A conceptual framework may be of limited value.
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Clinical Competence↗
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Ethics for the practicing dentist. A framework for studying professional ethics.
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Clinical Competence↗
Evaluation based on philosophy and objectives, conceptual framework, curriculum threads and course objectives.
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Clinical Competence↗
Voluntary dental laboratory certification program. Council on Prosthetic Services and Dental Laboratory Relations.
Laboratory certification does not offer concrete guarantees of consistent high quality of products or services. It does, however, identify, for the dental profession, a competency and acceptability factor on which to base a predication of performance by the laboratory. Also, laboratory certification establishes a framework within which the dental laboratory industry can work to continue upgrading its facilities and personnel, demonstrates the concern of certified laboratories for continuing competence, and indicates to government and third-party payers a willingness to develop standards endorsed by the industry.
Certification↗
Critical features of a curriculum in health care quality and resource management.
In response to mounting demands for quality and accountability in health care, a science of health care quality and resource management (QRM) has evolved, but too slowly and without the academic base needed to prepare practitioners to assume new roles and fulfill requirements to regulate their practice. To develop such a base, The University of Houston and The University of Texas Health Science Center sponsored a needs assessment survey to identify areas of knowledge and skills to be included in a master's degree curriculum in QRM. The study used a three-cycle Focus Delphi technique to secure experts' refinement of the survey instrument and consensus among participants, who included practitioner-members of the National Association of Quality Assurance Professionals (NAQAP), of health care administration educational program directors, and hospital administrators. Starting with a listing based on a competency outline obtained from NAQAP, the study identified critical learning needs and elaborated a framework with 12 broad categories and 108 specific knowledge and skill areas.
Curriculum↗
Nursing curriculum and continuing education: future directions.
Redefinition of roles and functions in the healthcare systems of the future requires embracing to the value of continuing education. Within this framework healthcare professional education and continuing education, there are several core competencies described by Institute of Medicine (IOM) [A.C. Greiner, E. Knebel (Eds.), Health Professionals Education: Bridge to Quality, IOM, available at, May 2003] that form the foundation for practice for nurses and other healthcare professionals. An overarching sentence in the document says "All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics" (p. 45). These IOM core competencies are: (1) Common value for respecting patients' differences, values, preferences and expressed needs. (2) Ability to cooperate, collaborate, communicate and integrate care using interdisciplinary teams. (3) Knowledge of and willingness to employ evidence-based practice principles. (4) Capability to apply quality and safety improvement approaches in care. (5) Understand, value and use informatics to all areas of health care, to reduce errors, manage knowledge and information, and make decisions and communicate. In enveloping these core competencies in basic and continuing education, it is necessary to build an evidence base for education itself, demand that faculty are prepared for the future. A crucial need is for healthcare professional students (including nursing students) learn interdisciplinary collaboration in the education of patients. A global strategy, using these competencies for preparing faculty is necessary; and some models already exist that can be further developed to meet future needs that are informatics driven in our increasingly technological future care systems.
Curriculum↗
Two structures of the catalytic domain of phosphorylase kinase: an active protein kinase complexed with substrate analogue and product.
BACKGROUND: Control of intracellular events by protein phosphorylation is promoted by specific protein kinases. All the known protein kinase possess a common structure that defines a catalytically competent entity termed the 'kinase catalytic core'. Within this common structural framework each kinase displays its own unique substrate specificity, and a regulatory mechanism that may be modulated by association with other proteins. Structural studies of phosphorylase kinase (Phk), the major substrate of which is glycogen phosphorylase, may be expected to shed light on its regulation. RESULTS: We report two crystal structures of the catalytic core (residues 1-298; Phk gamma trnc) of the gamma-subunit of rabbit muscle phosphorylase kinase: the binary complex with Mn2+/beta-gamma-imidoadenosine 5'-triphosphate (AMPPNP) to a resolution of 2.6 A and the binary complex with Mg2+/ADP to a resolution of 3.0 A. The structures were solved by molecular replacement using the cAMP-dependent protein kinase (cAPK) as a model. CONCLUSIONS: The overall structure of Phk gamma trnc is similar to that of the catalytic core of other protein kinases. It consists of two domians joined on one edge by a 'hinge', with the catalytic site located in the cleft between the domains. Phk gamma trnc is constitutively active, and lacks the need for an activatory phosphorylation event that is essential for many kinases. The structure exhibits an essentially 'closed' conformation of the domains which is similar to that of cAPK complexed with substrates. The phosphorylated residue that is located at the domain interface in many protein kinases and that is believed to stabilize an active conformation is substituted by a glutamate in Phk gamma trnc. The glutamate, in a similar manner to the phosphorylated residue in other protein kinases, interacts with an arginine adjacent to the catalytic aspartate but does not participate in interdomain contacts. The interactions between the enzyme and the nucleotide product of its activity, Mg2+/ADP, explain the inhibitory properties of the nucleotides that are observed in kinetic studies.
Adenosine Diphosphate↗
The testing of clinical skills in dietetic students prior to entering clinical placement.
