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PubMed2005

Preparing for the field: developing competence as an ethnographic field worker.

If ethnography can be considered as a form of work, then the rules and competencies of this work need to be learnt along with clear markers of progress to enable the ethnographer to gauge their developing competence. In this paper Fiona Murphy draws on the work of Benner (1984), which provides a framework for the proposition that there is a progression in developing competence as an ethnographic fieldworker from 'novice to expert'. This has implications for the preparation and support of novice fieldworkers in that these 'rules' and competencies should be made more explicit and transparent

Anthropology, Cultural↗

PubMed2005

The identification of best practices in teaching quality competencies for preparing future health care leaders.

The mandate for quality in all aspects of clinical practice, service delivery, and management practice has never been greater. The Institute of Medicine's (IOM) landmark work To Err is Human heightened the urgency of this serious issue. In a follow-up report, the IOM's Crossing the Quality Chasm called for radical change to achieve numerous quality objectives throughout the continuum of the healthcare system including the preparation of future healthcare leaders. This study was conducted to assess how effectively healthcare management education faculty are meeting the challenge of integrating quality improvement into their curricula and how faculty perceived their quality expertise. Another goal was to identify the student learning assessment strategies, teaching methods, content, and resources utilized by faculty to achieve this integration and to suggest a framework for "best practices" in teaching quality competencies citing the literature. The study's findings raise a number of important issues with respect to the ways in which QI is conceptualized and integrated into curricula and concludes that there is substantial need for 'quality improvement' in healthcare management education faculty's approaches to the teaching of QI.

Benchmarking↗

PubMed1994

An ethical framework for operating room infection control.

The operating room nurse has an ethical obligation to provide patients with safe, effective care during surgical intervention. Most basic to this care is surgical asepsis. Bioethics principles of autonomy, beneficence, nonmaleficence, justice, as well as the professional's character in meeting the responsibilities of competence and accountability, are presented as an ethical framework for surgical infection control.

Ethics, Nursing↗

PubMed2005

Cardiac nursing: achieving competent practitioners.

This paper describes how competency statements were integrated into an academic framework to provide a transparent yet flexible career pathway for the nurse working in acute cardiac care. Nurses are expanding and developing their roles and use wide ranging skills and knowledge to care for patients. Additionally, models of care delivery are changing and patients are cared for in a variety of settings. Where evidence exists, these models demonstrate improvement in the provision and quality of services and contribute to improved quality of life, maximise medication and therapy and reduce waiting times for investigations. However, whilst many studies have demonstrated benefit, translating these results into routine practice requires skilled nurses who are "fit for purpose," and to support this, professional competencies can be used to measure competence in practice whilst informing educational initiatives. This paper outlines the development of competency statements that identify the knowledge and skills required for safe, effective and competent care and direct the cardiac nurse acquire skills and knowledge in a focused and coherent way.

Attitude of Health Personnel↗

PubMed1991

Teaching clinical ethics in the residency years: preparing competent professionals.

Formal training in clinical ethics must become a central part of residency curricula to prepare practitioners to manage the ethical dimensions of patient care. Residency educators must ground their teaching in an understanding of the conceptual, biomedical, and psychosocial aspects of the important ethical issues that arise in that field of practice. Four aspects of professional competence in clinical ethics provide a useful framework for curricular planning. The physician should learn to: (1) recognize ethical issues as they arise in clinical care and identify hidden values and unacknowledged conflicts; (2) think clearly and critically about these issues in ways that lead to ethically justifiable courses of action; (3) apply those practical skills needed to implement an ethically justifiably course of action; and (4) judge when the management of a clinical situation requires consultation with individuals or institutional bodies with additional expertise or authority. We argue that these practical goals can be accomplished with a relatively modest emphasis on the theoretical aspects of medical ethics.

Bioethical Issues↗

PubMed2004

Assessing the strength and integrity of an intervention.

