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PubMed1999

Dualistic level competencies for professional nursing practice: an international educational initiative.

Ensuring professional nurses are competent is integral to promoting quality outcomes for persons with spinal cord impairment (SCI). This project, funded by the American Association of Spinal Cord Injury Nurses (AASCIN), was designed to develop instruments to validate the competencies of registered nurses (RNs) caring for persons with SCI. The project expanded a 1994 model project focusing on the competencies of licensed practical nurses and licensed vocational nurses (LPNs/LVNs) and RNs in an adult rehabilitation setting. Using the earlier project as a foundation, investigators identified competencies for RNs applicable to the life span trajectory of persons with SCI including pediatric, adolescent, adult, and geriatric populations. Additionally, the focus was broadened to encompass acute, rehabilitation, outpatient community, and long-term settings. This innovative project resulted in the development of the SCI Knowledge/Skill Competency tool for dualistic competency levels of "competent" RNs with two years of recent SCI nursing experience, and "expert" RNs with five years of recent SCI experience. Additionally, the SCI Behavior Competency tool for the "competent" level was developed using hermeneutic techniques and Patricia Benner's (1983) framework, "Novice to Expert." This complemented the "expert" level tool devised in the 1994 model project. Implementation will enable RNs to validate the competencies that are essential to provide care that results in quality outcomes for persons with SCI, their families, and other consumers of SCI health care services.

Adult↗
PubMed2004

An intentional modeling process to teach professional behavior: students' clinical observations of preceptors.

BACKGROUND: Most formal instruction in professionalism and communication occurs in the preclinical years of medical school, with an acknowledged need to fortify and apply these competencies during the clinical years. Role modeling provides a powerful way to teach professionalism, particularly when mentors identify specific learning goals and focus the learners' observations. DESCRIPTION: The authors discuss an innovative process, called Students' Clinical Observations of Preceptors (SCOOP), which reverses the traditional direction of structured observations. With written cues to focus their observations, students observe their preceptors, who intentionally model professionalism and communication during clinical encounters. Students and preceptors discuss the observed patient-physician interaction during postencounter sessions. EVALUATION: Most medical students rated the SCOOP process highly and reported professional behaviors they gained. CONCLUSION: As educators seek methods for learners to attain greater competence in communication and interpersonal skills, the SCOOP provides an explicit framework to optimize modeling for the learning of professionalism.

Clinical Competence↗
PubMed2001

Further testing of the Mental Health Problems Perception Questionnaire.

AIM OF THE STUDY: This paper reports a two-part study relating to the further psychometric development of the Mental Health Problems Perceptions Questionnaire. BACKGROUND: The instrument was developed and used originally in a study to investigate the role of district nurses in caring for people with mental health problems, who live in rural settings. It is underpinned by an explicit theoretical framework in which therapeutic commitment, role support and role competency are core concepts. DESIGN: A two-part study is described. Part One used a test-retest method to examine the stability of the instrument on repeated administration. Part Two examined the instrument's internal reliability and construct validity by calculation of Cronbach's alpha coefficients and exploratory factor analysis. RESULTS: Satisfactory internal reliability for a new instrument was demonstrated. Exploratory factor analysis supported the previously proposed theoretical framework. Significant correlations were demonstrated between the scales which constitute the instrument, thereby providing further evidence of construct validity. CONCLUSIONS: The Mental Health Problems Perceptions Questionnaire provides a potentially useful instrument in relation to future educational, clinical and managerial research.

Factor Analysis, Statistical↗
PubMed1986

The need for evaluation of the ultimate impact of continuing pharmaceutical education.

Many governmental agencies and professional associations are using continuing education as the single, and relatively untested, means of ensuring that professionals maintain an acceptable level of knowledge and skills. The ultimate goal of continuing education in the health professions is improved professional performance leading to an improvement in the quality of health care provided. However, there is justifiable concern over the lack of a significant link between participation in continuing education activities and professional competence. This issue is explored and a conceptual framework for the evaluation of continuing pharmaceutical education is presented. The conceptual framework is an evaluation hierarchy which depicts the following four levels of a comprehensive evaluation process: participant satisfaction; changes in knowledge, attitudes, and skills; behavior change in practice setting; and improvement in patient care.

