karlsson, Karin; Lindell, Lisbeth; Fors, Uno

2016-03-01

Psychiatric and mental health nursing is built on a trusted nurse and patient relationship. Therefore communication and clinical reasoning are two important issues. Our experiences as teachers in psychiatric educational programmes are that the students feel anxiety and fear before they start their clinical practices in psychiatry. Therefore there is a need for bridging over the fear. Technology enhanced learning might support such activities so we used Virtual patients (VPs), an interactive computer simulations of real-life clinical scenarios. The aim of this study was to investigate 4th term nursing students' opinions on the use of Virtual Patients for assessment in a Mental Health and Ill-health course module. We asked 24 volunteering students to practise with five different VP cases during almost 10 weeks before the exam. The participants were gathered together for participating in a written and an oral evaluation. The students were positive to the use of VPs in psychiatry and were very positive to use VPs in their continued nursing education. It seems that Virtual Patients can be an activity producing pedagogic model promoting students' independent knowledge development, critical thinking, reflection and problem solving ability for nurse students in psychiatric care. Copyright © 2016 Elsevier Ltd. All rights reserved.

Immersive simulated reality scenarios for enhancing students' experience of people with learning disabilities across all fields of nurse education.

PubMed

Saunder, Lorna; Berridge, Emma-Jane

2015-11-01

Poor preparation of nurses, regarding learning disabilities can have devastating consequences. High-profile reports and the Nursing and Midwifery Council requirements led this University to introduce Shareville into the undergraduate and postgraduate nursing curriculum. Shareville is a virtual environment developed at Birmingham City University, in which student nurses learn from realistic, problem-based scenarios featuring people with learning disabilities. Following the implementation of the resource an evaluation of both staff and student experience was undertaken. Students reported that problem-based scenarios were sufficiently real and immersive. Scenarios presented previously unanticipated considerations, offering new insights, and giving students the opportunity to practise decision-making in challenging scenarios before encountering them in practice. The interface and the quality of the graphics were criticised, but, this did not interfere with learning. Nine lecturers were interviewed, they generally felt positively towards the resource and identified strengths in terms of blended learning and collaborative teaching. The evaluation contributes to understandings of learning via simulated reality, and identifies process issues that will inform the development of further resources and their roll-out locally, and may guide other education providers in developing and implementing resources of this nature. There was significant parity between lecturers' expectations of students' experience of Shareville. Copyright © 2015 Elsevier Ltd. All rights reserved.

Effectiveness of patient feedback as an educational intervention to improve medical student consultation (PTA Feedback Study): study protocol for a randomized controlled trial.

PubMed

Lai, Michelle Mei Yee; Roberts, Noel; Martin, Jenepher

2014-09-17

Oral feedback from clinical educators is the traditional teaching method for improving clinical consultation skills in medical students. New approaches are needed to enhance this teaching model. Multisource feedback is a commonly used assessment method for learning among practising clinicians, but this assessment has not been explored rigorously in medical student education. This study seeks to evaluate if additional feedback on patient satisfaction improves medical student performance. The Patient Teaching Associate (PTA) Feedback Study is a single site randomized controlled, double-blinded trial with two parallel groups.An after-hours general practitioner clinic in Victoria, Australia, is adapted as a teaching clinic during the day. Medical students from two universities in their first clinical year participate in six simulated clinical consultations with ambulatory patient volunteers living with chronic illness. Eligible students will be randomized in equal proportions to receive patient satisfaction score feedback with the usual multisource feedback and the usual multisource feedback alone as control. Block randomization will be performed. We will assess patient satisfaction and consultation performance outcomes at baseline and after one semester and will compare any change in mean scores at the last session from that at baseline. We will model data using regression analysis to determine any differences between intervention and control groups. Full ethical approval has been obtained for the study. This trial will comply with CONSORT guidelines and we will disseminate data at conferences and in peer-reviewed journals. This is the first proposed trial to determine whether consumer feedback enhances the use of multisource feedback in medical student education, and to assess the value of multisource feedback in teaching and learning about the management of ambulatory patients living with chronic conditions. Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613001055796.

The effect of catch-and-release angling at high water temperatures on behaviour and survival of Atlantic salmon Salmo salar during spawning migration.

PubMed

Havn, T B; Uglem, I; Solem, Ø; Cooke, S J; Whoriskey, F G; Thorstad, E B

2015-08-01

In this study, behaviour and survival following catch-and-release (C&R) angling was investigated in wild Atlantic salmon Salmo salar (n = 75) angled on sport fishing gear in the River Otra in southern Norway at water temperatures of 16.3-21.1 °C. Salmo salar were tagged externally with radio transmitters and immediately released back into the river to simulate a realistic C&R situation. The majority of S. salar (91%) survived C&R. Most S. salar that were present in the River Otra during the spawning period 3-4 months later were located at known spawning grounds. Downstream movements (median furthest position: 0.5 km, range: 0.1-11.0 km) during the first 4 days after release were recorded for 72% of S. salar, presumably stress-induced fallback associated with C&R. Individuals that fell back spent a median of 15 days before commencing their first upstream movement after release, and 34 days before they returned to or were located above their release site. Mortality appeared to be somewhat elevated at the higher end of the temperature range (14% at 18-21 °C), although sample sizes were low. In conclusion, C&R at water temperatures up to 18 °C had small behavioural consequences and was associated with low mortality (7%). Nevertheless, low levels of mortality occur due to C&R angling and these losses should be accounted for by management authorities in rivers where C&R is practised. Refinement of best practices for C&R may help to reduce mortality, particularly at warmer temperatures. © 2015 The Fisheries Society of the British Isles.

Nurse had 'impaired' fitness to practise.

PubMed

2017-04-28

A nurse has been reprimanded by the Nursing and Midwifery Council (NMC) aft er depriving a care home resident of 'any chance he had to survive', by failing to commence cardiopulmonary resuscitation (CPR).

Transferability of laparoscopic skills using the virtual reality simulator.

PubMed

Yang, Cui; Kalinitschenko, Uljana; Helmert, Jens R; Weitz, Juergen; Reissfelder, Christoph; Mees, Soeren Torge

2018-03-30

Skill transfer represents an important issue in surgical education, and is not well understood. The aim of this randomized study is to assess the transferability of surgical skills between two laparoscopic abdominal procedures using the virtual reality simulator in surgical novices. From September 2016 to July 2017, 44 surgical novices were randomized into two groups and underwent a proficiency-based basic training consisting of five selected simulated laparoscopic tasks. In group 1, participants performed an appendectomy training on the virtual reality simulator until they reached a defined proficiency. They moved on to the tutorial procedural tasks of laparoscopic cholecystectomy. Participants in group 2 started with the tutorial procedural tasks of laparoscopic cholecystectomy directly. Finishing the training, participants of both groups were required to perform a complete cholecystectomy on the simulator. Time, safety and economy parameters were analysed. Significant differences in the demographic characteristics and previous computer games experience between the two groups were not noted. Both groups took similar time to complete the proficiency-based basic training. Participants in group 1 needed significantly less movements (388.6 ± 98.6 vs. 446.4 ± 81.6; P < 0.05) as well as shorter path length (810.2 ± 159.5 vs. 945.5 ± 187.8 cm; P < 0.05) to complete the cholecystectomy compared to group 2. Time and safety parameters did not differ significantly between both groups. The data demonstrate a positive transfer of motor skills between laparoscopic appendectomy and cholecystectomy on the virtual reality simulator; however, the transfer of cognitive skills is limited. Separate training curricula seem to be necessary for each procedure for trainees to practise task-specific cognitive skills effectively. Mentoring could help trainees to get a deeper understanding of the procedures, thereby increasing the chance for the transfer of acquired skills.

Planning and preparing for public health threats at airports.

PubMed

Martin, Greg; Boland, Mairin

2018-03-07

The ever-increasing speed and scope of human mobility by international air travel has led to a global transport network for infectious diseases with the potential to introduce pathogens into non-endemic areas, and to facilitate rapid spread of novel or mutated zoonotic agents.Robust national emergency preparedness is vital to mitigate the transmission of infectious diseases agents domestically and to prevent onward spread to other countries. Given the complex range of stakeholders who respond to an infectious disease threat being transmitted through air travel, it is important that protocols be tested and practised extensively in advance of a real emergency. Simulation exercises include the identification of possible scenarios based on the probability of hazards and the vulnerability of populations as a basis for planning, and provide a useful measure of preparedness efforts and capabilities.In October 2016, a live simulation exercise was conducted at a major airport in Ireland incorporating a public health threat for the first time, with the notification of a possible case of MERS-CoV aboard an aircraft plus an undercarriage fire. Strengths of the response to the communicable disease threat included appropriate public health risk assessment, case management, passenger information gathering, notification to relevant parties, and communication to passengers and multiple agencies.Lessons learned include:o Exercise planning should not be overly ambitious. In testing too many facets of emergency response, the public health response could be deprioritised.o The practical implementation of communication protocols in a real-time exercise of this scope proved challenging. These protocols should continue to be checked and tested by desk-top exercises to ensure that all staff concerned are familiar with them, especially in the context of staff turn-over.o The roles and responsibilities of the various agencies must be clear to avoid role confusion.o Equipment and infrastructure capacities must be considered and in place in advance of an actual incident or test, for example whether or not cell phone signals require boosting during a major event.Importantly, exercises bring together individuals representing organisations with different roles and perspectives allowing identification of capabilities and limitations, and problem solving about how to address the gaps and overlaps in a low-threat collaborative setting.

Evaluation of a theory-informed implementation intervention for the management of acute low back pain in general medical practice: the IMPLEMENT cluster randomised trial.

PubMed

French, Simon D; McKenzie, Joanne E; O'Connor, Denise A; Grimshaw, Jeremy M; Mortimer, Duncan; Francis, Jill J; Michie, Susan; Spike, Neil; Schattner, Peter; Kent, Peter; Buchbinder, Rachelle; Page, Matthew J; Green, Sally E

2013-01-01

This cluster randomised trial evaluated an intervention to decrease x-ray referrals and increase giving advice to stay active for people with acute low back pain (LBP) in general practice. General practices were randomised to either access to a guideline for acute LBP (control) or facilitated interactive workshops (intervention). We measured behavioural predictors (e.g. knowledge, attitudes and intentions) and fear avoidance beliefs. We were unable to recruit sufficient patients to measure our original primary outcomes so we introduced other outcomes measured at the general practitioner (GP) level: behavioural simulation (clinical decision about vignettes) and rates of x-ray and CT-scan (medical administrative data). All those not involved in the delivery of the intervention were blinded to allocation. 47 practices (53 GPs) were randomised to the control and 45 practices (59 GPs) to the intervention. The number of GPs available for analysis at 12 months varied by outcome due to missing confounder information; a minimum of 38 GPs were available from the intervention group, and a minimum of 40 GPs from the control group. For the behavioural constructs, although effect estimates were small, the intervention group GPs had greater intention of practising consistent with the guideline for the clinical behaviour of x-ray referral. For behavioural simulation, intervention group GPs were more likely to adhere to guideline recommendations about x-ray (OR 1.76, 95%CI 1.01, 3.05) and more likely to give advice to stay active (OR 4.49, 95%CI 1.90 to 10.60). Imaging referral was not statistically significantly different between groups and the potential importance of effects was unclear; rate ratio 0.87 (95%CI 0.68, 1.10) for x-ray or CT-scan. The intervention led to small changes in GP intention to practice in a manner that is consistent with an evidence-based guideline, but it did not result in statistically significant changes in actual behaviour. Australian New Zealand Clinical Trials Registry ACTRN012606000098538.

Evaluation of a Theory-Informed Implementation Intervention for the Management of Acute Low Back Pain in General Medical Practice: The IMPLEMENT Cluster Randomised Trial

PubMed Central

French, Simon D.; McKenzie, Joanne E.; O'Connor, Denise A.; Grimshaw, Jeremy M.; Mortimer, Duncan; Francis, Jill J.; Michie, Susan; Spike, Neil; Schattner, Peter; Kent, Peter; Buchbinder, Rachelle; Page, Matthew J.; Green, Sally E.

2013-01-01

Introduction This cluster randomised trial evaluated an intervention to decrease x-ray referrals and increase giving advice to stay active for people with acute low back pain (LBP) in general practice. Methods General practices were randomised to either access to a guideline for acute LBP (control) or facilitated interactive workshops (intervention). We measured behavioural predictors (e.g. knowledge, attitudes and intentions) and fear avoidance beliefs. We were unable to recruit sufficient patients to measure our original primary outcomes so we introduced other outcomes measured at the general practitioner (GP) level: behavioural simulation (clinical decision about vignettes) and rates of x-ray and CT-scan (medical administrative data). All those not involved in the delivery of the intervention were blinded to allocation. Results 47 practices (53 GPs) were randomised to the control and 45 practices (59 GPs) to the intervention. The number of GPs available for analysis at 12 months varied by outcome due to missing confounder information; a minimum of 38 GPs were available from the intervention group, and a minimum of 40 GPs from the control group. For the behavioural constructs, although effect estimates were small, the intervention group GPs had greater intention of practising consistent with the guideline for the clinical behaviour of x-ray referral. For behavioural simulation, intervention group GPs were more likely to adhere to guideline recommendations about x-ray (OR 1.76, 95%CI 1.01, 3.05) and more likely to give advice to stay active (OR 4.49, 95%CI 1.90 to 10.60). Imaging referral was not statistically significantly different between groups and the potential importance of effects was unclear; rate ratio 0.87 (95%CI 0.68, 1.10) for x-ray or CT-scan. Conclusions The intervention led to small changes in GP intention to practice in a manner that is consistent with an evidence-based guideline, but it did not result in statistically significant changes in actual behaviour. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN012606000098538 PMID:23785427

Human factors simulation in construction management education

NASA Astrophysics Data System (ADS)

Jaeger, M.; Adair, D.

2010-06-01

Successful construction management depends primarily on the representatives of the involved construction project parties. In addition to effective application of construction management tools and concepts, human factors impact significantly on the processes of any construction management endeavour. How can human factors in construction management be taught effectively? Although simulations are applied in construction management education, they have not incorporated human factors sufficiently. The focus on human factors as part of the simulation of construction management situations increases students' learning effectiveness within a cross-cultural teaching setting. This paper shows the development of discrete-event human factors in construction management simulation. A description of the source code is given. Learning effectiveness in a cross-cultural education setting was analysed by evaluating data obtained through student questionnaire surveys. The mean score obtained by the students using the simulator was 32% better than those not exposed to the simulator. The spread of results was noticeably greater for the students not exposed to the simulator. The human factors simulation provides an effective means to teach students the complexities and dynamics of interpersonal relationships in construction management.

Reflective intuition: defining A&E nursing.

PubMed

Cook, A

1996-01-01

A&E nurses may develop intuitive feelings about the condition of their patients. A&E nurses are practising reflective intuition, based on experience. Recognition of this skill could raise the professional status of nursing.

Why doctors don't use computers: some empirical findings.

PubMed Central

Anderson, J G; Jay, S J; Schweer, H M; Anderson, M M

1986-01-01

The attitudes of 148 medical students, 141 residents, and 644 practising physicians towards computer applications in medicine were studied. The results indicate that physicians recognize the potential of computers to improve patient care, but are concerned about the possibility of increased governmental and hospital control, threats to privacy, and legal and ethical problems. In general, all three groups are uncertain as to the potential effects of computers on their traditional professional role and on the organization of practice. Practising physicians, however, express more concern about these potential effects of computers than do medical students and residents. While attitudes appear to be somewhat independent of prior computer experience, they significantly affect the extent to which physicians use a computer-based hospital information system. This may be a major reason for the slow introduction of clinical computer systems. PMID:3701749

Educational agenda for diagnostic error reduction

PubMed Central

Trowbridge, Robert L; Dhaliwal, Gurpreet; Cosby, Karen S

2013-01-01

Diagnostic errors are a major patient safety concern. Although the majority of diagnostic errors are partially attributable to cognitive mistakes, the most effective means of improving clinician cognition in order to achieve gains in diagnostic reliability are unclear. We propose a tripartite educational agenda for improving diagnostic performance among students, residents and practising physicians. This agenda includes strengthening the metacognitive abilities of clinicians, fostering intuitive reasoning and increasing awareness of the role of systems in the diagnostic process. The evidence supporting initiatives in each of these realms is reviewed and a course of future implementation and study is proposed. The barriers to designing and implementing this agenda are substantial and include limited evidence supporting these initiatives and the challenges of changing the practice patterns of practising physicians. Implementation will need to be accompanied by rigorous evaluation. PMID:23764435

Facilitating and obstructing factors for development of learning in clinical practice: a student perspective.

PubMed

Löfmark, A; Wikblad, K

2001-04-01

The aim of this study was to provide information on what the student nurses found facilitating and obstructing for their learning during clinical practice. Earlier studies of experiences of learning in clinical practice have shown that factors as the possibilities of variations of experiences, the culture of the workplace, and communication between the educational institution and health care facilities are of importance. Less is known about the opportunities which students are given in order to practise the skills that they will be expected to perform as new graduate nurses. The experiences of 47 degree student nurses from two colleges in Sweden were gathered in weekly diaries during their final period of clinical practice. A content analysis technique was used to analyse their diaries. The students emphasized responsibility and independence, opportunities to practise different tasks, and receiving feedback as facilitating factors. Other perceived promoting factors included perceptions of control of the situation and understanding of the 'total picture'. Examples of obstructing factors were the nurses as supervisors not relying on the students, supervision that lacked continuity and lack of opportunities to practise. Perception of their own insufficiency and low self-reliance were drawbacks for some students. Recommended proposals are presented to lecturers and supervising staff concerning organizational and educational changes, and changes of attitudes for elucidating the students' experiences of different facilitating and obstructing factors. Changes may contribute to making easier the students' transition into the nursing profession.

Effect of wave action on near-well zone cleaning

NASA Astrophysics Data System (ADS)

Pen'kovskii, V. I.; Korsakova, N. K.

2017-10-01

Drilling filtrate invasion into the producing formation and native water accumulating of the near-well zone in well operation reduce the well productivity. As a result of that, depending on characteristic capillary pressure scale and differential pressure drawdown, oil production rate may become lower than expected one. In this paper, it is considered the hysteresis effects of capillary pressure after reversion of displacement. As applied to laboratory experiment conditions, the solution of problem of oil flow in formation model with a pressure drop on the model sides harmonically varied with time is presented. It was estimated a range of fluid vibration effective action on the near-well zone cleaning from capillary locking water. The plant simulating extraction of oil from formation using widely practised sucker-rod pump has been created. Formation model is presented as a slot filled with broken glass between two plates. In the process, natural oil and sodium chloride solution were used as working fluids. The experiments qualitatively confirm a positive effect of jack pumps on the near-well zone cleaning.

A dangerous method? The German discourse on hypnotic suggestion therapy around 1900

PubMed Central

Maehle, Andreas-Holger

2017-01-01

In the late nineteenth century, German-speaking physicians and psychiatrists intensely debated the benefits and risks of treatment by hypnotic suggestion. While practitioners of the method sought to provide convincing evidence for its therapeutic efficacy in many medical conditions, especially nervous disorders, critics pointed to dangerous side effects, including the triggering of hysterical attacks or deterioration of nervous symptoms. Other critics claimed that patients merely simulated hypnotic phenomena in order to appease their therapist. A widespread concern was the potential for abuses of hypnosis, either by giving criminal suggestions or in the form of sexual assaults on hypnotized patients. Official inquiries by the Prussian Minister for Religious, Educational and Medical Affairs in 1902 and 1906 indicated that relatively few doctors practised hypnotherapy, whereas the method was increasingly used by lay healers. Although the Ministry found no evidence for serious harm caused by hypnotic treatments, whether performed by doctors or by lay healers, many German doctors seem to have regarded hypnotic suggestion therapy as a problematic method and abstained from using it.

Challenges in the management of community pharmacies in Malaysia

PubMed Central

2017-01-01

Background: The provision of professional pharmacy services by community pharmacists continues to be limited, particularly in low and middle income countries. It was postulated that multiple management challenges faced by community pharmacists contribute to this situation. Objective: The primary aim of the research was to determine the challenges faced in the management of community pharmacies in Sarawak (the largest state in Malaysia), and practical strategies to cope and overcome the challenges. Methods: Semi-structured interviews were carried out with community pharmacists practising in Sarawak. Purposive and snowball sampling were employed to ensure a diverse group of informants. The interviews were audio-recorded and transcribed verbatim, with the resultant data analysed using thematic analysis. Data collection, coding, interpretation were carried out iteratively until theoretical saturation. Results: Twenty respondents from different demographic characteristics were recruited. Six major themes were identified. Management challenges faced by community pharmacists traverse five major domains: market competition, legislative issues, customers’ knowledge and expectations, macroeconomic impacts and operational challenges. Most of these challenges require government intervention to be resolved. In the meantime, improving customer service and expanding the range of professional services were seen as the most viable strategies to cope with existing challenges. The main concern is that current legislative and economic landscape may hinder these strategies. Enactment of dispensing separation and more protective measures against market competition were suggested to alleviate the challenges faced. Conclusion: Numerous management challenges faced by community pharmacists that distract them from delivering professional pharmacy services have been highlighted. Urgent affirmative actions by the government are warranted in supporting community pharmacists to realise and maximise their potentials. PMID:28690697

Mild traumatic brain injury in children: management practices in the acute care setting.

