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PubMed1997

The continuing professional education needs of midwives.

The philosophy behind Post Registration Education and Practice (PREP) dictates that continuing professional education (CPE) must be tailored to the needs of the individual and relevant to the practice environment. The study is set within the context of PREP and other changes that are currently affecting midwives and midwifery educational establishments. This study sought to explore the CPE needs of midwives. The main objective of the study was to seek information on a number of issues that would assist with the planning and implementation of continuing education programmes to meet the needs of midwives. The study takes the form of a descriptive survey. Questionnaires were sent to 696 midwives employed by 7 National Health Service Trusts in the South-West of England. A 45% response rate was achieved. Seven midwife managers were also interviewed to gain insight into their perspectives of CPE and to enhance the findings from the questionnaire. Results show that midwives use a variety of strategies to identify their CPE needs. One of the more significant seems to be through interaction with colleagues. 'Professional issues' and 'management topics' were the categories identified by both midwives and managers alike to be the greatest need. There is a demand for part-time and distance learning. The format and timings that would ensure that midwives find it easy to attend CPE events were identified. Findings illustrate how midwifery managers and educationalists can facilitate midwives with their CPE and career development.

Education, Nursing, Continuing↗

PubMed1993

Management of midface fractures: fifty years later.

Much has changed in the 50 years since Dr Parker described the development of rapid means of transportation as a portent of an increase in maxillofacial trauma. Contemporary surgeons must concern themselves with a host of nonsurgical care issues that are an integral part of oral and maxillofacial surgery practice. Expectations related to the patient, government, insurance carrier, and hospital staff have created a new practice environment. Standards of care are high and surgeon and patient needs are more complex. Dramatically improved diagnostic capabilities, use of open surgical techniques, improved rigid fixation devices, advances in techniques of resuscitation, and more focused surgical training have markedly improved the care of the facial trauma patient. The midface remains the central focus of our gaze when we engage in interpersonal relationships. Developmental and acquired aberrations of this region are likely to be more obvious than lower face abnormalities and, therefore, perceived as more disfiguring. Complex midface trauma repair requires precise surgical technique, with little margin for error. When ideal results are not achieved, the common contributing factors are intercurrent serious injury, anatomic and wound repair considerations, and failure to execute fracture repair principles. Hard and soft tissue volume changes may further compromise midface fracture repair, irrespective of the quality of the surgical outcome. Despite the advances made in the last 50 years, there is still room for future progress. An interdisciplinary committee of surgeons treating facial trauma should convene to establish a classification system for midface fractures that would satisfy medical record keeping and coding requirements, and facilitate fair and consistent reimbursement.(ABSTRACT TRUNCATED AT 250 WORDS)

Costs and Cost Analysis↗

PubMed1998

Survival rate of ceramic inlays.

OBJECTIVES: The aim of the present study was to evaluate the survival rate of ceramic inlays provided in a practice environment by one of the authors over the past decade. METHODS: 183 inlays were examined in 67 patients. The interval between placement and assessment was, on average, 4 years (s.d. 2.75 years) and varied from 4 months to 10 years. Kaplan-Meier survival-type curves were used to assess the survival rate. RESULTS: Five inlays failed: four due to endodontic reasons and one due to fracture. Four failures were in permanent molar teeth while the other was in a premolar tooth. A success rate of 97% at 10 years was estimated. CONCLUSIONS: The clinical durability of the resin-bonded ceramic inlays investigated was satisfactory.

Adult↗

PubMed1987

Laboratory diagnosis and characterization of renal disease in horses.

Laboratory evaluation of renal function in horses has advanced dramatically in the last 10 years largely as a result of the interest generated by the creative approach to diagnostic indices taken by Brobst, Traver, Coffman, and others. Some methods of assessing renal function discussed here are clearly outside the scope of a practice environment but are available in referral hospitals for use in difficult or unusual cases. Other methods described, such as calculation of fractional excretions and urine to serum creatinine ratios, are accessible and readily interpreted by the veterinary practitioner. These diagnostic methods should help in the early identification of renal disease in horses and therefore should allow veterinarians the option to treat renal disease before renal failure is advanced. In addition, practitioners may be able to offer more informed prognoses after a more complete evaluation of renal function.

Animals↗

PubMed1989

The political role of the health service executive.