BACKGROUND: One of the most important requirements for contemporary education of a health care professional is to develop a framework for theory and practise which results in attainment of professional competencies suitably robust for a lifetime of practise (Howe, 2002). In the context of those educating preregistration dietitians, this offers the challenge of presenting the student with innovative curricula designed to deliver the appropriate level of knowledge and understanding together with emphasis on skill and attitude development. The purpose of this study was to allow preregistration students the opportunity to practise key clinical skills prior to clinical placement and test skills acquisition using the model of an objective structured clinical examination (OSCE). METHODS: The learning experience of the student was altered to accommodate a more conceptually-driven, problem-centred, case-based approach. The curriculum was adjusted to incorporate a short clinical skills programme where emphasis was deliberately placed on skill acquisition. At the conclusion of this clinical skills programme, and prior to the students entering clinical placement, skill performance by students was tested using the OSCE. The method of testing was also evaluated by students. RESULTS: The OSCE was delivered to 37 preclinical students. Four of the test candidates (11%) failed in at least one of the skill areas: these students performed similarly during clinical placement. Twenty-one (57%) students returned the post-OSCE questionnaire. Twenty (95%) students reported a positive experience; 20 (95%) students reported initial anxiety that diminished as the test progressed. CONCLUSION: The Project Team was confident with the novel approach taken in re-designing the curriculum: to include a dedicated clinical skills programme, together with addition of the testing of clinical skills using the OSCE model. These curriculum changes were deemed to be highly appropriate additions to the student experience in determination of skill performance of students prior to clinical placement.
Clinical Competence↗
Towards a conceptualization of language and cognitive impairment in closed-head injury: use of clinical measures.
Language deficits following closed-head injury (CHI) are widely considered as impairments secondary to the cognitive disruptions common to closed-head injury. In addition, the use of standardized measures to assess the functioning of the language system in closed-head injury has mostly been limited to aphasia test batteries which examine primary language functions only. This has resulted in generalizations as to the integrity of the language system following closed-head injury, and as a consequence, consideration of the contribution of the language system to the achievement of communicative competence in this population has been minimized. This paper presents a framework in which the functional language system is identified as a hierarchical system containing primary and higher-order language processes involved in reciprocal relationships with cognitive functions at each level. A group of 25 closed-head injury subjects and 23 demographically matched control subjects were examined for linguistic proficiency using a battery of standardized tests which investigated the language system across a hierarchy of complexity, structure and predictability. In addition, 23 of the closed-head subjects were administered a comprehensive neuropsychological test battery in order to determine the nature and extent of concomitant impairments in cognitive processes and their relationship with impairments in the language system. The language battery was found to consistently discriminate between the control and clinical groups indicating that the linguistic system is significantly impaired following CHI, with the lexical-semantic system being the most vulnerable to disruption. A strong influential relationship between language and cognitive processes was statistically confirmed and the nature of the relationship between aspects of language and cognition further delineated.
Adolescent↗
Collaborative recovery: an integrative model for working with individuals who experience chronic and recurring mental illness.
OBJECTIVES: Recovery is an emerging movement in mental health. Evidence for recovery-based approaches is not well developed and approaches to implement recovery-oriented services are not well articulated. The collaborative recovery model (CRM) is presented as a model that assists clinicians to use evidence-based skills with consumers, in a manner consistent with the recovery movement. A current 5 year multisite Australian study to evaluate the effectiveness of CRM is briefly described. CONCLUSION: The collaborative recovery model puts into practice several aspects of policy regarding recovery-oriented services, using evidence-based practices to assist individuals who have chronic or recurring mental disorders (CRMD). It is argued that this model provides an integrative framework combining (i) evidence-based practice; (ii) manageable and modularized competencies relevant to case management and psychosocial rehabilitation contexts; and (iii) recognition of the subjective experiences of consumers.
Chronic Disease↗
Toward greater specificity in defining nursing's metaparadigm.
The thesis presented is that nursing in its disciplinary context cannot appropriately be considered a concept in the metaparadigm of nursing science. Nursing as a discipline is guided by theories and prescriptions that emanate from puzzles solved in the domain of nursing science. Failure to distinguish between the science of nursing and its disciplinary aspects in building conceptual frameworks will retard the growth of science. The merits of three competing paradigms--normal science, historical facts, and social facts-are discussed. None of these paradigms is adequate for discovery in nursing science. Efforts to develop knowledge around the phenomena of central concern to nursing may advance more rapidly if theory building follows a set of rules, as yet undefined, that incorporates the methods of both normal science and historical tradition.
Holistic Health↗
Range image segmentation into planar and quadric surfaces using an improved robust estimator and genetic algorithm.