Education, Pharmacy, Continuing↗
PubMed1993

Comparing regulatory regimens for pesticide control in 22 countries: toward a new generation of pesticide regulation.

Some historical developments of chemical control legislation are being traced, from specialized laws, such as pesticide acts, to the 1970/1980 generation of generalized legal instruments involving all commercial chemicals. It is then argued that from an environmental protection point of view, a "cradle-to-grave" assessment will henceforth be necessary. Ecological guidelines and indicators for the assessment of the life-cyclewide environmental impact intensity of economic outputs are presented. The international implications of the worldwide trade in pesticides are being considered. As the use of pesticides has invariably transfrontier effects and since unilateral import restrictions due to environmental quality requirements constitute nontariff barriers to trade, a high degree of international harmonization is desirable. This point is also of some importance with a view to the GATT negotiations and the chances for exporting chemicals from developing and postsocialist countries into industrialized hard currency areas in the future. The results of a comprehensive review in 1990/1991 of the regulatory pesticide management regime in 22 countries are presented, comprising countries from Central and Eastern Europe as well as the industrialized Western countries. The review is based upon the returns to a questionnaire which had been designed jointly by the International Institute of Applied Systems Analysis (IIASA) and the Regional Office of the WHO in Copenhagen. The information received was subsequently validated by the competent authorities. Taking all observations into consideration, the framework of an advanced prototype legislative framework for pesticides management is proposed.

Americas↗
PubMed1992

[Language competence of 14-year-old adolescents in relation to their sociocultural origin: results from a logopedic study in the framework of the Basel kindergarten study].

Between 1986 and 1988 speech and language abilities of a representative sample of 341 fourteen-year-old Basle schoolchildren were assessed as part of the 2nd Follow-up examination of the Basle Kindergarten-study. The language and speech test consisted of retelling and writing two stories, one of them played by tape-recorder, the other by video recorder. In addition three established language tests (Mottier-, IMK- and KLI-speechtest) were used. The results show significant differences between Swiss children and children of Italian workers in different test parts. There are also differences between boys and girls and between social classes. The high proportion of children with language difficulties is alarming. Parts of the tests used in this study were found to be appropriate for a screening of speech and language abilities.

Adolescent↗
PubMed1992

Ranking radiotherapy treatment plans using decision-analytic and heuristic techniques.

Radiotherapy treatment optimization is done by generating a set of tentative treatment plans, evaluating them, and selecting the plan closest to achieving a set of conflicting treatment objectives. The evaluation of potential plans involves making trade-offs among competing possible outcomes. Multiattribute decision theory provides a framework for specifying such trade-offs and using them to select optimal actions. Using these concepts, we have developed a plan-ranking model which ranks a set of tentative treatment plans from best to worst. Heuristics are used to refine this model so that it reflects the clinical condition of the patient being treated and the practice preference of the physician prescribing the treatment. A figure of merit is computed for each tentative plan and is used to rank the plans. The approach described is very general and can be used for other medical domains having similar characteristics. The figure of merit can also be used as an objective function by computer programs that attempt to automatically generate an optimal treatment plan.

Decision Making, Computer-Assisted↗
PubMed2004

Ectopic bone formation in rats: the importance of vascularity of the acceptor site.

Bone graft substitutes (BGS) can be fabricated by the combination of three key ingredients: (1) competent bone-forming cells, (2) a suitable framework or scaffold, and (3) the presence of biological stimulants. Although much research has been done to develop the ideal BGS, still the results are not very consistent. In view of this, the cellularity and vascularity of the recipient site are supposed to be important for the osteoinductive capacity of BGS. Therefore, we hypothesized that a muscle recipient site could favor bone formation in a cell-based BGS compared to a subcutaneous recipient site due to the higher vascularity of muscle tissue. To prove this hypothesis, 48 titanium fiber mesh implants were seeded with rat bone marrow stromal cells (RBM) and implanted subcutaneously and intramuscularly in the adductor thigh muscle of rats. The amount of bone formation after 1, 3 and 6 weeks was evaluated by histology and histomorphometry as well as by calcium content. Analysis revealed that the bone formation increased during implantation. However, bone formation did not exceed 12% of the implant surface, both for the intramuscular and subcutaneous recipient site. Also, no significant differences in bone amount between these two sites existed. Consequently, our hypothesis could not be confirmed.