The "politicization" of health care in Canada means an increasing political role for health service executives. This article focuses on the political activities and skills required for administrators to become effective in this expanded role. In the 1990s, the administrator must become increasingly externally oriented and proactive. Two externally oriented skills, networking and information processing, are discussed in relation to the current health care environment. Practical examples are provided to illustrate how these skills can be used to ensure both the success of the executive and the position of the organization.

Canada↗

PubMedDate not supplied

The R.U.B.B.E.R. tool: screening children for latex allergy.

The pediatric nurse practitioner may encounter IgE-mediated allergic reactions to natural latex rubber not only in patients with spina bifida but also in the general pediatric population. The R.U.B.B.E.R. screening tool is a short research-based questionnaire that elicits unrecognized past allergic reactions to latex and identifies children at risk for this condition. Management strategies include patient identification, referral for allergy evaluation, patient and family education about avoiding latex, and design of a latex-safe practice environment.

Child↗

PubMed1995

Retainment incentives in three rural practice settings: variations in job satisfaction among staff registered nurses.

Researchers have demonstrated repeatedly the importance of the relationship linking job satisfaction to employee retention. In rural areas of the country, where a persistent maldistribution of nurses continues to hamper health care delivery, the potential benefits of bolstering retention via enhancements in job satisfaction are of utmost utility to administrators and providers alike. Data were gathered from a multistate survey of registered nurses (RNs) practicing in rural hospitals, skilled nursing facilities, and community/public health settings (N = 1,647; response rate = 40.3%). The investigators found that the use of tuition reimbursement corresponded significantly with increased levels of job satisfaction among nurses in all three practice environments, as did day care services for nurses in acute care settings. Also, among hospital-based RNs, level of nursing education was found to be a significant factor in the relationship between tuition reimbursement and job satisfaction, with the highest level occurring among diploma-prepared nurses.

Career Mobility↗

PubMedDate not supplied

Creation of a modified angiography (endovascular) suite for transluminal endograft placement and combined interventional-surgical procedures.

PURPOSE: To describe early experience with an endovascular suite created for procedures requiring surgical access, endograft placement, or combined surgical and interventional radiologic expertise. MATERIALS AND METHODS: After examining the operating room and angiography environments, practice guidelines, state law, and regulatory agency requirements, a multidepartmental task force recommended reconfiguring an angiography suite to serve as an endovascular suite. Forty patients have been treated; 28 underwent vascular endograft placement and 12 underwent other combined procedures. RESULTS: Procedures included 31 femoral and axillary cutdowns; placement of one aortobifemoral graft, two iliofemoral grafts, two femoropopliteal grafts, and two femoral-femoral crossover grafts; two abdominopelvic exposures for aortic access, and five endarterectomies, including one at the carotid bifurcation performed in combination with common carotid stent placement. Three of the abdominopelvic procedures were not planned, including two emergency conversions. No patient had to be moved to an operating room. There was one major infection (2.5%), two minor wound infections (5%), and one wound with delayed healing (2.5%). CONCLUSION: Early experience with a combined surgical-interventional suite has been favorable, but a vigilant approach is warranted.

Angiography↗

PubMed1999

Heart failure disease management: a critical review.

BACKGROUND: Despite major advances in the pharmacotherapy of heart failure, hospitalization rates remain high, owing in large part to a multitude of psychosocial, behavioral, and financial factors that serve as barriers to effective compliance with prescribed treatment. To deal with these issues, many centers have adopted a multidisciplinary approach to heart failure disease management. METHODS AND RESULTS: A systematic review of the literature was conducted using the Medline database supplemented by reference lists from published articles. From 1983 to 1998, 16 studies describing multidisciplinary heart failure disease management programs were published in the English language literature. Of these, 10 were nonrandomized, observational studies and 6 were randomized clinical trials. All studies reported significant benefits in terms of reducing hospital utilization, and several studies reported improved quality of life, functional capacity, patient satisfaction, and compliance with diet and medications. In all studies in which a cost analysis was performed, heart failure disease management programs were found to be cost-effective. The limitations of the current data include concerns about the generalizability of published findings to the large and heterogenous population of patients with heart failure in the community, the feasibility of translating specific disease management programs into diverse practice environments, uncertainty about how to design and implement a maximally cost-effective heart failure disease management strategy, and how to best tailor the treatment program to the needs of each individual patient. The impact of heart failure disease management programs on survival is also unknown. CONCLUSION: Based on currently available data, heart failure disease management programs appear to be a cost-effective approach to reducing morbidity and enhancing quality of life in selected patients with heart failure. However, additional study is needed involving larger and more diverse populations to define the optimal approach to heart failure disease management.