PURPOSE/OBJECTIVES: To evaluate the strength and integrity of a pilot behavioral intervention designed to assist mothers with breast cancer and their children. RESEARCH APPROACH: A single-group analysis of the strength and integrity characteristics of an intervention developed for a pilot research study. SETTING: Homes of study participants in an urban area. PARTICIPANTS: Seven households with a mother and father and one household with a single mother. METHODOLOGIC APPROACH: Observer-reported checklists, audiorecorded intervention session data, and structured interview data obtained from study participants. MAIN RESEARCH VARIABLES: Strength of the intervention included dimensions such as the theoretical foundation, competence of the interventionist, and specificity to the breast cancer experience in the family. Intervention integrity consisted of adherence by the interventionist and participants to the intervention plan. FINDINGS: The strength of the intervention was determined to be an asset. Careful planning had included a framework, a defined set of scripted sessions, a competent interventionist, and content specific to the breast cancer experience. In regard to integrity, the protocol content was delivered as scripted. Improvements in the dosage and purity dimensions were found to be needed. Homework assignments and in-session skill-building approaches with the mothers were refined. CONCLUSIONS: An intervention can be examined carefully for strength and integrity with established criteria to determine improvements needed. INTERPRETATION: A clinical research protocol can be improved through an assessment of an intervention's strength and integrity.

Adolescent↗

PubMed2026

Competing subclones and fitness diversity shape tumor evolution across cancer types.

MOTIVATION: Intratumor heterogeneity arises from ongoing somatic evolution and complicates cancer diagnosis, prognosis, and treatment. Reconstructing evolutionary dynamics typically requires spatiotemporal samples, which are often unavailable in clinical settings. Computational approaches that can infer tumor evolutionary history from single-timepoint bulk sequencing data remain limited. RESULTS: We present estimating evolutionary events through single-timepoint sequencing (TEATIME), a novel computational framework that models tumors as mixtures of two competing cell populations: an ancestral clone with baseline fitness and a derived subclone with elevated fitness. Using cross-sectional bulk sequencing data, TEATIME estimates mutation rates, timing of subclone emergence, relative fitness, and number of generations of growth. To quantify intratumor fitness asymmetries, we introduce a novel metric-fitness diversity-which captures the imbalance between competing cell populations and serves as a measure of functional intratumor heterogeneity. Applying TEATIME to 33 tumor types from The Cancer Genome Atlas, we revealed divergent as well as convergent evolutionary patterns. Notably, we found that immune-hot microenvironments constraint subclonal expansion and limit fitness diversity. Moreover, we detected temporal dependencies in mutation acquisition, where early driver mutations in ancestral clones epistatically shape the fitness landscape, predisposing specific subclones to selective advantages. These findings underscore the importance of intratumor competition and tumor-microenvironment interactions in shaping evolutionary trajectories, driving intratumor heterogeneity. Lastly, we demonstrate that TEATIME-derived evolutionary parameters and fitness diversity offer novel prognostic insights across multiple cancer types. AVAILABILITY AND IMPLEMENTATION: R implementation of TEATIME is available on GitHub (https://github.com/liliulab/TEATIME) and Zenodo (https://zenodo.org/records/17422174).

Neoplasms↗

PubMed1995

The effect of a senior preceptorship on the adaptive competencies of community college nursing students.

A pre-post design was used to examine the effect of a senior preceptorship experience on the adaptive competencies, environmental press perceptions and learning styles of 55 third-year community college nursing students. Kolb's experiential learning theory provided the framework for the study. Subjects rated their concrete and abstract competencies and the importance of divergent and convergent competencies significantly higher following the preceptorship. They also felt that the preceptorship experience contributed significantly more to their competency development than their weekly clinical experiences during the year. Contrary to expectations, administration of the Learning Style Inventory LSI-1976 and LSI-1985 produced inconsistent classifications of subjects' learning styles. Implications for nursing are described.