PubMed

Kool, Bridget; King, Vivienne; Chelimo, Carol; Dalziel, Stuart; Shepherd, Michael; Neutze, Jocelyn; Chambers, Nikki; Wells, Susan

2014-08-01

Accurate diagnosis, treatment and follow up of children suffering mild traumatic brain injury (MTBI) is important as post-concussive symptoms and long-term disability might occur. This research explored the decisions clinicians make in their assessment and management of children with MTBI in acute care settings, and identified barriers and enablers to the delivery of best-practice care. A purposeful sample of 29 clinicians employed in two metropolitan paediatric EDs and one Urgent Care clinic was surveyed using a vignette-based questionnaire that also included domains of guideline awareness, attitudes to MTBI care, use of clinical decision support systems, and knowledge and skills for practising evidence-based healthcare. Overall, the evaluation and management of children presenting acutely with MTBI generally followed best-practice guidelines, particularly in relation to identifying intracranial injuries that might require surgical intervention, observation for potential deterioration, adequate pain management and the provision of written head injury advice on discharge. Larger variation emerged in regard to follow-up care and referral pathways. Potential barriers to best- practice were lack of guideline awareness, attitudes to MTBI, and lack of time or other priorities. Opportunities exist to improve care for children who present in acute care settings following mild traumatic brain injury. These include having up-to-date guidelines that are consistent across acute care settings; providing clearer pathways for referral and follow up; targeting continuing medical education towards potential complications; and providing computerised decision support so that assessment and management are conducted systematically. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Is ice right? Does cryotherapy improve outcome for acute soft tissue injury?

PubMed

Collins, N C

2008-02-01

The use of ice or cryotherapy in the management of acute soft tissue injuries is widely accepted and widely practised. This review was conducted to examine the medical literature to investigate if there is evidence to support an improvement in clinical outcome following the use of ice or cryotherapy. A comprehensive literature search was performed and all human and animal trials or systematic reviews pertaining to soft tissue trauma, ice or cryotherapy were assessed. The clinically relevant outcome measures were (1) a reduction in pain; (2) a reduction in swelling or oedema; (3) improved function; or (4) return to participation in normal activity. Six relevant trials in humans were identified, four of which lacked randomisation and blinding. There were two well conducted randomised controlled trials, one showing supportive evidence for the use of a cooling gel and the other not reaching statistical significance. Four animal studies showed that modest cooling reduced oedema but excessive or prolonged cooling is damaging. There were two systematic reviews, one of which was inconclusive and the other suggested that ice may hasten return to participation. There is insufficient evidence to suggest that cryotherapy improves clinical outcome in the management of soft tissue injuries.

A qualitative study analyzing access to physical rehabilitation for traffic accident victims with severe disability in Brazil.

PubMed

Sousa, Kelienny de Meneses; Oliveira, Wagner Ivan Fonsêca de; Melo, Laiza Oliveira Mendes de; Alves, Emanuel Augusto; Piuvezam, Grasiela; Gama, Zenewton André da Silva

2017-03-01

Purpose To identify access barriers to physical rehabilitation for traffic accident (TA) victims with severe disability and build a theoretical model to provide guidance towards the improvement of these services. Methods Qualitative research carried out in the city of Natal (Northeast Brazil), with semi-structured interviews with 120 subjects (19 key informer health professionals and 101 TA victims) identified in a database made available by the emergency hospital. The interviews were analyzed using Alceste software, version 4.9. Results The main barriers present in the interviews were: (1) related to services: bureaucratic administrative practises, low offer of rehabilitation services, insufficient information on rehabilitation, lack of guidelines that integrate hospital and ambulatory care and (2) related to patients: financial difficulties, functional limitations, geographic distance, little information on health, association with low education levels and disbelief in the system and in rehabilitation. Conclusion The numerous access barriers were presented in a theoretical model with causes related to organizational structure, processes of care, professionals and patients. This model must be tested by health policy-makers and managers to improve the quality of physical rehabilitation and avoid unnecessary prolongation of the suffering and disability experienced by TA survivors. Implications for rehabilitation Traffic accidents (TAs) are a global health dilemma that demands integrality of preventive actions, pre-hospital and hospital care and physical rehabilitation (PR). This study lays the foundation for improving access to PR for TA survivors, an issue of quality of care that results in preventable disabilities. The words of the patients interviewed reveal the suffering of victims, which is often invisible to society and given low priority by health policies that relegate PR to a second plan ahead of prevention and urgent care. A theoretical model of the causes of the problem of access to PR was built. The identified barriers are potentially preventable through the intervention of health policy-makers, managers, regulators and rehabilitation professionals, and by encouraging the participation of patients. Addressing timely access barriers involves the expansion of the supply of services and rehabilitation professionals, regulation and standardization of referencing practises and encouraging the provision of information to patients about continuity of care and their health needs.

Hands on + hands free: simulated on-call interaction.

PubMed

Fisher, James; Martin, Richard; Tate, David

2014-10-01

In hospital, doctors and nurses frequently discuss acutely unwell patients via the telephone. Telephone communication can be challenging, yet medical students receive little training in how to conduct such interactions. We aimed to provide a simple, innovative, simulation session to address this learning need for third-year medical students at Newcastle University. Groups of students were given a pager and a supervising tutor. Students responded to a 'bleep' from a nurse practitioner in a different room, who role-played a ward nurse concerned about a patient. Speakerphones were used, allowing the entire conversation to be audible. After the call, a student-led debriefing session took place. After the debriefing another student 'held' the bleep and a different scenario ensued. Following a resuscitation scenario, students made telephone contact with the medical registrar to hand over information pertaining to the case. Before and after the session, students rated their confidence in telephone interaction and handover using a 10-point Likert scale. Students also completed a feedback questionnaire. Fifty-four students attended the session. A statistically significant improvement in student confidence in telephone communication and handover was seen after the session. Free-text feedback highlighted that students had not received teaching on this previously, and that they welcomed opportunities to practise such skills within a controlled, safe environment. Simulation training can be costly, but speakerphones are cheap and readily available. Given the frequency of telephone interaction in hospital, we believe all medical students should receive telephone communication training. Locally, our department has now incorporated these teaching methods into simulation sessions elsewhere in the curriculum. Medical students receive little training in how to conduct [telephone] interactions. © 2014 John Wiley & Sons Ltd.

How do general practitioners manage patients with cancer symptoms? A video-vignette study.

PubMed

Jiwa, Moyez; Meng, Xingqiong; O'Shea, Carolyn; Magin, Parker; Dadich, Ann; Pillai, Vinita

2015-09-14

Determine how general practitioners (GPs) manage patients with cancer symptoms. GPs reviewed 24 video-vignettes and case notes on patients with cancer symptoms and indicated whether they would refer the patient and/or prescribe medication, and/or undertake further investigation. According to available guidelines, all cases warranted a referral to a specialist or further investigations. Australian primary care sector. 102 practising GPs participated in this study, including trainees. The research was part of a larger randomised controlled trial testing a referral pro forma; however, this paper reports on management decisions made throughout the study. This paper reports on how the participants would manage the patients depicted in each vignette. In more than one-in-eight cases, the patient was not investigated or referred. Patient management varied significantly by cancer type (p<0.001). For two key reasons, colorectal cancer was the chosen referent category. First, it represents a prevalent type of cancer. Second, in this study, colorectal cancer symptoms were managed in a similar proportion of options-that is, prescription, referral or investigation. Compared with vignettes featuring colorectal cancer participants were less likely to manage breast, bladder, endometrial, and lung cancers with a 'prescription only' or 'referral only' option. They were less likely to manage prostate cancer with a 'prescription only', yet more likely to manage it with a 'referral with investigation'. With regard to pancreatic and cervical cancers, participants were more likely to manage these with a 'referral only' or a 'referral with investigation'. Some patients may receive a delayed cancer diagnosis, even when they present with typical cancer symptoms to a GP who can access relevant diagnostic tests. ACTRN12611000760976. 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.

Report on neglect sparks FtP hearings.

PubMed

2015-07-22

A major review of neglect of older people has led to three nurses being removed from the register and a further six being involved in fitness to practise hearings, the Nursing and Midwifery Council said.

Evaluation of obstetricians' surgical decision making in the management of uterine rupture.

PubMed

Eze, Justus Ndulue; Anozie, Okechukwu Bonaventure; Lawani, Osaheni Lucky; Ndukwe, Emmanuel Okechukwu; Agwu, Uzoma Maryrose; Obuna, Johnson Akuma

2017-06-08

Uterine rupture is an obstetric calamity with surgery as its management mainstay. Uterine repair without tubal ligation leaves a uterus that is more prone to repeat rupture while uterine repair with bilateral tubal ligation (BTL) or (sub)total hysterectomy predispose survivors to psychosocial problems like marital disharmony. This study aims to evaluate obstetricians' perspectives on surgical decision making in managing uterine rupture. A questionnaire-based cross-sectional study of obstetricians at the 46th annual scientific conference of Society of Gynaecology and Obstetrics of Nigeria in 2012. Data was analysed by descriptive and inferential statistics. Seventy-nine out of 110 obstetricians (71.8%) responded to the survey, of which 42 (53.2%) were consultants, 60 (75.9%) practised in government hospitals and 67 (84.8%) in urban hospitals, and all respondents managed women with uterine rupture. Previous cesarean scars and injudicious use of oxytocic are the commonest predisposing causes, and uterine rupture carries very high incidences of maternal and perinatal mortality and morbidity. Uterine repair only was commonly performed by 38 (48.1%) and uterine repair with BTL or (sub) total hysterectomy by 41 (51.9%) respondents. Surgical management is guided mainly by patients' conditions and obstetricians' surgical skills. Obstetricians' distribution in Nigeria leaves rural settings starved of specialist for obstetric emergencies. Caesarean scars are now a rising cause of ruptures. The surgical management of uterine rupture and obstetricians' surgical preferences vary and are case scenario-dependent. Equitable redistribution of obstetricians and deployment of medical doctors to secondary hospitals in rural settings will make obstetric care more readily available and may reduce the prevalence and improve the outcome of uterine rupture. Obstetrician's surgical decision-making should be guided by the prevailing case scenario and the ultimate aim should be to avert fatality and reduce morbidity.

Case Management of Severe Malaria - A Forgotten Practice: Experiences from Health Facilities in Uganda

PubMed Central

Achan, Jane; Tibenderana, James; Kyabayinze, Daniel; Mawejje, Henry; Mugizi, Rukaaka; Mpeka, Betty; Talisuna, Ambrose; D'Alessandro, Umberto

2011-01-01

Introduction Severe malaria is a life-threatening medical emergency and requires prompt and effective treatment to prevent death. There is paucity of published information on current practices of severe malaria case management in sub-Saharan Africa; we evaluated the management practices for severe malaria in Ugandan health facilities Methods and Findings We did a cross sectional survey, using multi-stage sampling methods, of health facilities in 11 districts in the eastern and mid-western parts of Uganda. The study instruments were adapted from the WHO hospital care assessment tools. Between June and August 2009, 105 health facilities were surveyed and 181 health workers and 868 patients/caretakers interviewed. None of the inpatient facilities had all seven components of a basic care package for the management of severe malaria consistently available during the 3 months prior to the survey. Referral practices were appropriate for <10% (18/196) of the patients. Prompt care at any health facility was reported by 29% (247/868) of patients. Severe malaria was correctly diagnosed in 27% of patients (233).Though the quinine dose and regimen was correct in the majority (611/868, 70.4%) of patients, it was administered in the correct volumes of 5% dextrose in only 18% (147/815). Most patients (80.1%) had several doses of quinine administered in one single 500 ml bottle of 5% dextrose. Medications were purchased by 385 (44%) patients and medical supplies by 478 patients (70.6%). Conclusions Management of severe malaria in Ugandan health facilities was sub-optimal. These findings highlight the challenges of correctly managing severe malaria in resource limited settings. Priority areas for improvement include triage and emergency care, referral practises, quality of diagnosis and treatment, availability of medicines and supplies, training and support supervision. PMID:21390301

Management of dredge material in the Republic of Ireland - A review.

PubMed

Sheehan, C; Harrington, J

2012-05-01

As an island nation the Republic of Ireland's ports and harbours are key to the economic wellbeing of the country as they are the primary transport link to the United Kingdom, mainland Europe and beyond. This paper examines the main aspects of the Irish dredging industry with comparison to international practice and standards, including the source of the dredge material and volumes generated annually, the dredging plant employed and the management processes currently practised. Relevant European and Irish legislation governing dredging, disposal at sea and waste licensing are presented. The potential impacts of disposal at sea are discussed with the implications for the Irish dredging industry of recently introduced European Directives assessed. Beneficial use rates for dredge material and the techniques implemented in Ireland are examined and compared with international practice. Recent notable beneficial use projects for dredge material and proposed innovative dredge material management techniques for specific dredging projects in Ireland are presented. Proposals to encourage greater beneficial use of dredge material and minimise disposal at sea for Ireland are presented including the introduction of environmental credits, tax breaks and a grant system for pilot schemes. An alternative disposal at sea charge fee structure is also recommended to encourage alternative dredge material management practices. Ireland's management of contaminated sediment is also presented with recent projects described highlighting the current practice of primarily exporting contaminated sediment to mainland Europe. Alternative methods of treatment of contaminated sediment are assessed in an Irish context. Future issues and challenges facing the Irish dredging industry are assessed and a critical analysis of the current approaches to dredge material management is presented. Copyright © 2011 Elsevier Ltd. All rights reserved.

Neurologists' understanding and management of conversion disorder.

PubMed

Kanaan, Richard A; Armstrong, David; Wessely, Simon Charles

2011-09-01

Conversion disorder is largely managed by neurologists, for whom it presents great challenges to understanding and management. This study aimed to quantify these challenges, examining how neurologists understand conversion disorder, and what they tell their patients. A postal survey of all consultant neurologists in the UK registered with the Association of British Neurologists. 349 of 591 practising consultant neurologists completed the survey. They saw conversion disorder commonly. While they endorsed psychological models for conversion, they diagnosed it according to features of the clinical presentation, most importantly inconsistency and abnormal illness behaviour. Most of the respondents saw feigning as entangled with conversion disorder, with a minority seeing one as a variant of the other. They were quite willing to discuss psychological factors as long as the patient was receptive but were generally unwilling to discuss feigning even though they saw it as their responsibility. Those who favoured models in terms of feigning were older, while younger, female neurologists preferred psychological models, believed conversion would one day be understood neurologically and found communicating with their conversion patients easier than it had been in the past. Neurologists accept psychological models for conversion disorder but do not employ them in their diagnosis; they do not see conversion as clearly different from feigning. This may be changing as younger, female neurologists endorse psychological views more clearly and find it easier to discuss with their patients.

Neurologists' understanding and management of conversion disorder

PubMed Central

Armstrong, David; Wessely, Simon Charles

2011-01-01

Background Conversion disorder is largely managed by neurologists, for whom it presents great challenges to understanding and management. This study aimed to quantify these challenges, examining how neurologists understand conversion disorder, and what they tell their patients. Methods A postal survey of all consultant neurologists in the UK registered with the Association of British Neurologists. Results 349 of 591 practising consultant neurologists completed the survey. They saw conversion disorder commonly. While they endorsed psychological models for conversion, they diagnosed it according to features of the clinical presentation, most importantly inconsistency and abnormal illness behaviour. Most of the respondents saw feigning as entangled with conversion disorder, with a minority seeing one as a variant of the other. They were quite willing to discuss psychological factors as long as the patient was receptive but were generally unwilling to discuss feigning even though they saw it as their responsibility. Those who favoured models in terms of feigning were older, while younger, female neurologists preferred psychological models, believed conversion would one day be understood neurologically and found communicating with their conversion patients easier than it had been in the past. Discussion Neurologists accept psychological models for conversion disorder but do not employ them in their diagnosis; they do not see conversion as clearly different from feigning. This may be changing as younger, female neurologists endorse psychological views more clearly and find it easier to discuss with their patients. PMID:21325661

A pharmacy business management simulation exercise as a practical application of business management material and principles.

PubMed

Rollins, Brent L; Gunturi, Rahul; Sullivan, Donald

2014-04-17

To implement a pharmacy business management simulation exercise as a practical application of business management material and principles and assess students' perceived value. As part of a pharmacy management and administration course, students made various calculations and management decisions in the global categories of hours of operation, inventory, pricing, and personnel. The students entered the data into simulation software and a realistic community pharmacy marketplace was modeled. Course topics included accounting, economics, finance, human resources, management, marketing, and leadership. An 18-item posttest survey was administered. Students' slightly to moderately agreed the pharmacy simulation program enhanced their knowledge and understanding, particularly of inventory management, cash flow statements, balance sheets, and income statements. Overall attitudes toward the pharmacy simulation program were also slightly positive and students also slightly agreed the pharmacy simulation program enhanced their learning of pharmacy business management. Inventory management was the only area in which students felt they had at least "some" exposure to the assessed business management topics during IPPEs/internship, while all other areas of experience ranged from "not at all" to "a little." The pharmacy simulation program is an effective active-learning exercise and enhanced students' knowledge and understanding of the business management topics covered.

A Pharmacy Business Management Simulation Exercise as a Practical Application of Business Management Material and Principles

PubMed Central

Rollins, Brent L.; Gunturi, Rahul; Sullivan, Donald

2014-01-01

Objective. To implement a pharmacy business management simulation exercise as a practical application of business management material and principles and assess students’ perceived value. Design. As part of a pharmacy management and administration course, students made various calculations and management decisions in the global categories of hours of operation, inventory, pricing, and personnel. The students entered the data into simulation software and a realistic community pharmacy marketplace was modeled. Course topics included accounting, economics, finance, human resources, management, marketing, and leadership. Assessment. An 18-item posttest survey was administered. Students’ slightly to moderately agreed the pharmacy simulation program enhanced their knowledge and understanding, particularly of inventory management, cash flow statements, balance sheets, and income statements. Overall attitudes toward the pharmacy simulation program were also slightly positive and students also slightly agreed the pharmacy simulation program enhanced their learning of pharmacy business management. Inventory management was the only area in which students felt they had at least “some” exposure to the assessed business management topics during IPPEs/internship, while all other areas of experience ranged from “not at all” to “a little.” Conclusion. The pharmacy simulation program is an effective active-learning exercise and enhanced students’ knowledge and understanding of the business management topics covered. PMID:24761023

A Water Demand Management Strategy For The Namibian Tourism Sector

NASA Astrophysics Data System (ADS)

Schachtschneider, K.; Winter, K.

The arid conditions of Namibia are forcing its decision-makers to resort to new wa- ter resource management approaches, including Water Demand Management (WDM). When Namibia achieved its independence from South Africa 1990, a new opportunity arose to rewrite certain restrictive laws and policies in order to bring about redress, development and transformation. The new Water Policy is one example in which the mindset is changed from a supply to a demand oriented water management ap- proach. Legal support for WDM within the new Water Act is a critical component that will support the implementation of WDM in all economic sectors, such as agri- culture, mining and tourism. It is argued that an appropriate WDM strategy should be designed specifically for each sector, once the typical water use patterns in a sec- tor are understood and key water resource managers at all levels are identified. The Namibian tourism sector is geographically dispersed and control over its operations is compounded by the fact that it is frequently located in extremely remote areas that are arid and ecologically sensitive. In general, WDM is rarely practised, because it is not yet supported by law and there are currently no institutional arrangements to con- trol water use in this geographically dispersed industrial sector through which WDM could be enforced either through metering and/or payments. Managers of tourist en- terprises undertake most of the water management themselves, and have been identi- fied as being crucial to the implementation of WDM strategies. A study of six tourist facilities determined the willingness and motivation of these managers to undertake various WDM initiatives. The study identified three factors which appear to influence the actions of managers, namely external controls, economics and company ethics. It is recommended that a tourism sector WDM strategy should focus on these three factors in order to transform the WDM aims and objectives on the policy level into practical implementation at the tourist facility level.

The views of nurses regarding caring in the workplace.

PubMed

Minnaar, A

2003-05-01

This survey describes caring in the workplace in selected health services and is part of a greater study conducted in KwaZulu-Natal, South Africa. This study describes the views of nurse managers and nurses regarding caring in the workplace. Human competence, recovery and healing are central to caring. To ensure caring and healing of patients in health services it is of the utmost importance for nurse managers to ensure a healthy and caring environment in the management of nurses. When caring is present in the workplace, nurses are more able to render caring nursing practices in the patient care environment. It is clear that to become a caring person, one must be treated in a caring way and that caring may be impaired or reinforced by the environment. The environment of interest to this study was the environment in which nurses practise. A descriptive survey with a convenience sampling explored caring in the workplace of nurses. The questionnaire was divided into two sections. Section A comprised demographic information and in section B the questionnaire consisted of Likert type questions, open-ended questions and yes/no questions. Analysis included descriptive statistics. It was found that caring was not experienced in the hospitals by nurses in the major management tasks such as respect for human dignity, two-way communication, trust between nurses and nurse managers, wellness, cultural sensitivity, support and the recognition and handling of the concerns of nurses. It was clear that although nurse managers and nurses have the knowledge and structures for the implementation of caring in the hospitals, the everyday practical application of caring needs attention. Nurse managers were aware of caring practices but nurses did not always experience caring in their places of work in the hospitals. Nurse managers and nurses should all accept responsibility for finding means to improve communication and, in particular, participative leadership strategies in the hospitals. Previous research showed that a large majority of nurses agreed on which caring concepts were important aspects in nursing management.

NMC denies prioritising new FtP cases to meet government target.

PubMed

Osborne, Katie

2015-01-27

The Nursing and Midwifery Council's success in reducing the time it takes to handle fitness to practise cases has not been achieved by neglecting older cases, according to its chief executive Jackie Smith.