Cost-Benefit Analysis↗

PubMedDate not supplied

Supervision of pharmacy personnel.

OBJECTIVE: To review legal, acceptable, and optimal personnel practices. DATA SOURCES: A general literature search was conducted to identify appropriate material. In addition, the personnel manuals of several organizations (large and small) were reviewed for alternative ways to address similar problems. DATA SYNTHESIS: The cost of personnel is often the largest single non-drug expense in a pharmacy's operating budget. Pharmacists rarely receive comprehensive training during their professional training to address the unique issues of supervision. A review of the basics of supervision, and some topics unique to pharmacy, is presented. CONCLUSION: Familiarity with appropriate supervisory practices can enhance productivity, improve morale, and create a better practice environment.

Humans↗

PubMedDate not supplied

Analysis of grocery chain pharmacists' work-related behaviors.

OBJECTIVE: To measure grocery chain pharmacists' work-related behaviors to assess the impact of a Pharmaceutical Care Certificate Program (PCCP) and other future interventions intended to alter pharmacists' practice behaviors. DESIGN: This study used multidimensional work sampling (MWS), a work measurement methodology that breaks "work" into three components: activity (what was done), contact (with whom the activity was performed), and function (the purpose or objective of the activity). Pharmacists were signaled at random intervals during the workday by a random signal generator. A selection was made from a list of items in each of the three dimensions of work to form an activity-contact-function combination code that described the work-related behavior at that point in time. SETTING AND PARTICIPANTS: Pharmacists in 15 grocery chain stores in the Indianapolis area; 20 pharmacists were enrolled in Purdue University's PCCP and 10 served as controls. Data were collected for a period of six weeks during April through June 1997 before the beginning of the PCCP program. MAIN OUTCOME MEASURES: Pharmacists' work-related behaviors. RESULTS: Writing/keyboarding was the most frequently recorded activity (22%), followed by one-to-one meetings (21.6%), and drug preparation (18%). Pharmacists spent most of their time working alone (62.9%), while a smaller but still substantial proportion of time was spent interacting with patients (17.9%). The most frequently recorded purpose (i.e., function) of pharmacists' activities was drug distribution (23.9%), followed by personal time (12.4%), receiving or transferring a medication order (10.2%), and patient counseling (6.6%). Out of a possible, 1,760 activity-contact-function combinations, 10 accounted for 46.3% of all reported observations, with "Prepare drug-Self-Drug distribution" representing the most frequently recorded activity-contact-function combination (15.7%). CONCLUSION: MWS is useful in helping grocery chain management better understand how pharmacy personnel are currently being utilized. This study provides a baseline for evaluating the impact of training programs or other alterations in the practice environment on pharmacists' work-related behaviors.

Community Pharmacy Services↗

PubMed1999

Discovery of self: exploring, interconnecting and integrating self (concept) and nursing.

Self concept of individual nurses is still largely unexplored in nursing. While the role of self-knowledge and self-actualisation are recognised as integral to nursing practice, little has been done to examine their relationships to self concept and nursing practice. The aim of this research study was to explore the role and significance that self concept plays in women nurses' experience of their beginning practice. The exploration examined factors which contribute to and impact on self concept within a nursing practice environment. Self concept relates to how an individual experiences oneself and is integrally linked to one's interactions and relationships with others. This two phase research was situated in critical and feminist theory using reflective journalling (phase one) and story telling/narrative (phase two) as the research methods. This paper discusses the three major themes which arose in phase one of the research. Those were: exploring experiences; interconnecting personal and professional worlds; and, integrating self 'into' nursing. The paper also explores inter-subjectivity in terms of the contribution this concept makes to our understanding of research findings.

Female↗

PubMed2001

Students' perceptions of learning outcomes from group-based, problem-based teaching and learning activities.