Adaptation, Psychological↗

PubMed1984

Complex visual hallucinations and cyclosporine.

Insidious loss of visual acuity and simultaneous onset of complex visual hallucinations were observed in a patient with acute lymphoblastic leukemia who had recently received bone marrow transplantation and was being treated with prednisone and cyclosporine to suppress graft-v-host disease. Problems with visual acuity and visual hallucinations spontaneously ameliorated with reduction and termination of cyclosporine treatment. The complex visual hallucinations caused considerable psychological distress for the patient. These hallucinatory phenomena were placed within the framework of loss of control and decreased competence, often experienced by children with chronic illness. Recommendations for prompt therapeutic intervention were made.

Adult↗

PubMed2026

Tumor evolution shapes metastatic competence in colorectal cancer.

In this issue of Cancer Cell, Manca et al. investigate the genomic evolution and metastatic tropism of over 7,000 colorectal cancers. Integrating primary tumor location, genomic alterations, and clinical variables, they reveal how distinct patterns of tumor evolution shape metastatic competence and impact organ tropism, offering a framework to refine surveillance.

Humans↗

PubMed2000

ADHD in preschool children: parent-rated psychosocial correlates.

Twenty-five children (21 males, 4 females; mean age 4.8 years) with attention-deficit-hyperactivity disorder (ADHD) participated in this study in addition to 25 typically developing children (21 males, 4 females; mean age 4.9 years). Parental ratings of the preschool children and preschool child self-ratings were examined within the framework of three domains: behavioral disturbance, social competence, and familial environment. Compared to their typically developing peers, preschool children classified as having ADHD were rated by their parents as significantly more aggressive, more demanding of parental time, less socially skilled, less adaptable to change in routine, and as exhibiting more noncompliance. In contrast to these parental ratings, preschool children with ADHD perceived themselves as equally competent, and as socially accepted as their peers. Parents of preschool children with ADHD rated themselves as less competent parents, and as experiencing a restricted parenting role. Although parenting a preschool child with ADHD was viewed as stressful, the parents did not rate general family functioning to be adversely affected.

Adult↗

PubMed1998

Bioethics and humanities: what makes us one field?

Bioethics and humanities (inclusive of medical ethics, health care ethics, environmental ethics, research ethics, philosophy and medicine, literature and medicine, and so on) seems like one field; yet colleagues come from different academic disciplines with distinct languages, methods, traditions, core curriculum and competency examinations. The author marks six related "framework" features that unite and make it one distinct field. It is a commitment to (1) work systematically on some of the momentous and well-defined sets of problems about the human condition that drive our field (such as death and dying, disability, confidentiality, professionalism, informed consent, abortion, euthanasia, assisted suicide, personhood, health-care resource allocation and environmental ethics, as well as the impact of new technologies, including genetic and reproductive); (2) use interdisciplinary approaches to unravel them; (3) employ cases and practical reasoning to understand problems and solve answers; (4) apply teaching methods and goals associated with John Dewey to make students better problem-solvers; (5) find morally justifiable solutions to the problems driving our field; and (6) seek interdisciplinary and collaborative scholarship, service or teaching.

Bioethical Issues↗

PubMedDate not supplied

Creating and using staff development standards.

This article is an overview of the development of the revised Scope and Standards of Practice for Nursing Professional Development, published by the American Nurses Association in 2000. It provides some background information about the standards, and discusses implications for staff development educators. The framework for these revised standards is continuing competence, which is essential to promote evidence-based practice.

American Nurses' Association↗

PubMed1998

Recognizing abuse in culturally diverse clients.

Abuse is a major problem in American society. The problem of abuse among ethnically diverse persons is an area about which most health care professionals know little. This article describes the Giger-Davidhizar Model of Transcultural Assessment as a tool of assessment of the client who is abused. Use of a framework for assessment can enable more culturally competent care to be delivered.