Absorbable Implants↗
PubMed2001

Socioeconomic disparities in health change in a longitudinal study of US adults: the role of health-risk behaviors.

This study investigated the hypothesis that socioeconomic differences in health status change can largely be explained by the higher prevalence of individual health-risk behaviors among those of lower socioeconomic position. Data were from the Americans' Changing Lives study, a longitudinal survey of 3,617 adults representative of the US non-institutionalized population in 1986. The authors examined associations between income and education in 1986, and physical functioning and self-rated health in 1994, adjusted for baseline health status, using a multinomial logistic regression framework that considered mortality and survey nonresponse as competing risks. Covariates included age, sex, race, cigarette smoking, alcohol consumption, physical activity, and Body Mass Index. Both income and education were strong predictors of poor health outcomes. The four health-risk behaviors under study statistically explained only a modest portion of the socioeconomic differences in health at follow-up. For example, after adjustment for baseline health status, those in the lowest income group at baseline had odds of moderate/severe functional impairment in 1994 of 2.11 (95% C.I.: 1.40, 3.20) in an unadjusted model and 1.89 (95% C.I.: 1.23, 2.89) in a model adjusted for health-risk behaviors. The results suggest that the higher prevalence of major health-risk behaviors among those in lower socioeconomic strata is not the dominant mediating mechanism that can explain socioeconomic disparities in health status among US adults.

Adult↗
PubMed2003

[Mediation perspectives in the field of aesthetic surgery].

Since the law of 4 March 2002, that confirms the right of each person to dispose of his own body with respect for his own dignity, cosmetic surgery becomes the most regulated medical discipline. The establishment of regional commissions for conciliation and indemnification, which could within the framework of their mission of conciliation delegate their competences to one or more independent mediators, opens perspectives for mediation.

France↗
PubMed1981

Retinal location and its effect on the processing of target and distractor information.

Two experiments were conducted to study the perceptual facilitation and inhibition that occurs between foveal and parafoveal or peripheral regions of the eye. Experiment 1 used a Stroop task to compare color detection latencies of foveal and parafoveal targets. The target and distractor components of the Stroop stimuli were separated and presented with varied stimulus onset asynchronies. Experiment 2 used a Stroop-like task to replicate and extend the findings into the visual periphery. Subjects were found to process foveally presented distractor information while attending to targets presented in parafoveal or peripheral regions of the eye. Distractor information that was incompatible was suppressed while compatible information was used to facilitate target processing. When the targets were presented foveally along with the distractor information, subjects appeared to automatically process the distractor information. The findings are discussed within the framework of past studies that presented subjects with competing tasks across retinal location. The implications of these findings to a two-process theory of attention are also considered.

Attention↗
PubMed2001

Markovian domain fingerprinting: statistical segmentation of protein sequences.

MOTIVATION: Characterization of a protein family by its distinct sequence domains is crucial for functional annotation and correct classification of newly discovered proteins. Conventional Multiple Sequence Alignment (MSA) based methods find difficulties when faced with heterogeneous groups of proteins. However, even many families of proteins that do share a common domain contain instances of several other domains, without any common underlying linear ordering. Ignoring this modularity may lead to poor or even false classification results. An automated method that can analyze a group of proteins into the sequence domains it contains is therefore highly desirable. RESULTS: We apply a novel method to the problem of protein domain detection. The method takes as input an unaligned group of protein sequences. It segments them and clusters the segments into groups sharing the same underlying statistics. A Variable Memory Markov (VMM) model is built using a Prediction Suffix Tree (PST) data structure for each group of segments. Refinement is achieved by letting the PSTs compete over the segments, and a deterministic annealing framework infers the number of underlying PST models while avoiding many inferior solutions. We show that regions of similar statistics correlate well with protein sequence domains, by matching a unique signature to each domain. This is done in a fully automated manner, and does not require or attempt an MSA. Several representative cases are analyzed. We identify a protein fusion event, refine an HMM superfamily classification into the underlying families the HMM cannot separate, and detect all 12 instances of a short domain in a group of 396 sequences. CONTACT: jill@cs.huji.ac.il; tishby@cs.huji.ac.il.