Retrieval of past and future positive and negative autobiographical experiences.

PubMed

García-Bajos, Elvira; Migueles, Malen

2017-09-01

We studied retrieval-induced forgetting for past or future autobiographical experiences. In the study phase, participants were given cues to remember past autobiographical experiences or to think about experiences that may occur in the future. In both conditions, half of the experiences were positive and half negative. In the retrieval-practice phase, for past and future experiences, participants retrieved either half of the positive or negative experiences using cued recall, or capitals of the world (control groups). Retrieval practice produced recall facilitation and enhanced memory for the practised positive and negative past and future experiences. While retrieval practice on positive experiences did not impair the recall of other positive experiences, we found inhibition for negative past and future experiences when participants practised negative experiences. Furthermore, retrieval practice on positive future experiences inhibited negative future experiences. These positivity biases for autobiographical memory may have practical implications for treatment of emotional disorders.

Applications of biomechanics for prevention of work-related musculoskeletal disorders.

PubMed

Garg, Arun; Kapellusch, Jay M

2009-01-01

This paper summarises applications of biomechanical principles and models in industry to control musculoskeletal disorders of the low back and upper extremity. Applications of 2-D and 3-D biomechanical models to estimate compressive force on the low back, the strength requirements of jobs, application of guidelines for overhead work and application of strain index and threshold limit value to address distal upper extremity musculoskeletal disorders are presented. Several case studies applied in the railroad industry, manufacturing, healthcare and warehousing are presented. Finally, future developments needed for improved biomechanical applications in industry are discussed. The information presented will be of value to practising ergonomists to recognise how biomechanics has played a significant role in identifying causes of musculoskeletal disorders and controlling them in the workplace. In particular, the information presented will help practising ergonomists with how physical stresses can be objectively quantified.

How and when do students use flashcards?

PubMed

Wissman, Kathryn T; Rawson, Katherine A; Pyc, Mary A

2012-01-01

Previous survey research has documented students' use of self-regulated study strategies, with a particular interest in self-testing. These surveys indicate that students frequently use flashcards to self-test and that self-testing is primarily used as a way to monitor learning. Whereas previous surveys provide information about whether and why students self-test, they provide minimal information about how and when students choose to self-test. Accordingly, the primary purpose of the current survey was to explore how and when students engage in self-testing. We surveyed 374 undergraduates about the amount of practice and the timing of practice, two factors that strongly affect the efficacy of self-testing. Results indicate that students understand the benefits of practising to higher criterion levels (amount of practice) but do not typically implement or understand the benefits of practising with longer lags (timing of practice). We discuss practical implications for supporting more successful student learning.

Long-term care planning study: strengths and learning needs of nursing staff.

PubMed

Cruttenden, Kathleen E

2006-01-01

This planning study was designed and conducted in a predominantly rural Canadian province to examine the strengths and learning needs of four categories of nursing staff practising in New Brunswick nursing homes. Participants included directors of care, registered nurses, licensed practical nurses, and resident attendants. The nursing homes ranged in size from 38 to 196 beds and were located throughout the province. In health and planning studies, ethnography conveys a coherent statement of peoples' local knowledge as culture-sharing groups (Muecke, 1994). The study derived information from the Nursing Home Act, reports, the literature, key informants, and direct observations of and interviews with participants. Leadership strengths defined the roles for categories of staff and supported the capacity of each category to identify their learning needs. In conclusion, nurses practising in nursing homes can and must take an active role in decision making for their learning.

Karaoke therapy in the rehabilitation of mental patients.

PubMed

Leung, C M; Lee, G; Cheung, B; Kwong, E; Wing, Y K; Kan, C S; Lau, J

1998-04-01

To study the efficacy of karaoke singing and its implications in the rehabilitation of mental patients in Hong Kong Chinese. A double blind controlled trial was conducted over six weeks in a small sample of chronic schizophrenic patients matched in age, sex and duration of illness. The index group practised karaoke and the controlled group practised simple singing. Subjects were assessed in changes in mood and social interaction. No significant difference was detectable within the 2 groups. However, significant differences of anxiety and social interaction at the end of the third and sixth weeks respectively, were detectable between the 2 groups. Karaoke therapy may be more effective than simple singing in improving social interaction. There is preliminary evidence that it may be anxiety-provoking for unstable schizophrenic patients. More research is required for further elucidation of the characteristics of favourable candidates, optimal schedule and active components of the therapy.

Lifelong learning skills: how experienced are students when they enter medical school?

PubMed

Whittle, Sue R; Murdoch-Eaton, Deborah G

2004-09-01

Widening participation initiatives together with changes in school curricula in England may broaden the range of lifelong learning skills experience of new undergraduates. This project examines the experience levels of current students, as a comparative baseline. First-year medical students completed a questionnaire on arrival, investigating their practice of 31 skills during the previous two years. Responses show that most students have regularly practised transferable skills. However, significant numbers report little experience, particularly in IT skills such as email, using the Internet, spreadsheets and databases. Some remain unfamiliar with word processing. Library research, essay writing and oral presentation are also rarely practised by substantial numbers. One-third of students lack experience of evaluating their own strengths and weaknesses. Current students already show diversity of experience in skills on arrival at medical school. Changes in the near future may increase this range of experience further, and necessitate changes to undergraduate courses.

Scaling ethics up and down: moral craft in clinical genetics and in global health research

PubMed Central

Parker, Michael

2015-01-01

This paper engages with the question of what it is to ‘do good medical ethics’ in two ways. It begins with an exploration of what it might mean to say that health professionals practise good medical ethics as part of practising good ethical medicine. Using the example of the Genethics Club, a well-established national ethics forum for genetics professionals in the UK, the paper develops an account of moral craftsmanship grounded in the concepts of shared moral commitments and practices, moral work, ethics and living morality. In the light of this discussion, the paper goes on to consider what it might mean for a specialist in medical ethics, a bioethicist, to do good medical ethics. Finally, a research agenda focusing on the challenges of thinking about good medical ethics in a global context and a proposal for an innovative approach to bioethics methodology is outlined. PMID:25516955

An audit of NICE guidelines on antenatal pelvic floor exercises.

PubMed

Ismail, Sharif I M F

2009-12-01

The National Institute for Health and Clinical Excellence (NICE) recommends antenatal pelvic floor exercises during first pregnancy to reduce postpartum stress incontinence. The aim of this audit was to assess patient awareness and compliance with this guideline. An anonymous self-constructed questionnaire was given to patients after their first delivery. A total of 223 questionnaires were returned over a 6-month period. Although 95% of patients were aware of the importance of pelvic floor exercises, only a limited proportion of them had the right information and a minority practised them. Printed material seemed to be very influential in getting the message across. The importance of giving information early in pregnancy and national awareness was shown in the suggestions for improvement. Patient awareness and actual practise of antenatal pelvic floor exercises did not meet NICE guidelines, calling for strategies to improve awareness and adherence.

The English patient in post-colonial perspective, or practising surgery on the poms.

PubMed

Wilde, Sally

2005-04-01

Drawing on interviews with Australasian surgeons who trained in the 1950s and 1960s, this article discusses where, and on whom, they practised the manual skills involved in surgery, In the twentieth century, elite Australasian surgeons emphasized the importance of the science of surgery and the lengthy experience needed to acquire surgical judgement, and these concerns are reflected in the accreditation procedures adopted by the Royal Australasian College of Surgeons. However, trainee surgeons also ha to acquire th manual skills that they needed in the operating theatre. The rhetoric of training emphasized the intellectual skills needed in surgery, but in reality the manual skills remained important, and there was also a fascination with the drama and stress involved in operating. In this era, British and Australasian surgical training were closely linked and many Australasian surgeons gained significant cutting experience in Britain.

Advocacy: exploring the concept.

PubMed

Mardell, A

1996-10-01

The concept of the nurse as the patient's advocate is one that has become popular in the last fifteen years or so in both North America and the United Kingdom, having its basis in nursing theory. The UKCC first embraced the concept, stating in the Code of Professional Conduct that nurses must; 'act always in such a manner so as to promote and safeguard the interests and well being of patients and clients'. This is a laudable principle and one that nurses cannot dispute as there are many members of our society who are weak and vulnerable and may be unable to speak up for themselves. But are nurses always in a position to be an advocate for their patients? As the nature of nursing is so diverse then the nature of advocacy will be different in the multifarious settings in which nurses practise. Can theatre nurses ever be in a position to act as an advocate for a patient who is often anaesthetised? What precisely is advocacy and is the Concise Oxford Dictionary definition of 'one who pleads for another' appropriate in the nursing context? Then there is the position of nurses in the healthcare organisation in which they practise. In advocating for their patients, nurses may find they are pleading a case for a patient, or a group of patients, that could bring the nurse into conflict with their medical colleagues or with the management of the organisation by whom they are employed. Additionally, they may not posses the skills and knowledge to advocate effectively under such circumstances. Nursing is littered with the casualties of such conflicts over the years, the most publicised of whom, in the UK, was probably Graham Pink who lost his job as a charge nurse after drawing public attention to what he considered to be an unacceptable standard of care in the hospital in which he worked.

Opting for rural practice: the influence of medical student origin, intention and immersion experience.

PubMed

Playford, Denese; Ngo, Hanh; Gupta, Surabhi; Puddey, Ian B

2017-08-21

To compare the influence of rural background, rural intent at medical school entry, and Rural Clinical School (RCS) participation on the likelihood of later participation in rural practice. Analysis of linked data from the Medical School Outcomes Database Commencing Medical Students Questionnaire (CMSQ), routinely collected demographic information, and the Australian Health Practitioner Regulation Agency database on practice location. University of Western Australia medical students who completed the CMSQ during 2006-2010 and were practising medicine in 2016. Medical practice in rural areas (ASGC-RAs 2-5) during postgraduate years 2-5. Full data were available for 508 eligible medical graduates. Rural background (OR, 3.91; 95% CI, 2.12-7.21; P < 0.001) and experience in an RCS (OR, 1.93; 95% CI, 1.05-3.54; P = 0.034) were significant predictors of rural practice in the multivariate analysis of all potential factors. When interactions between intention, origin, and RCS experience were included, RCS participation significantly increased the likelihood of graduates with an initial rural intention practising in a rural location (OR, 3.57; 95% CI, 1.25-10.2; P = 0.017). The effect of RCS participation was not significant if there was no pre-existing intention to practise rurally (OR, 1.38; 95% CI, 0.61-3.16; P = 0.44). For students who entered medical school with the intention to later work in a rural location, RCS experience was the deciding factor for realising this intention. Background, intent and RCS participation should all be considered if medical schools are to increase the proportion of graduates working rurally.

A qualitative investigation of specialist orthodontists in New Zealand. Part 1. Orthodontists and orthodontic practice.

PubMed

Soma, Kieran J; Thomson, W Murray; Morgaine, Kate C; Harding, Winifred J

2012-05-01

Current knowledge of orthodontic practice is largely anecdotal and the lack of systematic knowledge can create barriers to better identifying the factors that make a successful orthodontist. The aim of this study was to investigate the routine practising lives of New Zealand orthodontists in order to generate an understanding of the reality of orthodontic specialist practice and its effects on their professional and personal lives. Semi-structured interviews were conducted involving 19 practising orthodontists (four females, 15 males; mean age 50 years) throughout New Zealand.Transcribed interviews were analysed for themes using an applied grounded theory approach. A core category of 'practising orthodontists' was derived, and related themes were grouped under the sub-categories of: (a) NZ orthodontic specialist practice; (b) NZ specialist orthodontists; and (c) work-life balance. The present paper reports on the first two subcategories. Themes elucidated under the specialist practice sub-category included modernisation, changing social norms, practice arrangement, branch practice, staffing, competition, legislation, advertising, the future and the provision of orthodontics by non-specialists. Themes in the orthodontic specialist sub-category were prior experience, postgraduate training, recent graduates, reasons for specialising, generational differences, females in orthodontics, NZ and overseas practice, the ageing profession and the prospect of an orthodontist shortage. This investigation has shed light on orthodontists and the practice of orthodontics in New Zealand and determined aspects rarely discussed in the current or previous literature. It will be valuable to observe how orthodontists and orthodontic practice continue to evolve in response to changes in NZ society.

Does medical student willingness to practise peer physical examination translate into action?

PubMed

Chen, Julie Y; Yip, Amber L M; Lam, Cindy L K; Patil, Nivritti G

2011-01-01

Peer physical examination (PPE) is commonly used in clinical skills teaching to allow students to practice physical examination techniques on each other. Previous studies have demonstrated medical students' generally positive attitudes towards PPE, but the correlation between student attitude and actual practice of PPE has yet to be examined. To determine if a positive student attitude towards PPE leads to subsequent action. The target population were MBBS I students (2006-2007 cohort) admitted to the Li Ka Shing Faculty of Medicine, The University of Hong Kong. Student attitude towards PPE and subsequent practice of PPE were assessed through self-completed written questionnaires before and after the compulsory Clinical Skills Programme (CSP). A total of 100/128 (78%) students completed both questionnaires, of which 83 (65%) could be linked to demographic data. All study participants were ethnically Chinese. A high level of willingness to conduct PPE persisted before and after the CSP for both male and female students. However, more than half of the students did not subsequently examine various non-intimate body regions of a fellow student during the CSP. Female students were more likely to exhibit attitude-behaviour inconsistency. The existing positive attitudes towards PPE need to be harnessed so that more students are encouraged to follow through and actually practise PPE, thus realizing the educational benefits of this activity. This may be done by ensuring that PPE is conducted in a safe setting while being conscientious of gender differences. Scheduled time and the use of a logbook may be useful to facilitate students practising PPE.

Educational priorities and current involvement in genetic practice: a survey of midwives in the Netherlands, UK and Sweden.

PubMed

Benjamin, Caroline M; Anionwu, Elizabeth N; Kristoffersson, Ulf; ten Kate, Leo P; Plass, Anne Marie C; Nippert, Irmgard; Julian-Reynier, Claire; Harris, Hilary J; Schmidtke, Joerg; Challen, Kirsty; Calefato, Jean Marc; Waterman, Christine; Powell, Eileen; Harris, Rodney

2009-10-01

to investigate whether practising midwives are adequately prepared to integrate genetic information into their practice. a cross-sectional, postal, structured questionnaire survey was sent to practising midwives. practising midwives from the Netherlands (NL), Sweden (SE) and the United Kingdom (UK). 1021 replies were received, achieving a response rate of 62%. 79% (799/1015) of midwives reported attending courses with some 'genetic content' during their initial training. Sixty-eight per cent (533/784) judged this to have been useful for clinical practice. Variation was seen between countries in the amount of genetic content in post-registration training (SE 87%, NL 44%, UK 17%) and most was considered useful. Questions assessing clinical activity identified a current need for genetic knowledge. Midwives described low levels of self-reported confidence both in overtly genetic procedures and in everyday tasks that were underpinned by genetic knowledge. For eight of the 12 procedures, fewer than 20% of midwives considered themselves to be confident. Differences were apparent between countries. Midwives identified psychosocial, screening and risk assessment aspects of genetic education as being important to them, rather than technical aspects or genetic science. given the low reported confidence with genetic issues in clinical practice, it is essential that this is addressed in terms of the amount, content and targeting of genetic education. This is especially important to ensure the success of national antenatal and baby screening programmes. The results of this study suggest that midwives would welcome further training in genetics, addressing genetic topics most relevant to their clinical practice.

The experiences of internationally educated nurses in the southeastern United States of America.

PubMed

Wheeler, R M; Foster, J W; Hepburn, K W

2013-09-01

US healthcare facilities have addressed nursing shortages in part by recruiting internationally educated nurses (IENs), and studies suggest IENs may make up a significant percentage of the nursing workforce in urban hospitals. Despite the economic recession of 2008-2012, international nurse migration is expected to continue. Little is known about IENs in the southeastern USA, and no studies have compared their perspectives to those of their US counterparts. The purpose of this study was to gain a deeper understanding about the experiences of IENs compared to those of US registered nurses (RNs) practising in two urban hospitals in southeastern USA. This study involved two rounds of semi-structured interviews of 82 IENs and US RNs. Interviews focused on themes relating to education, barriers to practice, intent to stay in nursing and IENs' migration experiences. Most IENs interviewed migrated to the USA after 1990 to join their family and do not plan to return to their home countries to practise. Most IENs initially received their Associate Degree in Nursing; many have obtained their Bachelor of Science in Nursing degree. IENs and newly licensed US RNs faced similar barriers when they began practising in the USA, but IENs faced additional challenges adjusting to the attitudes of US patients, the perceived lack of respect for nurses and delivering total patient care. IENs would benefit from orientation regarding the cultural differences in the USA. In other ways, their challenges are similar to those of US RNs; policies regarding education, recruitment and retention could target both groups together. © 2013 The Authors. International Nursing Review © 2013 International Council of Nurses.

Can early physical therapy positively affect the onset of independent walking in infants with Down syndrome? A retrospective cohort study.

PubMed

Corrado, Bruno; Sommella, Nadia; Ciardi, Gianluca; Raiano, Enza; Scala, Iris; Strisciuglio, Pietro; Servodio Iammarrone, Clemente

2018-02-19

The development of both gross and fine motor skills in a child with Down syndrome is generally delayed. The most seriously affected stage is the achievement of independent walking ability, which influences the onset of all following motor and cognityive skills. The study objectives were (a) to assess the time taken to achieve independent walking ability in a cohort of children with Down syndrome, (b) to examine differences in walking onset by patient characteristics, (c) to verify the effect of early physical therapy (Neurodevelopmental Treatment on the basis of Bobath Concept practised within the first months of life) in the achievement of that skill. A retrospective study was carried out on a cohort of 86 children with Down Syndrome. The knowledge of the exact age of walking onset and information about comorobities and rehabilitation practised since birth were the eligibility criteria. The average age at which walking began in the sample was 26 months (Standard Deviation = 9.66). Some patient characteristics proved to be related negatively to the walking onset: gender male, trisomy 21, improved joint ligamentous laxity. When practised, early physical therapy was able to contrast the delay in walking. NDT-Bobath is a well-known and valid instrument for a child with Down syndrome to attain his highest possible psychomotor functioning level. This study pointed out for the first time ever its capability to contrast the delay on walking onset, which can influences positively the development of the following motor and cognitive skills.

Under scrutiny: Midwives' experience of intrapartum transfer from home to hospital within the context of a planned homebirth in Western Australia.

PubMed

Ball, Colleen; Hauck, Yvonne; Kuliukas, Lesley; Lewis, Lucy; Doherty, Dorota

2016-06-01

Women's experience of homebirth has been a focus of research, with limited international research and no Australian evidence of the experiences of midwives in relation to their experience of intrapartum transfers within the context of a planned homebirth. To explore the experience of Western Australian midwives involved in an intrapartum transfer from home to hospital. A descriptive phenomenological study was conducted. Women who elect to have a homebirth in Western Australia have the choice of care from privately practising midwives or a publicly funded program. Midwives who were currently practising or had practised within the past three years and experienced an intrapartum transfer were invited to participate. In-depth interviews were conducted with 13 midwives and data analysed using the Stevick-Colaizzi-Keen method. Analysis revealed an overarching theme "under scrutiny" which captured four themes: "decision to transfer: getting the timing right"; "reception at the hospital: welcoming or not"; "maintaining continuity of carer" and "reflections: coming to terms with the experience". The decision to transfer to hospital represents a profound shift in expectations for the woman and midwife that is often not recognised by hospital staff. Intrapartum transfer is a challenging clinical decision for all parties; midwives, women, partners and health services. Increased effort by maternity health professionals to improve communication and collaboration must be a priority to better support women and their partners who make an informed decision to have a planned homebirth. Copyright © 2016 Elsevier B.V. All rights reserved.

Making it easy to do the right thing in healthcare: Advancing improvement science education through accredited pan European higher education modules.

PubMed

MacRae, Rhoda; Rooney, Kevin D; Taylor, Alan; Ritters, Katrina; Sansoni, Julita; Lillo Crespo, Manuel; Skela-Savič, Brigita; O'Donnell, Barbara

2016-07-01

Numerous international policy drivers espouse the need to improve healthcare. The application of Improvement Science has the potential to restore the balance of healthcare and transform it to a more person-centred and quality improvement focussed system. However there is currently no accredited Improvement Science education offered routinely to healthcare students. This means that there are a huge number of healthcare professionals who do not have the conceptual or experiential skills to apply Improvement Science in everyday practise. This article describes how seven European Higher Education Institutions (HEIs) worked together to develop four evidence informed accredited inter-professional Improvement Science modules for under and postgraduate healthcare students. It outlines the way in which a Policy Delphi, a narrative literature review, a review of the competency and capability requirements for healthcare professionals to practise Improvement Science, and a mapping of current Improvement Science education informed the content of the modules. A contemporary consensus definition of Healthcare Improvement Science was developed. The four Improvement Science modules that have been designed are outlined. A framework to evaluate the impact modules have in practise has been developed and piloted. The authors argue that there is a clear need to advance healthcare Improvement Science education through incorporating evidence based accredited modules into healthcare professional education. They suggest that if Improvement Science education, that incorporates work based learning, becomes a staple part of the curricula in inter-professional education then it has real promise to improve the delivery, quality and design of healthcare. Copyright © 2016 Elsevier Ltd. All rights reserved.

Going the distance: early results of a distributed medical education initiative for Royal College residencies in Canada.

