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Biomedical subjects

Tony Smith

Publications and source records attributed to Tony Smith.

At least 19 recordsLinked to original sources

Generic versus specific competencies of entry-level public health graduates: employers' perceptions in Poland, the UK, and the Netherlands.

Constant changes in society and the public health domain force public health professionals into new roles and the development of new competencies. Public health professionals will need to be trained to respond to this challenge. The aim of this comparative study among Poland, the UK and the Netherlands is to identify competence needs for Master of Public Health graduates entering the labour market from a European perspective. A self-administered questionnaire was sent to employers in the three countries, rating the importance of competency in public health on a master's level. In all three countries, interpersonal competencies, like team working and communication skills, are rated as highly important. However, employers in the UK and Poland generally rate public health specific competencies as much more important than their Dutch colleagues. It is concluded that while public health specific knowledge is providing a useful starting point for entry-level public health professionals, employers increasingly recognise the value of generic competencies such as communication and team working skills. The results suggest a stronger emphasis on teaching methods that encourage active learning and the integration of skills, which is crucial for enhancing graduates' employability, and foster an open attitude to multidisciplinary working, which is essential in modern health care.

Education, Graduate↗

Arthroscopic assessment of cartilage repair: a validation study of 2 scoring systems.

PURPOSE: This study tested the validity and reliability of the International Cartilage Repair Society (ICRS) cartilage repair assessment and the Oswestry Arthroscopy Score (OAS), which have been designed to assess repair of articular cartilage. TYPE OF STUDY: Prospective validation study of arthroscopic cartilage repair scores. METHODS: Arthroscopic videos were assessed by a panel of orthopaedic surgeons specializing in cartilage repair. Scoring was repeated after a 2-month interval. Scorers also answered a questionnaire to assess the face and content validity of the scoring systems. Validity of the 2 systems was compared and reliability and repeatability were measured. Pearson's correlation coefficient was used to measure equivalence reliability. The interclass correlation coefficient (ICC) was used to assess the repeatability and inter-rater reliability of each score, and internal consistency was assessed with Cronbach's alpha. RESULTS: Face and content validity are acceptable for both scores. There is good agreement (equivalence reliability) between the scores (Pearson's correlation coefficient, r = .88; P < .001). Stability (interobserver reliability) and repeatability (test-retest reliability) are satisfactory for both scores with an ICC >0.7 for each score. Cronbach's alpha was 0.91 for ICRS and 0.82 for OAS, indicating better internal consistency for the ICRS score. CONCLUSIONS: The ICRS and OAS arthroscopic scores have been validated for the assessment of cartilage repair and both have been found to be statistically reliable and repeatable. The ICRS score does not allow for graft hypertrophy and may overscore in this situation, whereas the OAS includes assessment of graft stiffness. Both scores show satisfactory stability and repeatability. Internal consistency is adequate for both scores, although it is higher for the ICRS score. Both the ICRS and OAS arthroscopic scores are effective tools in the evaluation of cartilage repair. LEVEL OF EVIDENCE: Level III, diagnostic study of nonconsecutive patients (no consistently applied reference gold standard).

Arthroscopy↗

Factors influencing prescribing: an intern's perspective.

OBJECTIVES: To examine the self-reported influences on intern prescribing practice. DESIGN: Qualitative interviews with a cross-sectional cohort. PARTICIPANTS AND SETTING: Ten interns practising in two urban teaching hospitals in New South Wales, Australia. RESULTS: The interns identified a number of factors that improve their confidence and perceived competence and allow them to extend their existing skills. These were approachable, available and up-to-date teachers (most often registrars and subspecialty nurses and pharmacists); timely, relevant and practical teaching (such as interactive bedside teaching); concise and widely accepted resources (such as prescribing pocket guides); and a constructive manner on the part of senior staff for dealing with prescribing errors. Interns also identified influences that are detrimental to confidence, conflict with their perceptions of appropriate prescribing and inhibit learning and skills acquisition. These were unapproachable, physically and mentally remote teachers (most often consultants); theoretical, inconsistent and irrelevant teaching (such as grand rounds or didactic education sessions); inconsistent and inaccessible resources; and a confrontational and accusatory way of dealing with prescribing errors. The added pressures of time, hospital hierarchies and the indirect influence of drug company promotion also impeded acquisition of good prescribing habits. CONCLUSIONS: At a critical time in skills development, interns encounter many forces that can potentially impact on prescribing practices in both positive and negative ways. Our data contribute to the understanding of the multifaceted learning environment of interns and may be useful in providing a foundation for prescriber education programmes tailored to the specific needs of junior doctors.