Adolescent↗

PubMed2000

Quality management in German health care--the EFQM Excellence Model.

A brief insight into the issues affecting German health care is given. Namely, upward pressure on costs leads to increasing expenditure within health care and downward pressure from economic recession and political unwillingness to increase taxes and budget spending. In the case of competing key stakeholder perspectives, a quality management framework is seen as a potential approach for addressing these issues. The framework is the European Foundation for Quality Management (EFQM) Excellence Model. The article briefly explains the pilot phase for utilising the EFQM Excellence Model within German health care organisations and the various implementation approaches recommended by EFQM. Specific details of an approach used by a health care organisation within Germany (providing social medicine, geriatric and elderly services) are described in detail. The benefits achieved from using the Model are a clear picture of where the gaps are in the organisation and a clear vision for concentrating future efforts towards total quality management.

Aged↗

PubMed1995

Machine technologies and caring in nursing.

Machine technologies and caring in nursing can be harmonious aspects of clinical nursing practice. The perception of technology and caring as dichotomous is so pervasive that one who is technologically proficient may often be assumed to be incapable of expressing caring. Within a framework of nursing as caring, true technologic competence in clinical nursing practice can be understood as an expression of caring. As such, technological competence assumes an indispensable place in contemporary clinical nursing practice. Nowhere is the link between machine technologies and caring demonstrated more clearly than in the practice of nursing in critical care. A model is presented to illustrate this concurrence.

Clinical Competence↗

PubMed2003

EMEA and Gene Therapy Medicinal Products Development in the European Union.

The evaluation of quality, safety, and efficacy of medicinal products by the European Medicines Evaluation Agency (EMEA) via the centralized procedure is the only available regulatory procedure for obtaining marketing authorization for gene therapy (GT) medicinal products in the European Union. The responsibility for the authorization of clinical trials remains with the national competent authorities (NCA) acting in a harmonized framework from the scientific viewpoint. With the entry into force of a new directive on good clinical practice implementation in clinical trials as of 1 May 2004, procedural aspects will also be harmonized at EU level. Scientifically sound development of medicinal products is the key for the successful registration of dossiers and for contributing to the promotion and protection of public health. The objective of this paper is to introduce the EMEA regulatory processes and scientific activities relevant to GT medicinal products.

Journal Article↗

PubMed2002

Spectrally resolved microscopy of GFP trafficking.

Folding and chromophore cyclization-oxidation processes of green and cyan fluorescent fusion proteins (GFP and CFP) in subcellular microenvironments of transfected C6 glioma cells were studied by multipixel spectrally resolved microscopy (SRM). Discrete time-dependent spectral transitions were characterized during protein folding and chromophore maturation in the cytosol, nucleus, mitochondria, endoplasmic reticulum (ER), and Golgi. Spectral similarity mapping of fluorophore transition phases demarcated spatio-temporal fluorescence correlation at a subcellular level. Folding stages were characterized by a transition from red-shifted spectral populations in the time interval of 7-10 hr after transfection to a fully matured fluorophore emitting typical GFP or CFP fluorescence after 10-15 hr. The nascent protein revealed an initial focal accumulation in cytosol emitting in the range of 580-680 nm. After 10 hr, mixed pixel population spectra were measured and at 15 hr GFP was visualized in the cytoplasm by its specific spectral fingerprints with maxima at 545 nm. For nucleus- and mitochondrion-targeted CFPs, the mature conformer was discovered only in its final destination, whereas intermediate steps of fluorophore synthesis (at 10 hr) were found in the cytoplasm. Enhanced fluorescence maturation was manifested only by the ER-Golgi-targeted CFP after 10 hr post transfection by spectral imaging. Moreover, only remnants of initial intermediate fluorescent pixels were localized externally to the Golgi framework at 15 hr. SRM assessed the competence of ER-Golgi to maintain efficient CFP folding in comparison to the rest of the cellular compartments.

Animals↗