PubMed

Myhre, Douglas L; Hohman, Stacey

2012-01-01

There is a shortage of specialty physicians practising in rural Canada: only 2.4% of Canadian specialist physicians practise rurally. Numerous strategies have been proposed and attempted that aim to increase the number of rural physicians. These include undergraduate and postgraduate distributed medical education opportunities. The Distributed Royal College Initiative at the University of Calgary is increasing the exposure of specialty residents to rural medicine through regional rotations and electives. An assessment of the initial impacts of this programme was made. Specialty residents were sent a voluntary survey following their regional rotation in academic year 2010-2011. The survey measured each resident's satisfaction with the experience, interest in undertaking another rotation and the impact of the rotation on potential rural practice location. The survey asked for written comments on the rotation. Data were analysed using descriptive statistics. A total of 73% (29) of the 40 eligible residents completed the survey that was distributed upon completion of the rotation. In the survey, 45% of respondents indicated they would have been likely to practise in a regional community prior to the experience. This changed to 76% following the rotation. Analysis of the comments revealed strong positive characteristics of the experience across all disciplines. Specialty-based, rural distributed programmes were perceived by the residents as educationally valuable and may be crucial in helping shift attitudes towards rural practice. Specific successful characteristics of the rotations provide direction to increase their quality further. These findings need to be verified in a larger sample.

Sensor-scheduling simulation of disparate sensors for Space Situational Awareness

NASA Astrophysics Data System (ADS)

Hobson, T.; Clarkson, I.

2011-09-01

The art and science of space situational awareness (SSA) has been practised and developed from the time of Sputnik. However, recent developments, such as the accelerating pace of satellite launch, the proliferation of launch capable agencies, both commercial and sovereign, and recent well-publicised collisions involving man-made space objects, has further magnified the importance of timely and accurate SSA. The United States Strategic Command (USSTRATCOM) operates the Space Surveillance Network (SSN), a global network of sensors tasked with maintaining SSA. The rapidly increasing number of resident space objects will require commensurate improvements in the SSN. Sensors are scarce resources that must be scheduled judiciously to obtain measurements of maximum utility. Improvements in sensor scheduling and fusion, can serve to reduce the number of additional sensors that may be required. Recently, Hill et al. [1] have proposed and developed a simulation environment named TASMAN (Tasking Autonomous Sensors in a Multiple Application Network) to enable testing of alternative scheduling strategies within a simulated multi-sensor, multi-target environment. TASMAN simulates a high-fidelity, hardware-in-the-loop system by running multiple machines with different roles in parallel. At present, TASMAN is limited to simulations involving electro-optic sensors. Its high fidelity is at once a feature and a limitation, since supercomputing is required to run simulations of appreciable scale. In this paper, we describe an alternative, modular and scalable SSA simulation system that can extend the work of Hill et al with reduced complexity, albeit also with reduced fidelity. The tool has been developed in MATLAB and therefore can be run on a very wide range of computing platforms. It can also make use of MATLAB’s parallel processing capabilities to obtain considerable speed-up. The speed and flexibility so obtained can be used to quickly test scheduling algorithms even with a relatively large number of space objects. We further describe an application of the tool by exploring how the relative mixture of electro-optical and radar sensors can impact the scheduling, fusion and achievable accuracy of an SSA system. By varying the mixture of sensor types, we are able to characterise the main advantages and disadvantages of each configuration.

Impact of an interprofessional education program on developing skilled graduates well-equipped to practise in rural and underserved areas.

PubMed

Mpofu, Ratie; Daniels, Priscilla S; Adonis, Tracy-Ann; Karuguti, Wallace M

2014-01-01

Poverty, limited access to resources and a lack of infrastructure characterise the division of rural areas from urban South Africa. Low numbers of social welfare professionals compound the problem. With education linked inextricably in social responsibility, higher education institutions (HEIs) are called upon increasingly to create conditions that encourage students and graduates to practise in more socially responsible ways, involving more than mere disciplinary expertise or technical knowledge, and that consider the problems of rural areas. Use of interprofessional education (IPE) programs, based on teamwork, could enable HEIs to train and guide health sciences students in how best to cooperate with each other and combine their skills to mutual benefit. This would enable them to develop professional skills facilitated by interactive engagement within community settings. Referencing experience gained in Australia and elsewhere, the Faculty of Community and Health Sciences (FCHS) at the University of Western Cape (UWC) has developed and applied an IPE program for South Africa. Students were placed in interdisciplinary groups in a rural and underserved municipality of the Western Cape - 17 students participated in a study on the effectiveness of this program. A quantitative self-administered questionnaire, followed by qualitative focus group discussions, established student perceptions of their IPE experience, how the experience influenced their intentions for or against future practice in rural and underserved areas, and their interest in future interprofessional collaboration and practice. More than 75% of the participating students agreed that they had learnt to develop knowledge base, procedural and healthcare practice presentation skills, along with preparing written community health histories. Student willingness to practise in rural areas was evidenced, citing community- and resource-based factors as determinants; however, concerns that some community members had 'own agendas' were expressed. Nearly all students highly appreciated their learning and service delivery development, but 47% felt that their educational experience did not go as far as expected. Student concerns were a lack of structured student placement for IPE to occur in the program, as well as limited staff supervision of students. The UWC FCHS IPE program is evidenced as a valid approach to encouraging health sciences students and graduates to choose to practise in more socially responsible ways. However, improvement of placement and supervision methodology and practice should be explored at faculty level and implemented in future IPE programs.

Predicting fitness to practise events in international medical graduates who registered as UK doctors via the Professional and Linguistic Assessments Board (PLAB) system: a national cohort study.

PubMed

Tiffin, Paul A; Paton, Lewis W; Mwandigha, Lazaro M; McLachlan, John C; Illing, Jan

2017-03-20

International medical graduates working in the UK are more likely to be censured in relation to fitness to practise compared to home graduates. Performance on the General Medical Council's (GMC's) Professional and Linguistic Assessments Board (PLAB) tests and English fluency have previously been shown to predict later educational performance in this group of doctors. It is unknown whether the PLAB system is also a valid predictor of unprofessional behaviour and malpractice. The findings would have implications for regulatory policy. This was an observational study linking data relating to fitness to practise events (referral or censure), PLAB performance, demographic variables and English language competence, as evaluated via the International English Language Test System (IELTS). Data from 27,330 international medical graduates registered with the GMC were analysed, including 210 doctors who had been sanctioned in relation to at least one fitness to practise issue. The main outcome was risk of eventual censure (including a warning). The significant univariable educational predictors of eventual censure (versus no censures or referrals) were lower PLAB part 1 (hazard ratio [HR], 0.99; 95% confidence interval, 0.98 to 1.00) and part 2 scores (HR, 0.94; 0.91 to 0.97) at first sitting, multiple attempts at both parts of the PLAB, lower IELTS reading (HR, 0.79; 0.65 to 0.94) and listening scores (HR, 0.76; 0.62 to 0.93) and higher IELTS speaking scores (HR, 1.28; 1.04 to 1.57). Multiple resits at either part of the PLAB and higher IELTS speaking score (HR, 1.49; 1.20 to 1.84) were also independent predictors of censure. We estimated that the proposed limit of four attempts at both parts of the PLAB would reduce the risk in this entire group by only approximately two censures per 5 years in this group of doctors. Making the PLAB, or any replacement assessment, more stringent and raising the required standards of English reading and listening may result in fewer fitness to practice events in international medical graduates. However, the number of PLAB resits permitted would have to be further capped to meaningfully impact the risk of sanctions in this group of doctors.

Retrospective analysis of census data on general practitioners who qualified in South Asia: who will replace them as they retire?

PubMed Central

Taylor, Donald H; Esmail, Aneez

1999-01-01

Objectives To determine the number and geographical distribution of general practitioners in the NHS who qualified medically in South Asia and to project their numbers as they retire. Design Retrospective analysis of yearly data and projection of future trends. Setting England and Wales. Subjects General practitioners who qualified medically in the countries of Bangladesh, India, Pakistan, and Sri Lanka and who were practising in the NHS on 1 October 1992. Main outcome measures Proportion and age of general practitioners who qualified in South Asia by health authority; the Benzeval and Judge measure of population need at the health authority level. Results 4192 of 25 333 (16.5%) of all unrestricted general practitioners practising full time on 1 October 1992 qualified in South Asian medical schools. The proportion varied by health authority from 0.007% to 56.5%. Roughly two thirds who were practising in 1992 will have retired by 2007; in some health authorities this will represent a loss of one in four general practitioners. The practices that these doctors will leave seem to be in relatively deprived areas as measured by deprivation payments and a health authority measure of population need. Conclusion Many general practitioners who qualified in South Asian medical schools will retire within the next decade. The impact will vary greatly by health authority. Those health authorities with the greatest number of such doctors are in some of the most deprived areas in the United Kingdom and have experienced the most difficulty in filling vacancies. Various responses will be required by workforce planners to mitigate the impact of these retirements. Key messagesCurrently, one in six general practitioners practising full time in the NHS qualified medically in a South Asian medical school; two thirds are likely to retire by 2007It is unlikely that doctors who qualify in South Asia will be a source of general practice recruitment in the futureThe posts from which South Asian qualifiers are retiring may be more difficult to fill because they are often in practices in areas of higher needThere is extreme variation in the proportion of total general practitioners who are South Asian qualifiers; flexibility for policy responses should be maintained PMID:9924060

Relationship between personal characteristics of specialist physicians and choice of practice location in Iran.

PubMed

Taati Keley, Elham; Ravaghi, Hamid; Salehi, Masoud; Nasiripour, Amir Ashkan; Abdi, Zhaleh; Meshkini, Ali

2016-01-01

Uneven geographic distribution of physicians is a major healthcare issue in Iran. This study aimed to explore the relationship between personal characteristics of the recently graduated specialist physicians in Iran and their choice of practice location. A cross-sectional study was conducted to extract information with regard to 3825 recently graduated specialist physicians from all medical schools across Iran between 2009 and 2012. The relationship between physicians' personal attributes and their desire to practise in underdeveloped areas was analyzed using χ2 test and logistic regression analysis. Birthplace, sex, exposure to rural practice before residency program, place of residence, and year of graduation were associated with physicians' desire to practise in an underdeveloped area. The logistic regression showed that female physicians were less likely to choose underdeveloped areas to practise as compared with their male counterparts (OR=0.659, 95%CI, 0.557-0.781, p≤0.001). Physicians who lived in underdeveloped areas were nine times more likely to choose underdeveloped areas to practise as compared with those living in other areas (OR=8.966, 95%CI, 4.717-17.041, p≤0.001). Physicians who did not have previous exposure to rural practice were 28% less likely to choose to serve in the underdeveloped areas as compared to those who had such exposure (OR=0.780, 95%CI, 0.661-0.922, p=0.004). Neither physicians' marital status nor their success in the board certification exam was associated with their choice of practice location. It seems that increasing the enrollment of physicians with a rural background in residency programs may solve the problem of uneven distribution of specialist physicians in Iran. Because female physicians are less willing to work in the underdeveloped areas than male physicians, increasing the number of male student admissions to residency programs, particularly in certain specialties that are more in demand in the underdeveloped areas, could alleviate the problem of uneven distribution of physicians in the short run. Further, programs that support raising the admissions of female students with a rural background into local medical universities along with providing incentives to encourage them to live and work in rural areas should be put on the policy agenda.

14 CFR Appendix E to Part 60 - Qualification Performance Standards for Quality Management Systems for Flight Simulation Training...

Code of Federal Regulations, 2010 CFR

2010-01-01

... Quality Management Systems for Flight Simulation Training Devices E Appendix E to Part 60 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRMEN FLIGHT SIMULATION...—Qualification Performance Standards for Quality Management Systems for Flight Simulation Training Devices Begin...

Ponderosa pine managed-yield simulator: PPSIM users guide.

Treesearch

D.J. DeMars; J.W. Barrett

1987-01-01

PPSIM simulates yields of natural and managed ponderosa pine stands. Management practices and effects that can be simulated include commercial thinning, fertilization, genetic improvement, and presence of dwarf mistletoe. An option is available that adjusts growth to simulate local conditions. Equations used in PPSIM describe growth of natural...

Evolution under domestication: ongoing artificial selection and divergence of wild and managed Stenocereus pruinosus (Cactaceae) populations in the Tehuacán Valley, Mexico

PubMed Central

Parra, Fabiola; Casas, Alejandro; Peñaloza-Ramírez, Juan Manuel; Cortés-Palomec, Aurea C.; Rocha-Ramírez, Víctor; González-Rodríguez, Antonio

2010-01-01

Background and Aims The Tehuacán Valley in Mexico is a principal area of plant domestication in Mesoamerica. There, artificial selection is currently practised on nearly 120 native plant species with coexisting wild, silvicultural and cultivated populations, providing an excellent setting for studying ongoing mechanisms of evolution under domestication. One of these species is the columnar cactus Stenocereus pruinosus, in which we studied how artificial selection is operating through traditional management and whether it has determined morphological and genetic divergence between wild and managed populations. Methods Semi-structured interviews were conducted with 83 households of three villages to investigate motives and mechanisms of artificial selection. Management effects were studied by comparing variation patterns of 14 morphological characters and population genetics (four microsatellite loci) of 264 plants from nine wild, silvicultural and cultivated populations. Key Results Variation in fruit characters was recognized by most people, and was the principal target of artificial selection directed to favour larger and sweeter fruits with thinner or thicker peel, fewer spines and pulp colours others than red. Artificial selection operates in agroforestry systems favouring abundance (through not felling plants and planting branches) of the preferred phenotypes, and acts more intensely in household gardens. Significant morphological divergence between wild and managed populations was observed in fruit characters and plant vigour. On average, genetic diversity in silvicultural populations (HE = 0·743) was higher than in wild (HE = 0·726) and cultivated (HE = 0·700) populations. Most of the genetic variation (90·58 %) occurred within populations. High gene flow (NmFST > 2) was identified among almost all populations studied, but was slightly limited by mountains among wild populations, and by artificial selection among wild and managed populations. Conclusions Traditional management of S. pruinosus involves artificial selection, which, despite the high levels of gene flow, has promoted morphological divergence and moderate genetic structure between wild and managed populations, while conserving genetic diversity. PMID:20729372

Evolution under domestication: ongoing artificial selection and divergence of wild and managed Stenocereus pruinosus (Cactaceae) populations in the Tehuacan Valley, Mexico.

PubMed

Parra, Fabiola; Casas, Alejandro; Peñaloza-Ramírez, Juan Manuel; Cortés-Palomec, Aurea C; Rocha-Ramírez, Víctor; González-Rodríguez, Antonio

2010-09-01

The Tehuacán Valley in Mexico is a principal area of plant domestication in Mesoamerica. There, artificial selection is currently practised on nearly 120 native plant species with coexisting wild, silvicultural and cultivated populations, providing an excellent setting for studying ongoing mechanisms of evolution under domestication. One of these species is the columnar cactus Stenocereus pruinosus, in which we studied how artificial selection is operating through traditional management and whether it has determined morphological and genetic divergence between wild and managed populations. Semi-structured interviews were conducted with 83 households of three villages to investigate motives and mechanisms of artificial selection. Management effects were studied by comparing variation patterns of 14 morphological characters and population genetics (four microsatellite loci) of 264 plants from nine wild, silvicultural and cultivated populations. Variation in fruit characters was recognized by most people, and was the principal target of artificial selection directed to favour larger and sweeter fruits with thinner or thicker peel, fewer spines and pulp colours other than red. Artificial selection operates in agroforestry systems favouring abundance (through not felling plants and planting branches) of the preferred phenotypes, and acts more intensely in household gardens. Significant morphological divergence between wild and managed populations was observed in fruit characters and plant vigour. On average, genetic diversity in silvicultural populations (H(E) = 0.743) was higher than in wild (H(E) = 0.726) and cultivated (H(E) = 0.700) populations. Most of the genetic variation (90.58 %) occurred within populations. High gene flow (Nm(FST) > 2) was identified among almost all populations studied, but was slightly limited by mountains among wild populations, and by artificial selection among wild and managed populations. Traditional management of S. pruinosus involves artificial selection, which, despite the high levels of gene flow, has promoted morphological divergence and moderate genetic structure between wild and managed populations, while conserving genetic diversity.

Evaluating the Impact of Classroom Education on the Management of Septic Shock Using Human Patient Simulation.

PubMed

Lighthall, Geoffrey K; Bahmani, Dona; Gaba, David

2016-02-01

Classroom lectures are the mainstay of imparting knowledge in a structured manner and have the additional goals of stimulating critical thinking, lifelong learning, and improvements in patient care. The impact of lectures on patient care is difficult to examine in critical care because of the heterogeneity in patient conditions and personnel as well as confounders such as time pressure, interruptions, fatigue, and nonstandardized observation methods. The critical care environment was recreated in a simulation laboratory using a high-fidelity mannequin simulator, where a mannequin simulator with a standardized script for septic shock was presented to trainees. The reproducibility of this patient and associated conditions allowed the evaluation of "clinical performance" in the management of septic shock. In a previous study, we developed and validated tools for the quantitative analysis of house staff managing septic shock simulations. In the present analysis, we examined whether measures of clinical performance were improved in those cases where a lecture on the management of shock preceded a simulated exercise on the management of septic shock. The administration of the septic shock simulations allowed for performance measurements to be calculated for both medical interns and for subsequent management by a larger resident-led team. The analysis revealed that receiving a lecture on shock before managing a simulated patient with septic shock did not produce scores higher than for those who did not receive the previous lecture. This result was similar for both interns managing the patient and for subsequent management by a resident-led team. We failed to find an immediate impact on clinical performance in simulations of septic shock after a lecture on the management of this syndrome. Lectures are likely not a reliable sole method for improving clinical performance in the management of complex disease processes.

A Cryogenic Fluid System Simulation in Support of Integrated Systems Health Management

NASA Technical Reports Server (NTRS)

Barber, John P.; Johnston, Kyle B.; Daigle, Matthew

2013-01-01

Simulations serve as important tools throughout the design and operation of engineering systems. In the context of sys-tems health management, simulations serve many uses. For one, the underlying physical models can be used by model-based health management tools to develop diagnostic and prognostic models. These simulations should incorporate both nominal and faulty behavior with the ability to inject various faults into the system. Such simulations can there-fore be used for operator training, for both nominal and faulty situations, as well as for developing and prototyping health management algorithms. In this paper, we describe a methodology for building such simulations. We discuss the design decisions and tools used to build a simulation of a cryogenic fluid test bed, and how it serves as a core technology for systems health management development and maturation.

[Mindfulness meditation, a source of professional wellbeing].

PubMed

Blot, Nathalie

2016-10-01

Mindfulness meditation, by focusing attention on what we are experiencing, improves personal wellbeing which is then expressed in caregivers' professional practices. Nurses who practise mindfulness will be better positioned to help their patients. Copyright © 2016. Publié par Elsevier Masson SAS.

Now is the time to demand change to punishing FtP procedures.

PubMed

Mason, Sharon

2016-05-25

Having undergone Nursing and Midwifery Council fitness to practise (FtP) proceedings after raising and escalating concerns, I read with interest your article about nurses facing FtP hearings being 'pushed to breaking point' (analysis, May 11).

Labrador program prepares MDs for northern, remote practice

PubMed Central

Gray, S

1997-01-01

Across Canada, residency programs are attempting to train more physicians to practise in rural and remote areas. The Northern Family Education Program developed in Newfoundland and Labrador is proving that physicians can learn to like life in remote areas. PMID:9371078

A Mirror for Managers: Using Simulation to Develop Management Teams. Technical Report 23.

ERIC Educational Resources Information Center

Kaplan, Robert E.; And Others

Although simulation is among the least common of the many methods consultants employ to stimulate team development, realistic simulation can help in the diagnosis of management teams. Simulations fill a gap in the repertoire of data collection methods for organizational diagnosis and development by affording an opportunity for direct observation…

Computer Simulation for Emergency Incident Management

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

Brown, D L

2004-12-03

This report describes the findings and recommendations resulting from the Department of Homeland Security (DHS) Incident Management Simulation Workshop held by the DHS Advanced Scientific Computing Program in May 2004. This workshop brought senior representatives of the emergency response and incident-management communities together with modeling and simulation technologists from Department of Energy laboratories. The workshop provided an opportunity for incident responders to describe the nature and substance of the primary personnel roles in an incident response, to identify current and anticipated roles of modeling and simulation in support of incident response, and to begin a dialog between the incident responsemore » and simulation technology communities that will guide and inform planned modeling and simulation development for incident response. This report provides a summary of the discussions at the workshop as well as a summary of simulation capabilities that are relevant to incident-management training, and recommendations for the use of simulation in both incident management and in incident management training, based on the discussions at the workshop. In addition, the report discusses areas where further research and development will be required to support future needs in this area.« less

Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults†

PubMed Central

Frerk, C.; Mitchell, V. S.; McNarry, A. F.; Mendonca, C.; Bhagrath, R.; Patel, A.; O'Sullivan, E. P.; Woodall, N. M.; Ahmad, I.

2015-01-01

These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. These guidelines have been informed by advances in the understanding of crisis management; they emphasize the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction. Planning for failed intubation should form part of the pre-induction briefing, particularly for urgent surgery. Emphasis is placed on assessment, preparation, positioning, preoxygenation, maintenance of oxygenation, and minimizing trauma from airway interventions. It is recommended that the number of airway interventions are limited, and blind techniques using a bougie or through supraglottic airway devices have been superseded by video- or fibre-optically guided intubation. If tracheal intubation fails, supraglottic airway devices are recommended to provide a route for oxygenation while reviewing how to proceed. Second-generation devices have advantages and are recommended. When both tracheal intubation and supraglottic airway device insertion have failed, waking the patient is the default option. If at this stage, face-mask oxygenation is impossible in the presence of muscle relaxation, cricothyroidotomy should follow immediately. Scalpel cricothyroidotomy is recommended as the preferred rescue technique and should be practised by all anaesthetists. The plans outlined are designed to be simple and easy to follow. They should be regularly rehearsed and made familiar to the whole theatre team. PMID:26556848

Healthcare waste management during disasters and its effects on climate change: Lessons from 2010 earthquake and cholera tragedies in Haiti.