Algorithms↗
PubMedDate not supplied

Hospital emergency care teams: our solution to out of hours emergency care.

The implementation of the European Working Time Directive and the compulsory reduction in junior doctors hours provided the main driver and background for this project. The project aim was to implement Hospital Emergency Care Teams (HECT) on three District General Hospitals (DGHs) to provide emergency out-of-hours care. The project strategy centred on the recruitment, training and preparation of critical care nurses to undertake advanced assessment roles. Methods used to monitor and evaluate activity include the use of innovative hand-held computers. Main outcomes include, the conclusion that a multidisciplinary HECT of five could manage the overnight workload and level of acuity in a DGH of 420-500 beds, and that critical care nursing staff can be prepared for advanced supporting roles. Experiences gained provide valuable learning that could be used to influence similar projects. Implications for practice include the development of a national framework to inform areas such as multidisciplinary competency-based education and training. Scientific evidence is required to evaluate the effect of HECT on hospital mortality and morbidity and quantify the staff, inpatient experiences.

After-Hours Care↗
PubMed1992

Making the fit: orienting new employees to community health nursing agencies.

Community health nurse managers require tested orientation methods to fit new employees into the rapidly changing conditions of professional practice, increase nursing productivity, and reduce turnover. The clinical competencies for community health nursing provide a workable framework for applying orientation principles to the special demands of community health nursing.

Community Health Nursing↗
PubMed2005

Strangers or friends? A proposal for a new spirituality-in-medicine ethic.

We argue that debate regarding whether and how physicians should engage religious concerns has proceeded under inadequate terms. The prevailing paradigm approaches dialogue regarding religion as a form of therapeutic technique, engaged by one stranger, the physician, upon another stranger, the patient. This stranger-technique framework focuses the debate on questions of physicians' competence, threats to patients' autonomy, and neutrality regarding religion, and in so doing, it too greatly circumscribes the scope of physician-patient dialogue. In contrast, we argue that dialogue regarding religion is better approached as a form of philosophical discourse about ultimate human concerns. Such moral discourse is often essential to the patient-physician relationship, and rather than shrinking from such discourse, physicians might engage patients regarding religious concerns guided by an ethic of moral friendship that seeks the patient's good through wisdom, candor, and respect.

Adult↗
PubMed1999

Encephalization, adaptation and evolution of chiroptera: A statistical analysis with further evidence for bat monophyly.

As part of a large-scale study on brain morphometrics and adaptations in mammals, we addressed the problem of chiropteran evolution. A specific statistical framework was designed to test which of two competing hypotheses (bat monophyly vs. diphyly) is more strongly supported by quantitative brain data. Our analyses, based on 120 species, revealed that megabats and microbats were more closely related to each other than to primates, and illustrated the convergent adaptations of the brain of bats to similar trophic (i.e. feeding related) niches. Ecologically-corrected characters were then used to derive a new phylogeny which also supports the chiropteran clade. The monophyletic origin of bats is the preferred hypothesis to explain brain quantitative evolution in chiropterans and primates.

Adaptation, Physiological↗
PubMed2004

Dancing to our own tune: understandings of advanced nursing practice in British Columbia.

There has been ongoing confusion about the meaning of advanced nursing practice (ANP) and the nature of ANP roles in Canada and elsewhere. A broad range of roles and titles have been adopted throughout Canada in an attempt to delineate specialized and/or advanced roles within nursing. One key objective in a recent three-phase study of ANP in British Columbia was to clarify the role and understanding of advanced nursing practice and related roles within the larger healthcare system. Our intent in this paper is to describe the understandings of ANP that emerged in Phase I of this recent study and to compare registered nurses' understandings of ANP to the characteristics and competencies identified by the Canadian Nurses Association (2002) framework. (Note: The term "nurse," as used in this paper, refers to "registered nurse.") We conclude by identifying future directions for development of advanced practice roles.

Attitude of Health Personnel↗