OBJECTIVE: A study aimed at exploring the variation in perceptions of learning outcomes reported by undergraduate nursing students enrolled in a problem-based learning subject in a pre-registration Bachelor of Nursing course (BN). METHOD: Students were asked to respond to four open-ended questions which focussed on their learning outcomes in the different teaching/learning modalities of the subject. Data were analysed in two phases using a modified phenomenographic analysis. In the first phase a set of categories of description were developed from the student responses to questions related to the learning modalities. In the second phase the individual responses were classified in terms of the categories. Finally, correlations between the learning modalities were identified. In this paper the approach to analysis, the process of category identification and the correlations between the learning modalities will be described and the implications for further research and teaching will be discussed. RESULTS: The findings indicated that there were two distinct groups of student responses. Inward focussed students who described outcomes in terms of their own learning and students whose focus was outward i.e. describing learning in terms of patient care and how learning relates to that care. Another important result shows the relationship between the learning modalities and outcomes. From the students' perspective, the most sophisticated outcomes of the lectures and laboratories were ideas and skills to be used and applied in clinical settings. Whereas, the group-based activities in which clinical problems were presented to the students in the form of Situation Improvement Packages (SIPS) focussed their attention on the clinical setting which constituted a preparation for the realities of clinical practice. CONCLUSION: The findings from this study indicate that students perceive their learning in the group based teaching/learning modality (SIPS) as effective in focussing them on the reality of their role in the clinical practice environment while lectures and laboratories provided the skills and knowledge required for this setting.

Curriculum↗

PubMed1999

Considerations for ethical practice in managed care.

How does one maintain an ethical practice while facing the requirements and limits of a health care system that is dominated by managed care? Psychologists are increasingly raising such questions about ethical issues when working in or contracting with managed care organizations. The authors review the process involved in ethical decision making and problem solving and focus on 4 areas in which ethical dilemmas most commonly arise in a managed care context: informed consent, confidentiality, abandonment, and utilization management-utilization review. The need for sustained and organized advocacy efforts to ensure patient access to quality health care is discussed, as is the impact of managed care's competitive marketplace on professional relationships. Hypothetical examples of typical dilemmas psychologists face in the current practice environment are provided to illustrate systematic ethical decision making.

Codes of Ethics↗

PubMed1988

Survey of treatment of primary breast cancer in Italy. GIVIO (Interdisciplinary Group for Cancer Care Evaluation).

A mail survey among 970 physicians from different specialties was carried out in Italy to learn about factors that influence physicians' decision-making for patients with early breast cancer. Ninety percent of respondents were in favour of a conservative procedure for the surgical treatment of a 35-year-old patient with primary tumour smaller than two centimeters. The same preference was also expressed by 66% of doctors for a 60-year-old patient with similar disease. Most physicians (78%) favoured the use of adjuvant chemotherapy for premenopausal node-positive women. Preferences for the treatment of post-menopausal patients were divided among those in favour of endocrine therapy (51%), chemotherapy (32%), the combination of the two (7%) or no further treatment after surgery (8%). Several factors appeared to relate to therapeutic preferences. Each physician's specialty was the single most important factor associated with the preference for surgical treatment together with the attitude towards patients' involvement in decision-making which, however, was statistically significant only for the older patient. Analysis of predictors of preferences for adjuvant therapy showed that specialty and hospital size were associated with choosing chemotherapy for a premenopausal woman, and specialty and physician's sex with the indication of endocrine treatment in a postmenopausal patient. Our study documents that the application of research results depends on many factors, some of which have a sound scientific basis while others reflect highly personal opinions and the influence of the practice environment.

Adult↗

PubMed1999

How long do routine dental restorations last? A systematic review.

OBJECTIVE: To conduct a systematic review of the literature on the longevity of routine dental restorations in permanent posterior teeth, and to identify and examine factors influencing its variability. METHOD: Accepted guidelines were followed. An advisory group oversaw the project. Simple Class I and Class II amalgam, composite resin, glass ionomer and cast gold restorations were covered. Comprehensive searching of electronic databases, hand-searching, and location of 'grey' literature, generated 124 research reports. Those considered relevant were assessed for validity and quality according to agreed criteria. The analysis was descriptive. RESULTS: Eight of 58 relevant research reports were categorised, according to agreed criteria, as being of satisfactory validity and quality. They suggested that 50% of all restorations last 10 to 20 years, although both higher and lower median survival times were reported. The findings were supported by the totality of studies reviewed. However, variability was substantial. Restoration type, materials, the patient, the operator, the practice environment and type of care system appeared to influence longevity. CONCLUSIONS: Many studies were imperfect in design. Those considered to be the most appropriate for analysis were too limited to undertake a formal statistical exploration. Therefore there remains a need for definitive randomised controlled trials of restoration longevity, of sound design and adequate power, employing standardised assessments and appropriate methods of analysis.