PubMed

Raila, Emilia M; Anderson, David O

2017-03-01

Despite growing effects of human activities on climate change throughout the world, and global South in particular, scientists are yet to understand how poor healthcare waste management practices in an emergency influences the climate change. This article presents new findings on climate change risks of healthcare waste disposal during and after the 2010 earthquake and cholera disasters in Haiti. The researchers analysed quantities of healthcare waste incinerated by the United Nations Mission in Haiti for 60 months (2009 to 2013). The aim was to determine the relationship between healthcare waste incinerated weights and the time of occurrence of the two disasters, and associated climate change effects, if any. Pearson product-moment correlation coefficient indicated a weak correlation between the quantities of healthcare waste disposed of and the time of occurrence of the actual emergencies (r (58) = 0.406, p = 0.001). Correspondingly, linear regression analysis indicated a relatively linear data trend (R 2 = 0.16, F (1, 58) = 11.42, P = 0.001) with fluctuating scenarios that depicted a sharp rise in 2012, and time series model showed monthly and yearly variations within 60 months. Given that the peak healthcare waste incineration occurred 2 years after the 2010 disasters, points at the need to minimise wastage on pharmaceuticals by improving logistics management. The Government of Haiti had no data on healthcare waste disposal and practised smoky open burning, thus a need for capacity building on green healthcare waste management technologies for effective climate change mitigation.

Efficacy of a self-management education program for people with type 2 diabetes: results of a 12 month trial.

PubMed

Moriyama, Michiko; Nakano, Masumi; Kuroe, Yuriko; Nin, Kazuko; Niitani, Mayumi; Nakaya, Takashi

2009-06-01

Patient education that enhances one's self-management ability is of utmost importance for improving patient outcomes in chronic diseases. We developed a 12 month self-management education program for type 2 diabetes, based on a previous 6 month program, and examined its efficacy. A randomized controlled trial was carried out on outpatients with type 2 diabetes from two hospitals who met the criteria and gave consent to participate. They were randomly divided into an intervention group that followed the program and a control group that followed usual clinical practise. The intervention group received <30 min of monthly interviews based on the program's textbook and biweekly telephone calls from a nurse educator throughout the 12 months. Of the 50 participants in the intervention group and the 25 participants in the control group, 42 and 23, respectively, completed the program (a completion rate of 84.0%). The body weight, HbA1c, self-efficacy, dietary and exercise stages, quality of life, diastolic blood pressure, and total cholesterol level were significant by two-way repeated-measures anova. As for changes over time within the groups, only the intervention group showed significant differences by Friedman's test. The complication prevention behaviors showed a high implementation rate in the intervention group. The overall evaluation of this program by the participants was very high and, therefore, they highly recognized the need for this type of program. Self-management education works successfully in relation to patients' behavior modification skills, degree of goal attainment, and self-efficacy, consequently improving their health outcomes.

A qualitative descriptive study of self-management issues in people with long-term intermittent urinary catheters.

PubMed

Wilde, Mary H; Brasch, Judith; Zhang, Yi

2011-06-01

The study was to identify and describe issues of intermittent urinary catheter users for future self-management research and/or training programmes. Limited studies were found of how people using clean intermittent catheterization manage their daily routines or troubleshoot problems. Self-management research related to intermittent catheterization could lead to improved compliance with the method and better quality of life. This qualitative descriptive study involved in-depth tape-recorded telephone interviews in 2008-2009 with 34 people in the United States of America using permanent intermittent catheterization, mostly individuals with spinal cord injury or multiple sclerosis. Recruitment was through Internet sites where individuals could link to the study website and then contact the researchers. The sample included 13 men and 21 women aged 21-72 years (mean 42 years). Content analysis for qualitative data involved iterative comparisons of transcripts, summaries and memos. Coding, key quotes and tables were developed to determine themes. Six major themes were identified: Knowing the Body, Practising Intermittent Catheterization, Limited Options in Catheters and Equipment, Inaccessible Bathrooms, Hassles, and Adjustment in Making Intermittent Catheterization a Part of Life. While some persons had choices in catheters, many did not because of insurance constraints. Some individuals developed knowledge of how to balance the procedure with fluid intake and activities. The lack of acceptable bathrooms can interfere with being able to go to work, travel or be with friends and family. All using intermittent catheterization should have adequate insurance coverage when this is needed. Research into training programmes could incorporate knowledge of experienced users. © 2011 Blackwell Publishing Ltd.

A conceptual model for the analysis of multi-stressors in linked groundwater-surface water systems.

PubMed

Kaandorp, Vince P; Molina-Navarro, Eugenio; Andersen, Hans E; Bloomfield, John P; Kuijper, Martina J M; de Louw, Perry G B

2018-06-15

Groundwater and surface water are often closely coupled and are both under the influence of multiple stressors. Stressed groundwater systems may lead to a poor ecological status of surface waters but to date no conceptual framework to analyse linked multi-stressed groundwater - surface water systems has been developed. In this paper, a framework is proposed showing the effect of groundwater on surface waters in multiple stressed systems. This framework will be illustrated by applying it to four European catchments, the Odense, Denmark, the Regge and Dinkel, Netherlands, and the Thames, UK, and by assessing its utility in analysing the propagation or buffering of multi-stressors through groundwater to surface waters in these catchments. It is shown that groundwater affects surface water flow, nutrients and temperature, and can both propagate stressors towards surface waters and buffer the effect of stressors in space and time. The effect of groundwater on drivers and states depends on catchment characteristics, stressor combinations, scale and management practises. The proposed framework shows how groundwater in lowland catchments acts as a bridge between stressors and their effects within surface waters. It shows water managers how their management areas might be influenced by groundwater, and helps them to include this important, but often overlooked part of the water cycle in their basin management plans. The analysis of the study catchments also revealed a lack of data on the temperature of both groundwater and surface water, while it is an important parameter considering future climate warming. Copyright © 2018. Published by Elsevier B.V.

Crisis management during anaesthesia: the development of an anaesthetic crisis management manual

PubMed Central

Runciman, W; Kluger, M; Morris, R; Paix, A; Watterson, L; Webb, R

2005-01-01

Background: All anaesthetists have to handle life threatening crises with little or no warning. However, some cognitive strategies and work practices that are appropriate for speed and efficiency under normal circumstances may become maladaptive in a crisis. It was judged in a previous study that the use of a structured "core" algorithm (based on the mnemonic COVER ABCD–A SWIFT CHECK) would diagnose and correct the problem in 60% of cases and provide a functional diagnosis in virtually all of the remaining 40%. It was recommended that specific sub-algorithms be developed for managing the problems underlying the remaining 40% of crises and assembled in an easy-to-use manual. Sub-algorithms were therefore developed for these problems so that they could be checked for applicability and validity against the first 4000 anaesthesia incidents reported to the Australian Incident Monitoring Study (AIMS). Methods: The need for 24 specific sub-algorithms was identified. Teams of practising anaesthetists were assembled and sets of incidents relevant to each sub-algorithm were identified from the first 4000 reported to AIMS. Based largely on successful strategies identified in these reports, a set of 24 specific sub-algorithms was developed for trial against the 4000 AIMS reports and assembled into an easy-to-use manual. A process was developed for applying each component of the core algorithm COVER at one of four levels (scan-check-alert/ready-emergency) according to the degree of perceived urgency, and incorporated into the manual. The manual was disseminated at a World Congress and feedback was obtained. Results: Each of the 24 specific crisis management sub-algorithms was tested against the relevant incidents among the first 4000 reported to AIMS and compared with the actual management by the anaesthetist at the time. It was judged that, if the core algorithm had been correctly applied, the appropriate sub-algorithm would have been resolved better and/or faster in one in eight of all incidents, and would have been unlikely to have caused harm to any patient. The descriptions of the validation of each of the 24 sub-algorithms constitute the remaining 24 papers in this set. Feedback from five meetings each attended by 60–100 anaesthetists was then collated and is included. Conclusion: The 24 sub-algorithms developed form the basis for developing a rational evidence-based approach to crisis management during anaesthesia. The COVER component has been found to be satisfactory in real life resuscitation situations and the sub-algorithms have been used successfully for several years. It would now be desirable for carefully designed simulator based studies, using naive trainees at the start of their training, to systematically examine the merits and demerits of various aspects of the sub-algorithms. It would seem prudent that these sub-algorithms be regarded, for the moment, as decision aids to support and back up clinicians' natural responses to a crisis when all is not progressing as expected. PMID:15933282

Crisis management during anaesthesia: the development of an anaesthetic crisis management manual.

PubMed

Runciman, W B; Kluger, M T; Morris, R W; Paix, A D; Watterson, L M; Webb, R K

2005-06-01

All anaesthetists have to handle life threatening crises with little or no warning. However, some cognitive strategies and work practices that are appropriate for speed and efficiency under normal circumstances may become maladaptive in a crisis. It was judged in a previous study that the use of a structured "core" algorithm (based on the mnemonic COVER ABCD-A SWIFT CHECK) would diagnose and correct the problem in 60% of cases and provide a functional diagnosis in virtually all of the remaining 40%. It was recommended that specific sub-algorithms be developed for managing the problems underlying the remaining 40% of crises and assembled in an easy-to-use manual. Sub-algorithms were therefore developed for these problems so that they could be checked for applicability and validity against the first 4000 anaesthesia incidents reported to the Australian Incident Monitoring Study (AIMS). The need for 24 specific sub-algorithms was identified. Teams of practising anaesthetists were assembled and sets of incidents relevant to each sub-algorithm were identified from the first 4000 reported to AIMS. Based largely on successful strategies identified in these reports, a set of 24 specific sub-algorithms was developed for trial against the 4000 AIMS reports and assembled into an easy-to-use manual. A process was developed for applying each component of the core algorithm COVER at one of four levels (scan-check-alert/ready-emergency) according to the degree of perceived urgency, and incorporated into the manual. The manual was disseminated at a World Congress and feedback was obtained. Each of the 24 specific crisis management sub-algorithms was tested against the relevant incidents among the first 4000 reported to AIMS and compared with the actual management by the anaesthetist at the time. It was judged that, if the core algorithm had been correctly applied, the appropriate sub-algorithm would have been resolved better and/or faster in one in eight of all incidents, and would have been unlikely to have caused harm to any patient. The descriptions of the validation of each of the 24 sub-algorithms constitute the remaining 24 papers in this set. Feedback from five meetings each attended by 60-100 anaesthetists was then collated and is included. The 24 sub-algorithms developed form the basis for developing a rational evidence-based approach to crisis management during anaesthesia. The COVER component has been found to be satisfactory in real life resuscitation situations and the sub-algorithms have been used successfully for several years. It would now be desirable for carefully designed simulator based studies, using naive trainees at the start of their training, to systematically examine the merits and demerits of various aspects of the sub-algorithms. It would seem prudent that these sub-algorithms be regarded, for the moment, as decision aids to support and back up clinicians' natural responses to a crisis when all is not progressing as expected.

The Use of Simulation to Improve the Effectiveness of Training in Performance Management

ERIC Educational Resources Information Center

Rachman-Moore, Dalia; Kenett, Ron S.

2006-01-01

Performance management is an important managerial tool that directs employees' goals and behavior toward the organization's strategic goals. This article focuses on simulation-based training in performance management systems. The simulation developed at the School of Business Administration of the College of Management in Israel is based on a…

Strategic Management: An Evaluation of the Use of Three Learning Methods.

ERIC Educational Resources Information Center

Jennings, David

2002-01-01

A study of 46 management students compared three methods for learning strategic management: cases, simulation, and action learning through consulting projects. Simulation was superior to action learning on all outcomes and equal or superior to cases on two. Simulation gave students a central role in management and greater control of the learning…

How can Doctors Improve their Communication Skills?

PubMed Central

Kumari, Archana; Chakrawarty, Avinash

2015-01-01

The process of curing a patient requires a holistic approach which involves considerations beyond treating a disease. It warrants several skills in a doctor along with technical expertise. Studies have shown that good communication skill in a doctor improve patient’s compliance and overall satisfaction. There are certain basic principles of practicing good communication. Patient listening, empathy, and paying attention to the paraverbal and non verbal components of the communication are the important ones that are frequently neglected. Proper information about the nature, course and prognosis of the disease is important. Besides, patients and attendants should always be explained about the necessity and yield of expensive investigations and risks/benefits involved in invasive procedures. One should be extremely cautious while managing difficult encounters and breaking bad news. Formal training of the doctors in improving communication skills is necessary and has proven to improve overall outcome. The authors recommend inclusion of formal training in communication skills in medical curriculum and training of practising doctors in the form of CMEs and CPEs. PMID:25954636

Dental treatment for people with cystic fibrosis.

PubMed

Harrington, N; Barry, P J; Barry, S M

2016-06-01

To describe the nature and consequences of the multi-system genetic condition cystic fibrosis with a view to ensuring optimal dental treatment planning for these patients. A literature search was conducted to identify the key medical and dental manifestations of cystic fibrosis. These findings are discussed and utilised to create recommendations for treatment planning in patients with cystic fibrosis for the practising dental practitioner. Cystic fibrosis is a complex, lethal, multisystem autosomal recessive disorder resulting from mutations on chromosome 7 which result in dysfunction of an ion channel that sits on epithelial surfaces. Respiratory disease remains the leading cause of mortality. Survival has greatly increased in recent decades secondary to improved treatment and specialist care. Specific dental manifestations of the disease may result from the condition itself or complications of treatment. Modification of patient management may be necessary to provide optimum patient care. The pathophysiology and clinical manifestations are relevant to practicing dental practitioners and inform recommendations to be utilised to ensure optimal treatment planning for these patients.

Terror Weapons: The British Experience of Gas and Its Treatment in the First World War

PubMed Central

Jones, Edgar

2016-01-01

Chemical weapons accounted for only 1 per cent of the 750,000 British troops killed in the First World War and yet caused disproportionate casualties (estimated at 180,100). The considerable investment in the development of new toxins and methods of delivery was designed to maintain the elements of surprise and uncertainty as these accentuated their psychological effect. Soldiers were continually challenged on the battlefield by combinations of different types of agent designed to undermine their confidence in respirators, disorientate them, and erode their morale. At first, army doctors practised defensive medicine, invaliding their patients for protracted periods to the UK or base hospitals. By 1917, progressive study of the physical and psychological effects of different types of toxin allowed physicians to design new management strategies. Borrowing ideas from shell shock, specialist units were set up closer to the front line and medical officers taught to identify crucial points in the course of illness to accelerate recovery times and forestall the accretion of psychosomatic symptoms. PMID:27917027

Terror Weapons: The British Experience of Gas and Its Treatment in the First World War.

PubMed

Jones, Edgar

2014-07-01

Chemical weapons accounted for only 1 per cent of the 750,000 British troops killed in the First World War and yet caused disproportionate casualties (estimated at 180,100). The considerable investment in the development of new toxins and methods of delivery was designed to maintain the elements of surprise and uncertainty as these accentuated their psychological effect. Soldiers were continually challenged on the battlefield by combinations of different types of agent designed to undermine their confidence in respirators, disorientate them, and erode their morale. At first, army doctors practised defensive medicine, invaliding their patients for protracted periods to the UK or base hospitals. By 1917, progressive study of the physical and psychological effects of different types of toxin allowed physicians to design new management strategies. Borrowing ideas from shell shock, specialist units were set up closer to the front line and medical officers taught to identify crucial points in the course of illness to accelerate recovery times and forestall the accretion of psychosomatic symptoms.

Disease and mortality in small ruminants in the North West Province of Cameroon.

PubMed

Ndamukong, K J; Sewell, M M; Asanji, M F

1989-08-01

Mortality rates and the prevalence of disease were assessed in 115 flocks of traditionally managed sheep and goats in two Divisions of the North West Province of Cameroon by means of a questionnaire to the owners. The mortality rate was significantly higher in sheep than in goats and also higher in young stock than in adults. Tethering the animals during the day resulted in significantly lower mortality in both adult and young sheep and also in kids. Disease problems of small ruminants, identified on the basis of signs reported by their owners, included intestinal parasitism, especially helminthiasis, tick infestation and associated diseases, pneumonia, goat plague (peste des petits ruminants) and Oestrus ovis infestation. Treatment of sick animals was only practised on a very small scale, often by possibly ineffective traditional methods. The owners identified tick infestation and diarrhoea as common causes of death. Recommendations are made on control measures suitable for application in this area.

Reducing dissolved inorganic nitrogen in surface runoff water from sugarcane production systems.

PubMed

Webster, A J; Bartley, R; Armour, J D; Brodie, J E; Thorburn, P J

2012-01-01

Nitrogen (N) lost from farms, especially as the highly bioavailable dissolved inorganic form, may be damaging Australia's Great Barrier Reef (GBR). As sugarcane is the dominant cropping system in GBR catchments, its N management practises are coming under increasing scrutiny. This study measured dissolved inorganic N lost in surface runoff water and sugarcane productivity over 3 years. The experiment compared the conventional fertiliser N application rate to sugarcane (average 180kg N/ha/year) and a rate based on replacing N exported in the previous crop (average 94kg N/ha/year). Dissolved inorganic N losses in surface water were 72%, 48% and 66% lower in the three monitored years in the reduced N fertiliser treatment. There was no significant difference in sugarcane yield between the two fertiliser N treatments, nor any treatment difference in soil mineral N - both of these results are indicators of the sustainability of the lower fertiliser N applications. Copyright © 2012 Elsevier Ltd. All rights reserved.

KAP study on mothers of children with Down syndrome.

PubMed

Lakshminarayana, P; Ibrahim, S; Venkataraman, P; Jagatheesan, T; Kamala, K G

1991-09-01

We evaluated 50 mothers of children with Down syndrome attending Genetic Clinic of the Institute of Child Health and Hospital for Children, Madras, with special reference to their knowledge, belief and attitudes in the care of these children. After evaluation, they were educated individually and in groups with demonstration, picture cards and pamphlets, on the causation, expected health problems, developmental potential of Down syndrome and the ways and means to help the child to attain the maximum developmental potential. They were taught on preventive aspects of Down syndrome as well. Re-evaluation was done after three months, and considerable improvement was noted in the mother's knowledge, and attitude towards bringing up such a child. The mothers also showed an improvement in the skills in providing developmental enrichment to these children. Thus this study has formulated a programme in the management of such children, which can be practised on any population, anywhere, especially, in rural areas, and by less affluent folk, with poor educational background.

Practising Cultures of Learning in Internationalising Universities

ERIC Educational Resources Information Center

Jin, Lixian; Cortazzi, Martin

2017-01-01

Internationalising higher education (HE) shows tensions between recruiting international students as a means of securing income and meeting their particular educational needs towards practices of caring for their social, psychological, intercultural and educational well-being. This paper briefly outlines the extent of current HE…

Validation of Algorithms for Basal Insulin Rate Reductions in Type 1 Diabetic Patients Practising Physical Activity

ClinicalTrials.gov

2013-04-19

Type 1 Diabetes With a Subcutaneous Insulin Pump; Adjustment of the Recommended Basal Insulin Flow Rate in the Event of Physical Activity; Adjustment of the Recommended Prandial Insulin in the Event of Physical Activity

Evidence of discrimination against BME nurses revealed.

PubMed

Longhurst, Chris

2017-04-27

University of Greenwich researchers responded to an advert from the Nursing and Midwifery Council (NMC) offering funding for an investigation into its fitness-to-practise (FtP) processes amid concerns about the treatment of NHS staff from black and minority ethnic (BME) backgrounds.

Pressure Groups and the Practising Administrator.

ERIC Educational Resources Information Center

Sackney, Larry

1984-01-01

Discusses the characteristics of pressure groups and how they attempt to influence decision making. Provides a synthesis of three typologies classifying pressure groups. Offers school administrators suggestions for dealing with pressure groups, emphasizing the need to accommodate various interests within the educational system. (MLF)

Being a Professional or Practising Professionally

ERIC Educational Resources Information Center

Dyer, Mary A.

2018-01-01

Research (Lloyd, E., and E. Hallet. [2010]. "Professionalising the Early Childhood Workforce in England: Work in Progress or Missed Opportunity?" "Contemporary Issues in Early Childhood" 11 (1): 75-788; Saks, M. [2012]. "Defining a Profession: The Role of Knowledge and Expertise." "Professions and…

Footrot and interdigital dermatitis in sheep: farmer satisfaction with current management, their ideal management and sources used to adopt new strategies.