Adult↗

Intern prescribing decisions: few and far between.

OBJECTIVE: To examine the scope of intern prescribing practices by determining: the proportion of prescriptions that interns chart compared with other medical staff; the proportion of intern-charted prescriptions for which interns are sole decision-makers; whether or not intern-initiated prescribing varies with respect to the specialty to which they are attached, the shifts they are working and the types of charts they are using; the types of clinical conditions for which interns initiate prescribing decisions; and the drug classes that interns use for their self-initiated prescribing. DESIGN: Prospective study of a random sample of intern-charted prescriptions. SETTING: Two teaching hospitals of the Hunter Area Health Service, Newcastle, Australia. The study was conducted from the fifth to the eighth month of the intern training year. MAIN OUTCOME MEASURES: The proportion of prescriptions charted by interns that resulted from their own decision-making, the circumstances relating to this, clinical conditions for which they prescribe and drugs prescribed. RESULTS: A total of 17,895 prescriptions were examined--3437 (19%) were intern-charted. Interns reported they were the sole decision-makers for 19% (95% CI: 14 -24%) of prescriptions they had charted. Interns were more likely to initiate decisions in accident and emergency (OR=7.5, 95% CI: 2.2- 25.2) and obstetric and gynaecology (OR=2.3, 95% CI: 1.6 -3.2) rotations than in medicine and were more likely to initiate decisions on night (OR=7.3, 95% CI: 3.4- 15.5) and weekend (OR=1.7, 95% CI: 1.0 -3.2) shifts than during the day. They were also more likely to prescribe on the "as required" (OR=36.6, 95% CI: 20.6-65.0), "statim" (OR=26.1, 95% CI: 17.0- 40.1) and "intravenous" (OR=7.2, 95% CI: 4.3-12.3) charts compared with "regular" charts. A total of 52% of intern-initiated prescriptions were for symptom relief; pain, insomnia and nausea; and 75% of the drugs for which interns made independent decisions were analgesics, antithrombotic agents, psycholeptics, antispasmodics, laxatives and anti-asthmatic agents. CONCLUSION: Interns have a limited role with respect to independent prescribing and take the sole responsibility for only one-fifth of the prescriptions they chart. This limited, albeit safe, approach to prescribing may impact significantly on an intern's opportunity to acquire the skills necessary to become an independent, rational prescriber.

Journal Article↗

Alternative cardiopulmonary resuscitation devices.

Cardiac arrest survival rates remain low despite increased access to advanced cardiac life support. Survival from cardiac arrest is, at least in part, related to the perfusion pressures and blood flow achieved during cardiopulmonary resuscitation (CPR). A number of alternative CPR devices have been developed that aim to improve the perfusion pressures and/or blood flow achieved during CPR. Active compression-decompression CPR devices are by far the most studied alternative CPR devices, but the results have been inconsistent and conflicting. A number of other devices, including the inspiratory impedance threshold valve, minimally invasive direct cardiac massage, phased chest and abdominal compression-decompression CPR, and vest CPR, are all capable of improving perfusion pressures and/or blood flow compared with standard external chest compressions. However, no convincing human outcome data has been produced yet for any of these devices. Although an interesting area of research, none of the alternative CPR devices convincingly improve long-term patient outcomes.

Animals↗

Relationship between team identification and trait aggression: a replication.

Research yielded no significant relationship between sport fandom and trait aggression. The current study replicated previous efforts using the Buss-Perry Aggression Questionnaire, an updated version of the Buss-Durkee Hostility Inventory. In contrast to past work, the current study did yield a significant relationship between fandom and aggression for men.

Adult↗

Genes and ethics.

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Age of Onset↗

Cheap, managed death.

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Administrative Personnel↗

Choosing sex.

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Abortion, Eugenic↗