Bicuspid↗

PubMed2001

Microleakage of three sealants following conventional, bur, and air-abrasion preparation of pits and fissures.

OBJECTIVES: The aim of this study was to compare the microleakage of a filled sealant with a drying agent (UltraSeal XT plus), a filled sealant (Prismashield) and an unfilled sealant (Delton), after conventional, bur, and air-abrasion tooth preparation techniques. SETTING: The study was completed in a clinical setting at the Simulated Practice Environment Clinic, School of Dentistry, University of Western Ontario, London, Ontario, Canada. SAMPLE AND METHODS: One hundred and eighty extracted teeth were cleaned and divided randomly into three groups. Group 1 was prepared using acid etch only. Group 2 was prepared with a 1/4 round bur in a low-speed handpiece followed by acid etching. Group 3 was prepared with high speed (120PSI) microabrasion using 27 microm alpha-alumina particles in a Midwest Airtouch unit. The teeth in each group were randomly assigned to one of the three subgroups according to the sealant applied. Subgroup A was sealed with a filled sealant with drying agent, B with a filled sealant only, and C with an unfilled sealant. All teeth were stored in artificial saliva for 7 days at 37 degrees C. After this, the teeth were coated with nail varnish 1 mm from the sealant and immersed in 1% methylene blue dye for 48 h at 37 degrees C. Each tooth was sectioned at four locations buccolingually and a total of 665 sections were ranked (0-3) for microleakage. Statistical analysis was completed using the Chi-squared test and Fisher's exact test. RESULTS: UltraSeal XT plus, the filled sealant with drying agent, showed significantly less microleakage than the other two sealants (P < 0.05). Delton, the unfilled sealant, showed significantly less microleakage than Prismashield, the filled sealant (P < 0.05). Air abrasion with acid etch showed significantly less microleakage than either bur with acid etch or acid etch alone. There was however, no significant difference between the bur and acid etch tooth preparations (P < 0.05). CONCLUSIONS: UltraSeal XT plus was the most effective sealant for preventing microleakage in this study. The most successful method of preparation was air abrasion with acid etch.

Acid Etching, Dental↗

PubMed2003

Nitrite reductase activity of sulphate-reducing bacteria prevents their inhibition by nitrate-reducing, sulphide-oxidizing bacteria.

Sulphate-reducing bacteria (SRB) can be inhibited by nitrate-reducing, sulphide-oxidizing bacteria (NR-SOB), despite the fact that these two groups are interdependent in many anaerobic environments. Practical applications of this inhibition include the reduction of sulphide concentrations in oil fields by nitrate injection. The NR-SOB Thiomicrospira sp. strain CVO was found to oxidize up to 15 mM sulphide, considerably more than three other NR-SOB strains that were tested. Sulphide oxidation increased the environmental redox potential (Eh) from -400 to +100 mV and gave 0.6 nitrite per nitrate reduced. Within the genus Desulfovibrio, strains Lac3 and Lac6 were inhibited by strain CVO and nitrate for the duration of the experiment, whereas inhibition of strains Lac15 and D. vulgaris Hildenborough was transient. The latter had very high nitrite reductase (Nrf) activity. Southern blotting with D. vulgaris nrf genes as a probe indicated the absence of homologous nrf genes from strains Lac3 and Lac6 and their presence in strain Lac15. With respect to SRB from other genera, inhibition of the known nitrite reducer Desulfobulbus propionicus by strain CVO and nitrate was transient, whereas inhibition of Desulfobacterium autotrophicum and Desulfobacter postgatei was long-lasting. The results indicate that inhibition of SRB by NR-SOB is caused by nitrite production. Nrf-containing SRB can overcome this inhibition by further reducing nitrite to ammonia, preventing a stalling of the favourable metabolic interactions between these two bacterial groups. Nrf, which is widely distributed in SRB, can thus be regarded as a resistance factor that prevents the inhibition of dissimilatory sulphate reduction by nitrite.

Antibiosis↗