PubMed

Wassink, G J; George, T R N; Kaler, J; Green, L E

2010-08-01

The aims of this research were to identify management practices that sheep farmers currently use to treat and prevent footrot in sheep and whether they consider that these are successful management tools and to find out how sheep farmers would ideally like to manage footrot in their flock. Over 90% of lameness in sheep in the UK is caused by Dichelobacter nodosus, which presents clinically as interdigital dermatitis (ID) alone or with separation of hoof horn (FR). A questionnaire was sent to 265 farmers to investigate their current management and their satisfaction with current management of the spectrum of clinical presentations of footrot. Farmers were also asked their ideal management of footrot and their interest in, and sources of information for, change. Approximately 160 farmers responded. Farmers satisfied with current management reported a prevalence of lameness < or = 5%. These farmers caught and treated lame sheep within 3 days of first seeing them lame, and treated sheep with FR and ID with parenteral antibacterials. Farmers dissatisfied with their management reported a prevalence of lameness >5%. These farmers practised routine foot trimming, footbathing and vaccination against footrot. Whilst 89% of farmers said they were satisfied with their management of FR over 34% were interested in changing management. Farmers identified veterinarians as the most influential source for new information. Farmers reported that ideally they would control FR by culling/isolating lame sheep, sourcing replacements from non-lame parents, trimming feet less, using antibacterial treatments less and using vaccination more. Footbathing was a commonly used management that was linked with dissatisfaction and that also was listed highly as an ideal management. Consequently, some of the ideal managements are in agreement with our understanding of disease control (culling and isolation, sourcing healthy replacements) but others are in contrast with our current knowledge of management and farmers self-reporting of satisfaction of management of footrot (less use of antibacterial treatment, more footbathing and vaccination). One explanation for this is the theory of cognitive dissonance where belief follows behaviour, i.e. farmers report that they believe an ideal which is what they are currently doing, even if the management is sub-optimal. Copyright 2010 Elsevier B.V. All rights reserved.

Simulation Games in Production Management Education--A Review. Department of Management Systems Research Report Series.

ERIC Educational Resources Information Center

Basnet, C.

Some 40 years after the inception of management simulation games, the effectiveness of games in management education/training remains unclear. Despite the lack of consensus regarding the teaching and grading methods to be used in conjunction with such games, it is clear that well-conducted simulation games can provide excellent experiential…

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

Approaches to the diagnosis and management of occupational asthma amongst UK respiratory physicians.

PubMed

Barber, C M; Naylor, S; Bradshaw, L M; Francis, M; Harris-Roberts, J; Rawbone, R; Curran, A D; Fishwick, D

2007-09-01

This study aimed to assess the approach to the diagnosis and management of occupational asthma amongst general (non-specialist) respiratory consultants in the UK. A random sample of 100 UK general respiratory physicians were invited to participate, and asked to provide information on their diagnostic approach to a case scenario of a patient with possible occupational asthma relating to flour exposure. Participation rates were 42% for the main part of the study. Less than half of consultants specifically reported they would ask whether symptoms improved away from work, and just over a third mentioned examining the patient. All of those interviewed recommended a chest X-ray, and 98% simple spirometry. Eighty-six per cent suggested measurement of serial peak flows, recorded for between 2 and 8 weeks, with measurements taken half-twelve hourly. Less than half advocated a specific flour allergy test, and almost one-quarter (23%) would not perform any immunological test at all. Once a diagnosis of occupational asthma was confirmed, less than two-thirds of those interviewed commented they would recommend some form of exposure reduction, and only 28% specifically stated they would offer compensation advice. The diagnosis of occupational asthma by general respiratory physicians within the UK lacks standardisation, and in some cases falls short of evidence-based best practise.

Expert opinion on the management of infections in the diabetic foot.

PubMed

Lipsky, B A; Peters, E J G; Senneville, E; Berendt, A R; Embil, J M; Lavery, L A; Urbančič-Rovan, V; Jeffcoate, W J

2012-02-01

This update of the International Working Group on the Diabetic Foot incorporates some information from a related review of diabetic foot osteomyelitis (DFO) and a systematic review of the management of infection of the diabetic foot. The pathophysiology of these infections is now well understood, and there is a validated system for classifying the severity of infections based on their clinical findings. Diagnosing osteomyelitis remains difficult, but several recent publications have clarified the role of clinical, laboratory and imaging tests. Magnetic resonance imaging has emerged as the most accurate means of diagnosing bone infection, but bone biopsy for culture and histopathology remains the criterion standard. Determining the organisms responsible for a diabetic foot infection via culture of appropriately collected tissue specimens enables clinicians to make optimal antibiotic choices based on culture and sensitivity results. In addition to culture-directed antibiotic therapy, most infections require some surgical intervention, ranging from minor debridement to major resection, amputation or revascularization. Clinicians must also provide proper wound care to ensure healing of the wound. Various adjunctive therapies may benefit some patients, but the data supporting them are weak. If properly treated, most diabetic foot infections can be cured. Providers practising in developing countries, and their patients, face especially challenging situations. Copyright © 2012 John Wiley & Sons, Ltd.

Health service support of breast feeding--are we practising what we preach?

PubMed Central

Beeken, S.; Waterston, T.

1992-01-01

OBJECTIVE--To ascertain the attitudes of health professionals and breast feeding mothers to breast feeding and their views on current practice. DESIGN--Questionnaire to all midwives and health visitors and to breast feeding mothers in Newcastle upon Tyne. SETTING--Maternity units and community in Newcastle upon Tyne. SUBJECTS--127 hospital midwives, 23 community midwives, 63 health visitors, and 50 first time breast feeding mothers. RESULTS--Optimum practice guidelines were not followed. 30 (60%) mothers said they were separated from their babies on the first night after birth. 82 (42%) professionals said that breast fed babies were frequently given water to drink. 28 (56%) babies in the mothers survey had received food or water other than breast milk; 19 of these had been given water. Professionals expressed mainly positive attitudes towards breast feeding in general but less positive attitudes to specific issues such as the beneficial effects on child health and the value of voluntary organisations in breast feeding promotion and management. CONCLUSIONS--Although many health workers are in favour of breast feeding there is conflict among the professions working most closely with breast feeding mothers. Good breast feeding support requires closer attention to monitoring hospital practices and continued training on good lactation management. Images p286-a p287-a PMID:1392861

RNTCP 2007: looking ahead to future challenges.

PubMed

Chauhan, L S

2007-04-01

The largest TB control programme in terms of patients treated is India's Revised National Tuberculosis Control Programme (RNTCP). The treatment success of new smear positive TB cases under RNTCP has exceeded the global benchmark of 85%. Also there are some challenges in TB control programme eg, addressing TB in HIV-infected persons and accurate diagnosis and management of multidrug resistant TB (MDR-TB). Diagnosis of MDR-TB requires sophisticated laboratories. If MDR-TB is not managed effectively, then there is possibility to emerge drug-resistant TB which is virtually untreatable. The Public-Private mix initiatives of RNTCP attempt to make quality assured treatment for TB for all patients, regardless of healthcare providers they choose. The International Standards of TB Care (ISTC) is an international effort which has articulated the diagnostic, treatment and public health standards which all providers should hold themselves and their peers accountable to. For providers the path to practise the ISTC is to diagnose and treat patients in collaboration with RNTCP. The IMA has taken up the cause of TB control in India very seriously. This organisation of the doctors (IMA) deserves recognition for becoming the first professional association to endorse the ISTC in India. All health providers should work with and support the RNTCP, so that the programme can be made into a genuine mass movement to fight TB.

Characterization of indigenous chicken production systems in Kenya.

PubMed

Okeno, Tobias O; Kahi, Alexander K; Peters, Kurt J

2012-03-01

Indigenous chicken (IC) and their production systems were characterized to understand how the whole system operates for purposes of identifying threats and opportunities for holistic improvement. A survey involving 594 households was conducted in six counties with the highest population of IC in Kenya using structured questionnaires. Data on IC farmers' management practices were collected and analysed and inbreeding levels calculated based on the effective population size. Indigenous chicken were ranked highest as a source of livestock income by households in medium- to high-potential agricultural areas, but trailed goats in arid and semi-arid areas. The production system practised was mainly low-input and small-scale free range, with mean flock size of 22.40 chickens per household. The mean effective population size was 16.02, translating to high levels of inbreeding (3.12%). Provision for food and cash income were the main reasons for raising IC, whilst high mortality due to diseases, poor nutrition, housing and marketing channels were the major constraints faced by farmers. Management strategies targeting improved healthcare, nutrition and housing require urgent mitigation measures, whilst rural access road network needs to be developed for ease of market accessibility. Sustainable genetic improvement programmes that account for farmers' multiple objectives, market requirements and the production circumstances should be developed for a full realization of IC productivity.

The role of material engineering within the concept of an integrated water resources management

NASA Astrophysics Data System (ADS)

Breiner, Raphael; Müller, Harald S.

2016-09-01

By means of a case study, the successful implementation of a rheologically optimised cement-based mortar for the construction as well as for the rehabilitation of rain water cisterns is presented in this paper. The material was developed within the scope of a German-Indonesian joint project ["Integrated Water Resources Management" (IWRM)], funded by the German Federal Ministry of Education and Research. Comprehensive rheological investigations are presented which provide the database for the optimization of the mortar with regard to its intended range of application. For the selection of the source materials, special emphasis was placed on the ready availability at low cost. The rheological properties of the fresh mortar allow an easy workability by hand while the hardened mortar shows a durable and tight appearance at the same time. The developed material can be used as a coating for walls, floors and ceilings of cisterns, for the local rehabilitation of damaged areas only or even as a construction material for complete new cisterns. The future multiplication of the IWRM project results within the region was assured by a local capacity development when the presented material concept was applied in practise in Indonesia for the construction of sustainable rain water cisterns in Gunung Kidul.

Motor control and the management of musculoskeletal dysfunction.

PubMed

van Vliet, Paulette M; Heneghan, Nicola R

2006-08-01

This paper aims to develop understanding of three important motor control issues--feedforward mechanisms, cortical plasticity and task-specificity and assess the implications for musculoskeletal practice. A model of control for the reach-to-grasp movement illustrates how the central nervous system integrates sensorimotor processes to control complex movements. Feedforward mechanisms, an essential element of motor control, are altered in neurologically intact patients with chronic neck pain and low back pain. In healthy subjects, cortical mapping studies using transcranial magnetic stimulation have demonstrated that neural pathways adapt according to what and how much is practised. Neuroplasticity has also been demonstrated in a number of musculoskeletal conditions, where cortical maps are altered compared to normal. Behavioural and neurophysiological studies indicate that environmental and task constraints such as the goal of the task and an object's shape and size, are determinants of the motor schema for reaching and other movements. Consideration of motor control issues as well as signs and symptoms, may facilitate management of musculoskeletal conditions and improve outcome. Practice of entire everyday tasks at an early stage and systematic variation of the task is recommended. Training should be directed with the aim of re-educating feedforward mechanisms where necessary and the amount of practice should be sufficient to cause changes in cortical activity.

Management of allergy to penicillins and other beta-lactams.

PubMed

Mirakian, R; Leech, S C; Krishna, M T; Richter, A G; Huber, P A J; Farooque, S; Khan, N; Pirmohamed, M; Clark, A T; Nasser, S M

2015-02-01

The Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and an expert panel have prepared this guidance for the management of immediate and non-immediate allergic reactions to penicillins and other beta-lactams. The guideline is intended for UK specialists in both adult and paediatric allergy and for other clinicians practising allergy in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking, the panel reached consensus. During the development of the guideline, all BSACI members were consulted using a Web-based process and all comments carefully considered. Included in the guideline are epidemiology of allergic reactions to beta-lactams, molecular structure, formulations available in the UK and a description of known beta-lactam antigenic determinants. Sections on the value and limitations of clinical history, skin testing and laboratory investigations for both penicillins and cephalosporins are included. Cross-reactivity between penicillins and cephalosporins is discussed in detail. Recommendations on oral provocation and desensitization procedures have been made. Guidance for beta-lactam allergy in children is given in a separate section. An algorithm to help the clinician in the diagnosis of patients with a history of penicillin allergy has also been included. © 2015 John Wiley & Sons Ltd.

Oral surgery in the European Union: challenges of diversity in training and practice.

PubMed

Nasseripour, M N; Hervé, C; Meningaud, J-P

2017-02-01

At the crossroads of medicine and dentistry, oral surgery with orthodontics are the only recognised dental specialties by the European Union. The goal of our study is to evaluate the current state of oral surgery in Europe from its teaching to its practice, the hypothesis being that a notable diversity persists despite European Union harmonisation process. To understand the impact of this diversity applied to European Union freedom of movement and its ethical implications for the practice of oral surgery, English and French questionnaires were sent by email to universities and organisations delivering authorisation to practise in France, Germany, Spain, Sweden and United Kingdom chosen based upon inclusion and exclusion criteria. An analysis of documents on these organisations' official websites was also conducted. Demographic information was obtained from the aforementioned organisations. The profile of practising oral surgeons is different dependent on the country. The university and hospital trainings conform to European recommendations and span 3-4 years. European Board certification is not required. Continuing education is mandatory only in France, Germany and United Kingdom. As for curricula and scope of practice, no consensus can be derived. There is potential conflict of interest between European Union principles of freedom of movement and protection of all citizens, as member countries do not uniformly apply Directives and recommendations. A new survey of all European Union oral surgery programmes as well as organisations delivering authorisation to practise is necessary to implement across the board harmonisation of training and practice to insure patient safety in light of the migration of European Union practitioners. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Pharmacist independent prescribing in critical care: results of a national questionnaire to establish the 2014 UK position.

PubMed

Bourne, Richard S; Whiting, Paul; Brown, Lisa S; Borthwick, Mark

2016-04-01

Clinical pharmacist practice is well established in the safe and effective use of medicines in the critically ill patient. In the UK, independent pharmacist prescribers are generally recognised as a valuable and desirable resource. However, currently, there are only anecdotal reports of pharmacist-independent prescribing in critical care. The aim of this questionnaire was to determine the current and proposed future independent prescribing practice of UK clinical pharmacists working in adult critical care. The questionnaire was distributed electronically to UK Clinical Pharmacy Association members (closed August 2014). There were 134 responses to the questionnaire (response rate at least 33%). Over a third of critical care pharmacists were practising independent prescribers in the specialty, and 70% intended to be prescribers within the next 3 years. Pharmacists with ≥5 years critical care experience (P < 0.001) or worked in a team (P = 0.005) were more likely to be practising independent prescribers. Pharmacists reported significant positives to the use of independent prescribing in critical care both in patient care and job satisfaction. Independently, prescribing was routine in: dose adjustment for multi-organ failure, change in route or formulation, correction prescribing errors, therapeutic drug monitoring and chronic medication. The majority of pharmacist prescribers reported they spent ≤5% of their clinical time prescribing and accounted for ≤5% of new prescriptions in critical care patients. Most critical care pharmacists intend to be practising as independent prescribers within the next 3 years. The extent and scope of critical care pharmacist prescribing appear to be of relatively low volume and within niche prescribing areas. © 2015 Royal Pharmaceutical Society.

Interpreting patient-reported outcomes from clinical trials in COPD: a discussion

PubMed Central

Jones, Paul W; Rennard, Stephen; Tabberer, Maggie; Riley, John H; Vahdati-Bolouri, Mitra; Barnes, Neil C

2016-01-01

One of the challenges faced by the practising physician is the interpretation of patient-reported outcomes (PROs) in clinical trials and the relevance of such data to their patients. This is especially true when caring for patients with progressive diseases such as COPD. In an attempt to incorporate the patient perspective, many clinical trials now include assessments of PROs. These are formalized methods of capturing patient-centered information. Given the importance of PROs in evaluating the potential utility of an intervention for a patient with COPD, it is important that physicians are able to critically interpret (and critique) the results derived from them. Therefore, in this paper, a series of questions is posed for the practising physician to consider when reviewing the treatment effectiveness as assessed by PROs. The focus is on the St George’s Respiratory Questionnaire for worked examples, but the principles apply equally to other symptom-based questionnaires. A number of different ways of presenting PRO data are discussed, including the concept of the minimum clinically important difference, whether there is a ceiling effect to PRO results, and the strengths and weaknesses of responder analyses. Using a worked example, the value of including a placebo arm in a study is illustrated, and the influence of the study on PRO results is considered, in terms of the design, patient withdrawal, and the selection of the study population. For the practising clinician, the most important consideration is the importance of individualization of treatment (and of treatment goals). To inform such treatment, clinicians need to critically review PRO data. The hope is that the questions posed here will help to build a framework for this critical review. PMID:27994447

New graduate separations from New Zealand's nursing workforce in the first 5 years after registration: a retrospective cohort analysis of a national administrative data set 2005-2010.

PubMed

North, Nicola; Leung, William; Lee, Rochelle

2014-08-01

To describe workforce separation rates and its relationship with demographic and work characteristics in the 2005 new graduate cohort's first 5 years as practising RNs in NZ. Retaining new graduate RNs is critical to nursing workforce sustainability; one study showed that if an RN is still employed in a hospital setting 5 years after graduation, he/she tends to remain active in the health industry. Retrospective analysis using the Nursing Council of New Zealand's registration data set for years 2005-2010. All newly registered NZ graduates practising in NZ in 2005 (n = 1236) were tracked for 5 years. Within 5 years of graduation, 26% of the cohort had separated from the NZ nursing workforce, 18% in the first year. The under-25s (n = 517), 42% of the cohort, had the highest loss, 32%, in 5 years. Separations were significantly lower for graduates in their 30s vs. their 20s and for those who gained postgraduate tertiary qualifications post-registration (10%) vs. those who did not (29%). Hospitals were the most frequent employment setting over 5 years, the largest increase being community settings. Five-year retention rates in the four largest practice areas were surgical 26%, medical 16%, mental health 60% and continuing care 10%. After 5 years, 24% of those still practising (n = 920) worked in a different health board region. New graduate RN losses were higher than in previous research, with younger RNs at most risk, threatening future sustainability of the nursing workforce and highlighting the need for evidence-based targeted strategies to retain them. © 2013 John Wiley & Sons Ltd.

Coping with future epidemics: Tai chi practice as an overcoming strategy used by survivors of severe acute respiratory syndrome (SARS) in post-SARS Hong Kong.

PubMed

Siu, Judy Yuen-Man

2016-06-01

Although SARS had been with a controversial topic for a decade at the time of this study, numerous SARS survivors had not yet physically, psychologically or socially recovered from the aftermath of SARS. Among chronically ill patients, the use of complementary and alternative medicine (CAM) is reported to be widespread. However, extremely little is known about the use of CAM by SARS survivors in the post-SARS period and even less is known about how the use of CAM is related to the unpleasant social and medical-treatment experiences of SARS survivors, their eagerness to re-establish social networks, and their awareness to prepare for future epidemics. To investigate the motivations for practising tai chi among SARS survivors in post-SARS Hong Kong. Using a qualitative approach, I conducted individual semi-structured interviews with 35 SARS survivors, who were purposively sampled from a tai chi class of a SARS-patient self-help group in Hong Kong. Health concerns and social experiences motivated the participants to practise tai chi in post-SARS Hong Kong. Experiencing health deterioration in relation to SARS-associated sequelae, coping with unpleasant experiences during follow-up biomedical treatments, a desire to regain an active role in recovery and rehabilitation, overcoming SARS-associated stigmas by establishing a new social network and preparing for potential future stigmatization and discrimination were the key motivators for them. The participants practised tai chi not only because they sought to improve their health but also because it provided a crucial social function and meaning to them. © 2014 John Wiley & Sons Ltd.

Use of caries-preventive agents in children: findings from the dental practice-based research network.

PubMed

Riley, J L; Richman, Joshua S; Rindal, D Brad; Fellows, Jeffrey L; Qvist, Vibeke; Gilbert, Gregg H; Gordan, Valeria V

2010-01-01

Scientific evidence supports the application of caries-preventive agents in children and adolescents, and this knowledge must be applied to the practice of dentistry. There are few multi-region data that allow for comparisons of practice patterns between types of dental practices and geographical regions. The objective of the present study was to characterise the use of specific caries-preventive agents for paediatric patients in a large multi-region sample of practising clinicians. The present study surveyed clinicians from the Dental Practice-based Research Network who perform restorative dentistry in their practices. The survey consisted of a questionnaire that presented a range of questions about caries risk assessment and the use of preventive techniques in children aged 6 to 18 years. Dental sealants (69%) or in-office fluoride (82%) were the most commonly used caries-preventive agents of the caries preventive regimens. The recommendation of at-home caries-preventive agents ranged from 36% to 7%,with the most commonly used agent being non-prescription fluoride rinse. Clinicians who practised in a large group practice model and clinicians who come from the Scandinavian region use caries risk assessment more frequently compared to clinicians who come from regions that had, predominantly, clinicians in private practice. Whether or not clinicians used caries risk assessment with their paediatric patients was poorly correlated with the likelihood of actually using caries-preventive treatments on patients. Although clinicians reported the use of some form of in-office caries-preventive agent, there was considerable variability across practices. These differences could represent a lack of consensus across practising clinicians about the benefits of caries-preventive agents, or a function of differing financial incentives, or patient pools with differing levels of overall caries risk.

Sports-specific differences in postsurgical infections after arthroscopically assisted anterior cruciate ligament reconstruction.

PubMed

Krutsch, Werner; Zellner, Johannes; Zeman, Florian; Nerlich, Michael; Koch, Matthias; Pfeifer, Christian; Angele, Peter

2017-12-01

Post-operative infection after arthroscopically assisted anterior cruciate ligament (ACL) reconstruction is a rare but severe complication, particularly for young and active patients. It is unclear whether the prevalence of knee infection is correlated with the type of sports or the level of performance. From 2008 to 2012, the internal single-centre ACL registry of the FIFA Medical Centre of Excellence Regensburg was retrospectively screened for sex, age, time between isolated primary ACL rupture and surgery, surgical technique, rate of infection after ACL reconstruction and the type of sports practised. In total, 4801 ACL reconstructions had been conducted over 5 years, 4579 in amateur and 221 in professional athletes. After application of the exclusion criteria, 1809 athletes with ACL reconstruction were analysed regarding postsurgical infection and the type of sports practised. Professionals and amateurs did not significantly differ with regard to infection rates (n.s.) but in the timing of ACL repair (p < 0.001). Eleven of 1130 football players had developed postsurgical infection after ACL reconstruction (1.0%) in contrast to 557 skiers and snowboarders without infection (p = 0.02). The timing of ACL repair did not differ between the different types of sports (n.s.). Staphylococcus aureus and epidermidis were the predominant detected bacteria. All patients were hospitalised and successfully treated with arthroscopic lavage and antibiotic medication. ACL infections showed sports-related differences. Athletes practising summer outdoor sports such as football had a significantly higher risk of infection after ACL reconstruction than winter sports athletes. No difference was found between professional and amateur athletes. Relevant prevention strategies for postsurgical ACL infections should consider influencing patient factors such as the type of sports activity and attendant circumstances. III.

Creation and pilot testing of cases for case-based learning: A pedagogical approach for pathology cancer diagnosis.

PubMed

Sayed, Shahin; Lester, Susan C; Wilson, Michael; Berney, Daniel; Masia, Ricard; Moloo, Zahir; Stall, Jennifer; Eslan, Alexia; Ayers, Stephanie; Mutuku, Angela; Guarner, Jeannette

2017-01-01

Case-based learning (CBL) is an established pedagogical active learning method used in various disciplines and defined based on the field of study and type of case. The utility of CBL for teaching specific aspects of cancer diagnosis to practising pathologists has not been previously studied in sub-Saharan Africa. We aimed to pilot test standardised cancer cases on a group of practising pathologists in sub-Saharan Africa to evaluate case content, clarity of questions and delivery of content. Expert faculty created cases for the four most commonly diagnosed cancers. The format included mini-cases and bullet cases which were all open-ended. The questions dealt with interpretation of clinical information, gross specimen examination, morphologic characteristics of tumours, ancillary testing, reporting and appropriate communication to clinicians. Cases on breast, cervical, prostate and colorectal cancers were tested on seven practising pathologists. Each case took an average of 45-90 min to complete.Questions that were particularly challenging to testers were on: Specimens they should have been but for some reason were not exposed to in routine practice.Ancillary testing and appropriate tumour staging.New knowledge gained included tumour grading and assessment of radial margins. Revisions to cases were made based on testers' feedback, which included rewording of questions to reduce ambiguity and adding of tables to clarify concepts. Cases were created for CBL in Kenya, but these are applicable elsewhere in Africa and beyond to teach cancer diagnosis. The pilot testing of cases prepared faculty for the actual CBL course and feedback provided by the testers assisted in improving the questions and impact on day-to-day practice.

Interpreting patient-reported outcomes from clinical trials in COPD: a discussion.

PubMed

Jones, Paul W; Rennard, Stephen; Tabberer, Maggie; Riley, John H; Vahdati-Bolouri, Mitra; Barnes, Neil C

2016-01-01

One of the challenges faced by the practising physician is the interpretation of patient-reported outcomes (PROs) in clinical trials and the relevance of such data to their patients. This is especially true when caring for patients with progressive diseases such as COPD. In an attempt to incorporate the patient perspective, many clinical trials now include assessments of PROs. These are formalized methods of capturing patient-centered information. Given the importance of PROs in evaluating the potential utility of an intervention for a patient with COPD, it is important that physicians are able to critically interpret (and critique) the results derived from them. Therefore, in this paper, a series of questions is posed for the practising physician to consider when reviewing the treatment effectiveness as assessed by PROs. The focus is on the St George's Respiratory Questionnaire for worked examples, but the principles apply equally to other symptom-based questionnaires. A number of different ways of presenting PRO data are discussed, including the concept of the minimum clinically important difference, whether there is a ceiling effect to PRO results, and the strengths and weaknesses of responder analyses. Using a worked example, the value of including a placebo arm in a study is illustrated, and the influence of the study on PRO results is considered, in terms of the design, patient withdrawal, and the selection of the study population. For the practising clinician, the most important consideration is the importance of individualization of treatment (and of treatment goals). To inform such treatment, clinicians need to critically review PRO data. The hope is that the questions posed here will help to build a framework for this critical review.

Creation and pilot testing of cases for case-based learning: A pedagogical approach for pathology cancer diagnosis

PubMed Central

Wilson, Michael; Masia, Ricard; Moloo, Zahir; Stall, Jennifer; Eslan, Alexia; Ayers, Stephanie; Mutuku, Angela

2017-01-01

Background Case-based learning (CBL) is an established pedagogical active learning method used in various disciplines and defined based on the field of study and type of case. The utility of CBL for teaching specific aspects of cancer diagnosis to practising pathologists has not been previously studied in sub-Saharan Africa. Objectives We aimed to pilot test standardised cancer cases on a group of practising pathologists in sub-Saharan Africa to evaluate case content, clarity of questions and delivery of content. Methods Expert faculty created cases for the four most commonly diagnosed cancers. The format included mini-cases and bullet cases which were all open-ended. The questions dealt with interpretation of clinical information, gross specimen examination, morphologic characteristics of tumours, ancillary testing, reporting and appropriate communication to clinicians. Results Cases on breast, cervical, prostate and colorectal cancers were tested on seven practising pathologists. Each case took an average of 45–90 min to complete. Questions that were particularly challenging to testers were on: Specimens they should have been but for some reason were not exposed to in routine practice.Ancillary testing and appropriate tumour staging. New knowledge gained included tumour grading and assessment of radial margins. Revisions to cases were made based on testers’ feedback, which included rewording of questions to reduce ambiguity and adding of tables to clarify concepts. Conclusion Cases were created for CBL in Kenya, but these are applicable elsewhere in Africa and beyond to teach cancer diagnosis. The pilot testing of cases prepared faculty for the actual CBL course and feedback provided by the testers assisted in improving the questions and impact on day-to-day practice. PMID:29147646

The integration of minimally invasive surgery in surgical practice in a Canadian setting: results from 2 consecutive province-wide practice surveys of general surgeons over a 5-year period

PubMed Central

Hallet, Julie; Mailloux, Olivier; Chhiv, Mony; Grégoire, Roger C.; Gagné, Jean-Pierre

2015-01-01

Background Although minimally invasive surgery (MIS) has been quickly embraced, the introduction of advanced procedures appears more complex. We assessed the evolution of MIS in the province of Quebec over a 5-year period to identify areas for improvement in the modern surgical era. Methods We developed, test-piloted and conducted a self-administered questionnaire among Quebec general surgeons in 2007 and 2012 to examine stated MIS practice, MIS training and barriers and facilitators to the use of MIS. Results Response rates were 51.3% (251 of 489) in 2007 and 31.3% (153 of 491) in 2012. A significant increase was observed for performance of most advanced MIS procedures, especially for colectomy for benign (66.0% v. 84.3%, p < 0,001) and malignant diseases (43.3% v. 77.8%, p < 0,001) and for rectal surgery for malignancy (21.0% v. 54.6%, p < 0.001). More surgeons practised 3 or more advanced MIS procedures in 2012 than in 2007 (82.3% v. 64.3%, p < 0,001). At multivariate analysis, the 2007 survey administration was associated with fewer surgeons practising advanced MIS (odds ratio 0.13, 95% confidence interval 0.06–0.29). In 2012, more respondents stated they gained their skills during residency (p = 0.028). Conclusion From 2007 to 2012 there was a significant increase in advanced MIS procedures practised by general surgeons in Québec. This technique appears well established in current surgical practice. The growing place of MIS in residency training seems to be a paramount part of this development. Results from this study could be used as a baseline for studies focusing on ways to further improve the MIS practice. PMID:25598180

Efficacy of teaching methods used to develop critical thinking in nursing and midwifery undergraduate students: A systematic review of the literature.

PubMed

Carter, Amanda G; Creedy, Debra K; Sidebotham, Mary

2016-05-01

The value and importance of incorporating strategies that promote critical thinking in nursing and midwifery undergraduate programmes are well documented. However, relatively little is known about the effectiveness of teaching strategies in promoting CT. Evaluating effectiveness is important to promote 'best practise' in teaching. To evaluate the efficacy of teaching methods used to develop critical thinking skills in nursing and midwifery undergraduate students. The following six databases; CINAHL, Ovid Medline, ERIC, Informit, PsycINFO and Scopus were searched and resulted in the retrieval of 1315 papers. After screening for inclusion, each paper was evaluated using the Critical Appraisal Skills Programme tool. Twenty-eight studies met the inclusion criteria and quality appraisal. Twelve different teaching interventions were tested in 8 countries. Results varied, with little consistency across studies using the same type of intervention or outcome tool. Sixteen tools were used to measure the efficacy of teaching in developing critical thinking. Seventeen studies identified a significant increase in critical thinking, while nine studies found no increases, and two found unexplained decreases in CT when using a similar educational intervention. Whilst this review aimed to identify effective teaching strategies that promote and develop critical thinking, flaws in methodology and outcome measures contributed to inconsistent findings. The continued use of generalised CT tools is unlikely to help identify appropriate teaching methods that will improve CT abilities of midwifery and nursing students and prepare them for practise. The review was limited to empirical studies published in English that used measures of critical thinking with midwifery and nursing students. Discipline specific strategies and tools that measure students' abilities to apply CT in practise are needed. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Factors associated with a positive willingness to practise oral health care in the future amongst oral healthcare and nursing students.

PubMed

Haresaku, S; Monji, M; Miyoshi, M; Kubota, K; Kuroki, M; Aoki, H; Yoshida, R; Machishima, K; Makino, M; Naito, T

2018-06-06

The purpose of this study was to identify the weak points in the knowledge and attitudes of first-year oral health care and nursing students towards oral health care and to identify the factors associated with their positive willingness to practise oral health care after becoming a health professional in order to develop oral healthcare curricula. The subjects were 88 first-year dental students (DSs), 64 dental hygiene students (DHSs) and 119 nursing students (NSs) enrolled in schools in Japan, as of April 2017. A questionnaire was distributed to subjects in each school to assess their knowledge and attitudes towards oral health care. Less than half knew that oral health care was also provided in cancer hospitals, hospices, acute care hospitals, maternity wards and psychiatric wards. Only 46.2% knew that oral health care was effective in the prevention of aspiration pneumonia. The level of knowledge and attitudes in NSs regarding oral health care were likely to be lowest amongst the student groups. Only NSs' high interest towards oral health care was associated with their positive willingness to practise oral health care in the future although oral health students' high perceptions and interest regarding oral health care were associated with the willingness. This study showed oral healthcare and nursing students' weak points regarding their attitudes and knowledge of oral health care at early stages. Oral health academic staff and professionals should develop effective oral healthcare curricula for oral healthcare students and help nursing staff develop a collaborative nursing oral healthcare curriculum to motivate nursing students. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A qualitative investigation of specialist orthodontists in New Zealand: part 2. Orthodontists' working lives and work-life balance.

PubMed

Soma, Kieran J; Thomson, W Murray; Morgaine, Kate C; Harding, Winifred J

2012-11-01

Orthodontics is the most widely practised form of specialist dentistry in New Zealand. To date, no known qualitative research has been published examining the work-life balance of practitioners. The aim of this study was to investigate the working lives and work-life balance of NZ orthodontists in order to generate an understanding of the reality of orthodontic specialist practice and its effects on orthodontists' professional and personal lives. Semi-structured interviews were conducted involving 19 practising orthodontists (four females, 15 males; mean age 50 years) from throughout New Zealand and selected for maximum variation in the sample. Transcribed interviews were analysed for themes using an applied grounded theory approach. A core category of 'practising orthodontist' was derived, and related themes were grouped under the sub-categories of: (a) NZ orthodontic specialist practice; (b) NZ specialist orthodontists; and (c) Work-life balance. The present paper reports on the final sub-category. Themes emerging from the work-life sub-category were further divided into two sub-themes of 'work' and 'life'. Themes in the 'work' subgroup included time off, injuries and illness, regrets, personality traits, job stress and criticism, establishing a practice, peer support and contact, and success in orthodontics. Themes in the 'life' sub-group were personal development, family life, life balance and interests outside work, and financial security. This was the first qualitative investigation of the orthodontic profession in New Zealand. The findings provided a valuable insight into the working lives of New Zealand orthodontists and effects on their day-today lives. It will be revealing and interesting to observe how the modernisation of orthodontic practice will affect the work-life balance of New Zealand orthodontists in the future.

Simulation-based crisis resource management training for pediatric critical care medicine: a review for instructors.

PubMed

Cheng, Adam; Donoghue, Aaron; Gilfoyle, Elaine; Eppich, Walter

2012-03-01

To review the essential elements of crisis resource management and provide a resource for instructors by describing how to use simulation-based training to teach crisis resource management principles in pediatric acute care contexts. A MEDLINE-based literature source. OUTLINE OF REVIEW: This review is divided into three main sections: Background, Principles of Crisis Resource Management, and Tools and Resources. The background section provides the brief history and definition of crisis resource management. The next section describes all the essential elements of crisis resource management, including leadership and followership, communication, teamwork, resource use, and situational awareness. This is followed by a review of evidence supporting the use of simulation-based crisis resource management training in health care. The last section provides the resources necessary to develop crisis resource management training using a simulation-based approach. This includes a description of how to design pediatric simulation scenarios, how to effectively debrief, and a list of potential assessment tools that instructors can use to evaluate crisis resource management performance during simulation-based training. Crisis resource management principles form the foundation for efficient team functioning and subsequent error reduction in high-stakes environments such as acute care pediatrics. Effective instructor training is required for those programs wishing to teach these principles using simulation-based learning. Dissemination and integration of these principles into pediatric critical care practice has the potential for a tremendous impact on patient safety and outcomes.

Gait rehabilitation machines based on programmable footplates

PubMed Central

Schmidt, Henning; Werner, Cordula; Bernhardt, Rolf; Hesse, Stefan; Krüger, Jörg

2007-01-01

Background Gait restoration is an integral part of rehabilitation of brain lesioned patients. Modern concepts favour a task-specific repetitive approach, i.e. who wants to regain walking has to walk, while tone-inhibiting and gait preparatory manoeuvres had dominated therapy before. Following the first mobilization out of the bed, the wheelchair-bound patient should have the possibility to practise complex gait cycles as soon as possible. Steps in this direction were treadmill training with partial body weight support and most recently gait machines enabling the repetitive training of even surface gait and even of stair climbing. Results With treadmill training harness-secured and partially relieved wheelchair-mobilised patients could practise up to 1000 steps per session for the first time. Controlled trials in stroke and SCI patients, however, failed to show a superior result when compared to walking exercise on the floor. Most likely explanation was the effort for the therapists, e.g. manually setting the paretic limbs during the swing phase resulting in a too little gait intensity. The next steps were gait machines, either consisting of a powered exoskeleton and a treadmill (Lokomat, AutoAmbulator) or an electromechanical solution with the harness secured patient placed on movable foot plates (Gait Trainer GT I). For the latter, a large multi-centre trial with 155 non-ambulatory stroke patients (DEGAS) revealed a superior gait ability and competence in basic activities of living in the experimental group. The HapticWalker continued the end effector concept of movable foot plates, now fully programmable and equipped with 6 DOF force sensors. This device for the first time enables training of arbitrary walking situations, hence not only the simulation of floor walking but also for example of stair climbing and perturbations. Conclusion Locomotor therapy is a fascinating new tool in rehabilitation, which is in line with modern principles of motor relearning promoting a task-specific repetitive approach. Sophisticated technical developments and positive randomized controlled trials form the basis of a growing acceptance worldwide to the benefits or our patients. PMID:17291335

GHG emissions and mitigation potential in Indian agriculture

NASA Astrophysics Data System (ADS)

Vetter, Sylvia; Feliciano, Diana; Sapkota, Tek; Hillier, Jon; Smith, Pete; Stirling, Clare

2016-04-01

India is one of the world's largest greenhouse gas (GHG) emitter, accounting for about 5% of global emissions with further increases expected in the future. The Government of India aims to reduce emission intensities by 20-25% by 2020 compared with the 2005 level. In a recent departure from past practice the reconvened Council on Climate Change stated that climate change in agriculture would include a component that would focus on reducing emissions in agriculture, particularly methane and nitrous oxide emissions. To develop recommendations for mitigation in agriculture in India, a baseline study is presented to analyse the GHG emissions from agriculture for current management (Directorate of Economics and Statistics of the government of India). This analysis is done for the two states Bihar and Haryana, which differ in their management and practises based on different climate and policies. This first analysis shows were the highest GHG emissions in agriculture is produced and were the highest mitigation potential might be. The GHG emissions and mitigation potential are calculated using the CCAFS Mitigation Option Tool (CCAFS-MOT) (https://ccafs.cgiar.org/mitigation-option-tool-agriculture#.VpTnWL826d4) with modifications for the special modelling. In a second step, stakeholder meetings provided a wide range of possible and definite scenarios (management, policy, technology, costs, etc.) for the future to mitigate emissions in agriculture as well as how to increase productivity. These information were used to create scenarios to give estimates for the mitigation potential in agriculture for India in 2020.

The relationship between organizational justice and workplace aggression.

PubMed

St-Pierre, Isabelle; Holmes, Dave

2010-05-01

This paper is a discussion of the links between organizational justice and workplace aggression. Managers have been identified as key players in implementing and maintaining an organizational culture of trust and justice. Employees who perceive themselves to be victims of injustice may rebel, using various means to 'punish' the source of the injustice. Literature review of publications in English and French from the early 1960 to 2009, including books, was conducted. Bibliographic databases searched for journal articles were Cumulative Index to Nursing and Allied Health Literature, Current Content, EMBASE, Medline, PsycINFO and Web of Science. The work environment and roles of nursing managers have changed considerably in the last 20 years, resulting in challenging working conditions for nursing managers. These can have an impact on their ability to create a trusting and fair culture, and can mean that they themselves be considered victims of organizational injustice. The failure of many re-engineering projects has been linked to a lack of consideration of the impact of perception of justice when implementing change. In addition, perception of organizational justice has the potential to influence many organizational outcomes, such as perception of respect and trust. As justice is a founding principle of biomedical ethics, principles of justice, equity and fairness must be upheld in practice in accordance with the requirements of professional codes of ethics. The concept of justice is linked to the founding principles of biomedical ethics, and these must be upheld in order to practise in accordance with professional codes of ethics and conduct.

EAACI Food Allergy and Anaphylaxis Guidelines. Protecting consumers with food allergies: understanding food consumption, meeting regulations and identifying unmet needs.

PubMed

Muraro, A; Hoffmann-Sommergruber, K; Holzhauser, T; Poulsen, L K; Gowland, M H; Akdis, C A; Mills, E N C; Papadopoulos, N; Roberts, G; Schnadt, S; van Ree, R; Sheikh, A; Vieths, S

2014-11-01

Individuals suffering from IgE-mediated food allergy usually have to practise life-long food allergen avoidance. This document aims to provide an overview of recent evidence-based recommendations for allergen risk assessment and management in the food industry and discusses unmet needs and expectations of the food allergic consumer in that context. There is a general duty of care on the food industry and obligations in European Union legislation to reduce and manage the presence of allergens alongside other food hazards. Current evidence enables quantification of allergen reference doses used to set-up reliable food safety management plans for some foods. However, further work is required to include a wider variety of foods and to understand the impact of the food matrix as well as additional factors which affect the progression and severity of symptoms as a function of dose. Major concerns have been raised by patients, carers and patient groups about the use of precautionary 'may contain' labelling to address the issue of unintended presence of allergens; these therefore need to be reconsidered. New and improved allergen detection methods should be evaluated for their application in food production. There is an urgent requirement for effective communication between healthcare professionals, patient organizations, food industry representatives and regulators to develop a better approach to protecting consumers with food allergies. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Spiritual beliefs in bipolar affective disorder: their relevance for illness management.

PubMed

Mitchell, Logan; Romans, Sarah

2003-08-01

There has been growing interest in investigating religion as a relevant element in illness outcome. Having religious beliefs has been shown repeatedly to be associated with lessened rates of depression. Most of the limited published research has been restricted to elderly samples. Religious coping is thought to play a key role in religion's effects. Strangely, psychiatric research has neglected this area. A questionnaire covering religious, spiritual and philosophical beliefs and religious practice was given to a sample of patients with bipolar affective disorder in remission. Most patients often held strong religious or spiritual beliefs (78%) and practised their religion frequently (81.5%). Most saw a direct link between their beliefs and the management of their illness. Many used religious coping, and often religio-spiritual beliefs and practice put them in conflict with illness models (24%) and advice (19%) used by their medical advisors. This was a cross-sectional design without a control group and thus it is not possible to determine causal associations from the data set. Religio-spiritual ideas are of great salience to many patients with bipolar disorder and shape the ways in which they think about their illness. Many reported experiencing significant paradigm conflict in understanding and managing their illness between medical and their spiritual advisors. These data suggest that the whole area of religion and spirituality is directly relevant to people living with a chronic psychiatric illness and should be firmly on the discussion agenda of clinicians working with patients with bipolar disorder.

[Computer-assisted education in problem-solving in neurology; a randomized educational study].

PubMed

Weverling, G J; Stam, J; ten Cate, T J; van Crevel, H

1996-02-24

To determine the effect of computer-based medical teaching (CBMT) as a supplementary method to teach clinical problem-solving during the clerkship in neurology. Randomized controlled blinded study. Academic Medical Centre, Amsterdam, the Netherlands. 103 Students were assigned at random to a group with access to CBMT and a control group. CBMT consisted of 20 computer-simulated patients with neurological diseases, and was permanently available during five weeks to students in the CBMT group. The ability to recognize and solve neurological problems was assessed with two free-response tests, scored by two blinded observers. The CBMT students scored significantly better on the test related to the CBMT cases (mean score 7.5 on a zero to 10 point scale; control group 6.2; p < 0.001). There was no significant difference on the control test not related to the problems practised with CBMT. CBMT can be an effective method for teaching clinical problem-solving, when used as a supplementary teaching facility during a clinical clerkship. The increased ability to solve problems learned by CBMT had no demonstrable effect on the performance with other neurological problems.

The virtual child: evaluation of an internet-based pediatric behavior management simulation.

PubMed

Boynton, James R; Green, Thomas G; Johnson, Lynn A; Nainar, S M Hashim; Straffon, Lloyd H

2007-09-01

This article describes an Internet-based instructional tool designed to give predoctoral dental students a virtual simulation of clinical pediatric dentistry to develop their pediatric behavior management knowledge. Effectiveness of this tool was evaluated using two consecutive classes of junior dental students. The control group was exposed to the traditional behavior management curriculum (two lectures) in a spring term course. The next class of dental students was exposed to the two lectures and, in addition, completed the behavior management simulation during the following spring term. Both groups completed a two-part examination (objective section=18 questions; open-ended section=responses to a clinical situation) designed to test their behavior management knowledge. The simulation group performed significantly better in both parts of the examination (objective section: p=.028; open-ended section: p=.012). The simulation was evaluated by students and perceived by most to be an effective addition to the curriculum. It was concluded that the experimental behavior management simulation, when added to the traditional lecture curriculum, improved pediatric behavior management knowledge in predoctoral dental students.

Barriers to Participatory Extension in Egypt: Agricultural Workers' Perspectives

ERIC Educational Resources Information Center

McDonough, Chris; Nuberg, Ian K.; Pitchford, Wayne S.

2015-01-01

Purpose: This paper examines extension practises of agricultural workers within the Egyptian government and the perceived barriers they face in implementing participatory approaches, identifying improvements required in research and extension processes to meet the real needs of Egyptian farming communities. Design/Methodology/Approach: Key…

Practising Conservation Biology in a Virtual Rainforest World

ERIC Educational Resources Information Center

Schedlbauer, Jessica L.; Nadolny, Larysa; Woolfrey, Joan

2016-01-01

The interdisciplinary science of conservation biology provides undergraduate biology students with the opportunity to connect the biological sciences with disciplines including economics, social science and philosophy to address challenging conservation issues. Because of its complexity, students do not often have the opportunity to practise…

The orthopaedic workforce in Queensland now and into the twenty-first century.

PubMed

Licina, P; McGuire, T P

1993-06-01

The objectives of this study were to determine the number and distribution of orthopaedic surgeons in Queensland at present and to assess the adequacy of trainee intake for the future. Characteristics of the orthopaedic workforce in Queensland in 1990 were analysed with regard to the total number of orthopaedic surgeons, their regional distribution, their ratio to the population and their age distribution. Similar statistics were derived for the years 1981 and 1986 and trends were examined. By projecting these trends, the number of surgeons likely to be practising in 2001 was estimated. Using projected population figures, the number of orthopaedic surgeons required in 2001 was calculated, assuming an optimum ratio of surgeons to population of one per 25,000. It was found that in 1990 sufficient orthopaedic surgeons were practising in Queensland but that there was some maldistribution. With the increased intake of five new training registrars per year, the number of orthopaedic surgeons in Queensland in 2001 should be appropriate, as long as current trends continue.

US in pubalgia.

PubMed

Balconi, Giuseppe

2011-09-01

There is considerable confusion over the word "pubalgia" with regard to the definition and the etiological causes of this condition. The term pubalgia should be used to indicate disabling pain affecting the pubic region in people who practise sports. Pubalgia affects 10% of those who practise sports and it is particularly prevalent in football players. According to the literature, about 40% of cases of pubalgia are caused by overuse of the symphysis pubis with progressive lesions affecting the rectus abdominal muscles, adductors (rectal-adductor syndrome) and the symphysis itself (osteitis pubis and joint injury). An initial study of the tendons is carried out by ultrasound (US) whereas magnetic resonance imaging (MRI) should be performed to study the bones and joints.Another 40% of cases of pubalgia are caused by "sports hernia" defined as anteroinferior abdominal wall insufficiency. These alterations can only be identified at dynamic US examination.About 20% of cases of pubalgia are caused by diseases of the neighboring structures or joints such as diseases of the hip, iliopsoas, hamstring, sacred iliac or nerves, or by urogenital diseases.

The place and practices of well-being in local governance.

PubMed

Atkinson, Sarah; Joyce, Kerry E

2010-10-20

The concept of well-being has become prominent within national policy goals in the UK since the end of the 1990s. However, the concept of well-being remains ill defined, an instability that is increasingly understood as problematic to policy making. We engage with this terminological instability through an exploration of how the concept of well-being is practised discursively in local governance and critically examine the place of the concept in local policy making. In contrast to the current enthusiasm to define and measure well-being, we argue that the conceptual instability has inherent value for local governance. The concept of well-being is practised through a number of potentially conflicting discourses, but it is exactly this conceptual instability that enables a local negotiation and combination of alternative policy frameworks for local place-shaping strategies. As such, well-being not only is an overarching goal of governance but also contributes to the dynamics of the policy process.

Implementation of newly adopted technology in acute care settings: a qualitative analysis of clinical staff

PubMed Central

Langhan, Melissa L.; Riera, Antonio; Kurtz, Jordan C.; Schaeffer, Paula; Asnes, Andrea G.

2015-01-01

Objective Technologies are not always successfully implemented into practise. We elicited experiences of acute care providers with the introduction of technology and identified barriers and facilitators in the implementation process. Methods A qualitative study using one-on-one interviews among a purposeful sample of 19 physicians and nurses within ten emergency departments and intensive care units was performed. Grounded theory, iterative data analysis and the constant comparative method were used to inductively generate ideas and build theories. Results Five major categories emerged: decision-making factors, the impact on practise, technology's perceived value, facilitators and barriers to implementation. Barriers included negative experiences, age, infrequent use, and access difficulties. A positive outlook, sufficient training, support staff, and user friendliness were facilitators. Conclusions This study describes strategies implicated in the successful implementation of newly adopted technology in acute care settings. Improved implementation methods and evaluation of implementation processes are necessary for successful adoption of new technology. PMID:25367721

Defining deviation: The peer professional opinion defence and its relationship to scope expansion and emerging non-medical health professions.

PubMed

Wardle, Jon

2016-03-01

The law imposes a duty to exercise reasonable care and skill in the provision of professional advice and treatment on all health practitioners, which in Australia is assessed via a modified Bolam principle. In an era of medical dominance, this standard was clearly related to the standards of the medical profession. However, the evolving nature of the Australian health workforce has fuelled speculation as to how non-medical professions are assessed to be practising in accordance with established standards. This article explores the peer-professional defence in relation to new, emerging and established non-medical professions practising in areas that were not historically part of their remit, and finds that individual health professions--even those which do not possess traits historically defined by professionalism--have ultimate discretion in determining the standards by which they are assessed, though such standards may be rejected by courts if they are deemed irrational.

Building community and public health nursing capacity: a synthesis report of the National Community Health Nursing Study.

PubMed

Underwood, Jane M; Mowat, David L; Meagher-Stewart, Donna M; Deber, Raisa B; Baumann, Andrea O; MacDonald, Mary B; Akhtar-Danesh, Noori; Schoenfeld, Bonnie M; Ciliska, Donna K; Blythe, Jennifer M; Lavoie-Tremblay, Mélanie; Ehrlich, Anne S; Knibbs, Kristin M; Munroe, Valerie J

2009-01-01

1) To describe the community health nursing workforce in Canada; 2) To compare, across political jurisdictions and community health sectors, what helps and hinders community nurses to work effectively; 3) To identify organizational attributes that support one community subsector--public health nurses--to practise the full scope of their competencies. Our study included an analysis of the Canadian Institute for Health Information nursing databases (1996-2007), a survey of over 13,000 community health nurses across Canada and 23 focus groups of public health policy-makers and front-line public health nurses. Over 53,000 registered and licensed practical nurses worked in community health in Canada in 2007, about 16% of the nursing workforce. Community nurses were older on average than the rest of their profession. Typical practice settings for community nurses included community health centres, home care and public health units/departments. To practise effectively, community nurses need professional confidence, good team relationships, supportive workplaces and community support. Most community nurses felt confident in their practice and relationships with other nurses and professionals, though less often with physicians. Their feelings about salary and job security were mixed, and most community nurses would like more learning opportunities, policy and practice information and chances to debrief about work. They needed their communities to do more to address social determinants of health and provide good quality resources. Public health nursing needs a combination of factors to succeed: sound government policy, supportive organizational culture and good management practices. Organizational attributes identified as supports for optimal practice include: flexibility in funding, program design and job descriptions; clear organizational vision driven by shared values and community needs; coordinated public health planning across jurisdictions; and strong leadership that openly promotes public health, values their staff's work and invests in education and training. The interchangeable and inconsistent use of titles used by community nurses and their employers makes it difficult to discern differences within this sector such as home care, public health, etc. Our studies also revealed that community nurses: thrive in workplaces where they share the vision and goals of their organization and work collaboratively in an atmosphere that supports creative, autonomous practice; work well together, but need time, flexible funding and management support to develop relationships with the community and their clients, and to build teams with other professionals; could sustain their competencies and confidence in their professional abilities with more access to continuing education, policies, evidence and debriefing sessions.

Simulation modeling for the health care manager.

PubMed

Kennedy, Michael H

2009-01-01

This article addresses the use of simulation software to solve administrative problems faced by health care managers. Spreadsheet add-ins, process simulation software, and discrete event simulation software are available at a range of costs and complexity. All use the Monte Carlo method to realistically integrate probability distributions into models of the health care environment. Problems typically addressed by health care simulation modeling are facility planning, resource allocation, staffing, patient flow and wait time, routing and transportation, supply chain management, and process improvement.

An Investigation of Computer-based Simulations for School Crises Management.

ERIC Educational Resources Information Center

Degnan, Edward; Bozeman, William

2001-01-01

Describes development of a computer-based simulation program for training school personnel in crisis management. Addresses the data collection and analysis involved in developing a simulated event, the systems requirements for simulation, and a case study of application and use of the completed simulation. (Contains 21 references.) (Authors/PKP)

Girls' Bodies, Drama and Unruliness

ERIC Educational Resources Information Center

Ramsay, Alison

2014-01-01

This article examines some of the performance outcomes from a practised-based research project that took place with adolescent girls attending an after-school drama club. Participants experimented with slapstick humour in a series of workshops, before presenting their own devised physical comedy performance for a live audience. Comic performances…

Another Breakthrough, Another Baby Thrown out with the Bathwater

ERIC Educational Resources Information Center

Bell, David M.

2009-01-01

"Process-oriented pedagogy: facilitation, empowerment, or control?" claims that process-oriented pedagogy (POP) represents the methodological perspective of most practising teachers and that outcomes-based education (OBE) poses a real and present danger to stakeholder autonomy. Whereas POP may characterize methodological practices in the inner…

Examining Teacher Ethical Dilemmas in Classroom Assessment

ERIC Educational Resources Information Center

Pope, Nakia; Green, Susan K.; Johnson, Robert L.; Mitchell, Mark

2009-01-01

The current spotlight on assessment in education raises ethical issues as practices evolve. This study documents ethical conflicts faced by teachers in the United States regarding assessment of students. Critical incidents generated by practising teachers revealed a majority of reported conflicts related to score pollution, and conflicts…

Connecting to Community: What Do We Want in Our Special Education Graduates?

ERIC Educational Resources Information Center

Hughes, Stephen; De George-Walker, Linda

2010-01-01

With a commitment to establishing collaborative relationships with a local special education community, a consultation process was undertaken to ascertain what practising educators considered essential special education graduate characteristics. This consultation occurred against the backdrop of broad-scale university organisational restructure,…

Student Experiences with Studio Instruction

ERIC Educational Resources Information Center

Upitis, Rena; Abrami, Philip C.; Varela, Wynnpaul; King, Matthew; Brook, Julia

2017-01-01

The purpose of the study was to examine students' experiences of independent music lessons, and to ascertain what factors predicted enjoyment and success, especially those predictors arising from self-regulation learning theory. A self-report survey was used to gather data on student demographics, practising habits, musical skills, achievements,…

MUNICIPAL WASTE COMBUSTION ASSESSMENT: WASTE CO-FIRING

EPA Science Inventory

The report is an overview of waste co-firing and auxiliary fuel fired technology and identifies the extent to which co-firing and auxiliary fuel firing are practised. Waste co-firing is defined as the combustion of wastes (e. g., sewage sludge, medical waste, wood waste, and agri...

MUNICIPAL WASTE COMBUSTION ASSESSMENT: WASTE CO- FIRING

EPA Science Inventory

The report is an overview of waste co-firing and auxiliary fuel fired technology and identifies the extent to which co-firing and auxiliary fuel firing are practised. Waste co-firing is defined as the combustion of wastes (e. g., sewage sludge, medical waste, wood waste, and agri...

Conceptualizing Learning from the Everyday Activities of Digital Kids

ERIC Educational Resources Information Center

Hsi, Sherry

2007-01-01

This paper illustrates the intensified engagement that youth are having with digital technologies and introduces a framework for examining "digital fluency"--the competencies, new representational practises, design sensibilities, ownership, and strategic expertise that a learner gains or demonstrates by using digital tools to gather, design,…

Women's groups practising participatory learning and action to improve maternal and newborn health in low-resource settings: a systematic review and meta-analysis.

PubMed

Prost, Audrey; Colbourn, Tim; Seward, Nadine; Azad, Kishwar; Coomarasamy, Arri; Copas, Andrew; Houweling, Tanja A J; Fottrell, Edward; Kuddus, Abdul; Lewycka, Sonia; MacArthur, Christine; Manandhar, Dharma; Morrison, Joanna; Mwansambo, Charles; Nair, Nirmala; Nambiar, Bejoy; Osrin, David; Pagel, Christina; Phiri, Tambosi; Pulkki-Brännström, Anni-Maria; Rosato, Mikey; Skordis-Worrall, Jolene; Saville, Naomi; More, Neena Shah; Shrestha, Bhim; Tripathy, Prasanta; Wilson, Amie; Costello, Anthony

2013-05-18

Maternal and neonatal mortality rates remain high in many low-income and middle-income countries. Different approaches for the improvement of birth outcomes have been used in community-based interventions, with heterogeneous effects on survival. We assessed the effects of women's groups practising participatory learning and action, compared with usual care, on birth outcomes in low-resource settings. We did a systematic review and meta-analysis of randomised controlled trials undertaken in Bangladesh, India, Malawi, and Nepal in which the effects of women's groups practising participatory learning and action were assessed to identify population-level predictors of effect on maternal mortality, neonatal mortality, and stillbirths. We also reviewed the cost-effectiveness of the women's group intervention and estimated its potential effect at scale in Countdown countries. Seven trials (119,428 births) met the inclusion criteria. Meta-analyses of all trials showed that exposure to women's groups was associated with a 37% reduction in maternal mortality (odds ratio 0.63, 95% CI 0.32-0.94), a 23% reduction in neonatal mortality (0.77, 0.65-0.90), and a 9% non-significant reduction in stillbirths (0.91, 0.79-1.03), with high heterogeneity for maternal (I(2)=58.8%, p=0.024) and neonatal results (I(2)=64.7%, p=0.009). In the meta-regression analyses, the proportion of pregnant women in groups was linearly associated with reduction in both maternal and neonatal mortality (p=0.026 and p=0.011, respectively). A subgroup analysis of the four studies in which at least 30% of pregnant women participated in groups showed a 55% reduction in maternal mortality (0.45, 0.17-0.73) and a 33% reduction in neonatal mortality (0.67, 0.59-0.74). The intervention was cost effective by WHO standards and could save an estimated 283,000 newborn infants and 41,100 mothers per year if implemented in rural areas of 74 Countdown countries. With the participation of at least a third of pregnant women and adequate population coverage, women's groups practising participatory learning and action are a cost-effective strategy to improve maternal and neonatal survival in low-resource settings. Wellcome Trust, Ammalife, and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Birmingham and the Black Country programme. Copyright © 2013 Elsevier Ltd. All rights reserved.

Factors Associated with Induced Abortion in Women Prostitutes in Asturias (Spain)

PubMed Central

Tsakiridu, Domingo Ojer; Franco Vidal, Amalia; Vázquez Valdés, Fernando; Junquera Llaneza, Maria Luisa; Varela Uría, Jose Antonio; Cuesta Rodríguez, Mar; López Sanchez, Carmen; Busto Folgosa, Margarita; Fernández Ollero, Maria Jesús

2008-01-01

Background The aim is to investigate the factors that might be associated with the presence of induced abortion (IA) in women prostitutes in Asturias (Spain). Methodology/Principal Findings Cross-sectional descriptive study by self-completion questionnaire of 212 women prostitutes who attended the three Sexually Transmitted Disease Clinics in Asturias, between January–December 2003. The questionnaire was designed to investigate the women's perceived knowledge (what they claimed to know), their real knowledge (what they really knew), the use of contraceptive methods and socio-demographic variables. Multivariate analysis was carried out. 92% of the participants were immigrants. 76% were practising at brothel. 37.6% (95%CI:30.7–44.4%) reported to have undergone at least one IA during their life. According to the logistic regression the “presence of IA” was directly associated with the variables “number of pregnancies”(OR:65.82;95%IC:7.73–560.14) and “years of practising prostitution”(OR:1.13;95%CI:0.99–1.29); and inversely associated with “children”(0 = no children;1 = one or more children; OR:0.005;95%CI:0.000–0.057), “women's age”(OR:0.89;95%CI:0.82–0.97) and “real contraceptive knowledge”(OR:0.50; 95%CI:0.34–0.75). Married women were more likely to have undergone an IA (OR:2.74;95%IC:1.05–7.13). No association with “perceived contraceptive knowledge” was found. Conclusions/Significance The characteristics more closely linked to the reproductive history of the women (such as “pregnancies”, “children”), together with the “real contraceptive knowledge” and the “time practising prostitution” explain the presence of IA better than factors more closely linked to the conditions in which the women practise prostitution (“place of activity”, “other activities compatible with prostitution”, “use of safe method in commercial relation”). It is possible that IA is being used as a birth control method, hypothesis suggested by the inverse association observed between the variable “children” and the “presence of IA”. Therefore, the promotion of the use of safe contraceptive methods should be a high-priority. If the real contraceptive knowledge was measured correctly, all strategies to increase it would be justified because it was inversely associated with the presence of IA. PMID:18523646

Improvements to information management systems simulator

NASA Technical Reports Server (NTRS)

Bilek, R. W.

1972-01-01

The performance of personnel in the augmentation and improvement of the interactive IMSIM information management simulation model is summarized. With this augmented model, NASA now has even greater capabilities for the simulation of computer system configurations, data processing loads imposed on these configurations, and executive software to control system operations. Through these simulations, NASA has an extremely cost effective capability for the design and analysis of computer-based data management systems.

Aviation Human-in-the-Loop Simulation Studies: Experimental Planning, Design, and Data Management

DTIC Science & Technology

2014-01-01

Aviation Human-in-the-Loop Simulation Studies: Experimental Planning, Design , and Data Management Kevin W. Williams1 Bonny Christopher2 Gena...Simulation Studies: Experimental Planning, Design , and Data Management January 2014 6. Performing Organization Code 7. Author(s) 8. Performing...describe the process by which we designed our human-in-the-loop (HITL) simulation study and the methodology used to collect and analyze the results

Nexus: A modular workflow management system for quantum simulation codes

NASA Astrophysics Data System (ADS)

Krogel, Jaron T.

2016-01-01

The management of simulation workflows represents a significant task for the individual computational researcher. Automation of the required tasks involved in simulation work can decrease the overall time to solution and reduce sources of human error. A new simulation workflow management system, Nexus, is presented to address these issues. Nexus is capable of automated job management on workstations and resources at several major supercomputing centers. Its modular design allows many quantum simulation codes to be supported within the same framework. Current support includes quantum Monte Carlo calculations with QMCPACK, density functional theory calculations with Quantum Espresso or VASP, and quantum chemical calculations with GAMESS. Users can compose workflows through a transparent, text-based interface, resembling the input file of a typical simulation code. A usage example is provided to illustrate the process.

Computer Simulation for Pain Management Education: A Pilot Study.

PubMed

Allred, Kelly; Gerardi, Nicole

2017-10-01

Effective pain management is an elusive concept in acute care. Inadequate knowledge has been identified as a barrier to providing optimal pain management. This study aimed to determine student perceptions of an interactive computer simulation as a potential method for learning pain management, as a motivator to read and learn more about pain management, preference over traditional lecture, and its potential to change nursing practice. A post-computer simulation survey with a mixed-methods descriptive design was used in this study. A college of nursing in a large metropolitan university in the Southeast United States. A convenience sample of 30 nursing students in a Bachelor of Science nursing program. An interactive computer simulation was developed as a potential alternative method of teaching pain management to nursing students. Increases in educational gain as well as its potential to change practice were explored. Each participant was asked to complete a survey consisting of 10 standard 5-point Likert scale items and 5 open-ended questions. The survey was used to evaluate the students' perception of the simulation, specifically related to educational benefit, preference compared with traditional teaching methods, and perceived potential to change nursing practice. Data provided descriptive statistics for initial evaluation of the computer simulation. The responses on the survey suggest nursing students perceive the computer simulation to be entertaining, fun, educational, occasionally preferred over regular lecture, and with potential to change practice. Preliminary data support the use of computer simulation in educating nursing students about pain management. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.