This paper presents a novel range image segmentation method employing an improved robust estimator to iteratively detect and extract distinct planar and quadric surfaces. Our robust estimator extends M-estimator Sample Consensus/Random Sample Consensus (MSAC/RANSAC) to use local surface orientation information, enhancing the accuracy of inlier/outlier classification when processing noisy range data describing multiple structures. An efficient approximation to the true geometric distance between a point and a quadric surface also contributes to effectively reject weak surface hypotheses and avoid the extraction of false surface components. Additionally, a genetic algorithm was specifically designed to accelerate the optimization process of surface extraction, while avoiding premature convergence. We present thorough experimental results with quantitative evaluation against ground truth. The segmentation algorithm was applied to three real range image databases and competes favorably against eleven other segmenters using the most popular evaluation framework in the literature. Our approach lends itself naturally to parallel implementation and application in real-time tasks. The method fits well, into several of today's applications in man-made environments, such as target detection and autonomous navigation, for which obstacle detection, but not description or reconstruction, is required. It can also be extended to process point clouds resulting from range image registration.
Algorithms↗
Important parameters in plasma fractionation.
Important parameters in plasma fractionation are derived from the needs of providing assured quality and the operational requirements of good manufacturing practice. There are many inputs to quality assurance, collectively described as the quality design of the manufacturing process. Quality design is an all-embracing concept depending on selection of source plasma, proper production facilities and equipment systems and highest pharmaceutical operational standards. The scientific process must meet the requirements of safety and efficacy of product and balance the competing parameters of purity, potency and yield within an acceptable economic framework. The paper illustrates problems within the theory of quality design through current experience in the production of immunoglobulin and factor VIII fractions.
Blood Proteins↗
Use of modeling to evaluate the cost-effectiveness of cancer screening programs.
Cost-effectiveness analysis (CEA) is an analytic tool that provides a framework for comparing the health benefits and resource expenditures associated with competing medical and public health interventions, thereby allowing decision makers to identify interventions that yield the greatest amount of health, given their resource constraints. Models are important components of most, if not all, CEAs, and they play a key role in evaluating the cost-effectiveness of cancer screening programs, in particular. In this article, we describe the basic types of models used to evaluate cancer screening programs and provide examples of the use of models in CEAs and to guide cancer screening policy. Finally, we offer some suggestions for important concepts to consider when interpreting model results.
Cost-Benefit Analysis↗
Stochastic models for horizontal gene transfer: taking a random walk through tree space.
Horizontal gene transfer (HGT) plays a critical role in evolution across all domains of life with important biological and medical implications. I propose a simple class of stochastic models to examine HGT using multiple orthologous gene alignments. The models function in a hierarchical phylogenetic framework. The top level of the hierarchy is based on a random walk process in "tree space" that allows for the development of a joint probabilistic distribution over multiple gene trees and an unknown, but estimable species tree. I consider two general forms of random walks. The first form is derived from the subtree prune and regraft (SPR) operator that mirrors the observed effects that HGT has on inferred trees. The second form is based on walks over complete graphs and offers numerically tractable solutions for an increasing number of taxa. The bottom level of the hierarchy utilizes standard phylogenetic models to reconstruct gene trees given multiple gene alignments conditional on the random walk process. I develop a well-mixing Markov chain Monte Carlo algorithm to fit the models in a Bayesian framework. I demonstrate the flexibility of these stochastic models to test competing ideas about HGT by examining the complexity hypothesis. Using 144 orthologous gene alignments from six prokaryotes previously collected and analyzed, Bayesian model selection finds support for (1) the SPR model over the alternative form, (2) the 16S rRNA reconstruction as the most likely species tree, and (3) increased HGT of operational genes compared to informational genes.
Archaea↗
Using developmental assessments in the NICU to empower families.
NICU nurses and developmental specialists have a unique opportunity to facilitate the beginning of a meaningful parent/infant relationship in the NICU setting. The Brazelton Neonatal Behavioral Assessment Scale (BNBAS) is one tool that can be utilized to support this process. When parents observe this assessment, they learn to recognize and understand infant cues and gain confidence for everyday routines such as diapering, feeding, general caregiving, and even taking that first trip with the baby to the grocery store. Parents become empowered when they discover not only their baby's amazing competencies, but also their own. In addition, the BNBAS provides a framework through which parents can effectively communicate and advocate for their baby.
Adult↗
Improving safety and quality: how can education help?
National efforts to improve the quality and safety of health care present challenges for medical education and training. Today's doctors need to be skilled communicators who know how to identify, prevent and manage adverse events and near misses, how to use evidence and information, how to work safely in a team, how to practise ethically, and how to be workplace teachers and learners. These competencies (knowledge, skills and attitudes) are set out in the National Patient Safety Education Framework (NPSF) of the Australian Council for Safety and Quality in Health Care. The NPSF is designed to help medical schools, vocational colleges, health organisations and private practitioners develop curricula to enable health professionals to work safely. The NPSF describes what doctors (depending on their level of knowledge and experience) can do to demonstrate competencies in a range of quality and safety activities. Medical schools, vocational colleges, health organisations and private practitioners need to work collaboratively with one another and with other health professionals to ensure that patient safety and quality curricula are implemented and evaluated, and that valid and reliable assessments of learning outcomes are developed. Interdisciplinary and vertically integrated education and training are needed, incorporating innovative methods, to create a safer health care system.
Australia↗
Family systems practice in pediatric psychology.
OBJECTIVE: To present a pediatric psychology consultation treatment framework based on family systems and developmental theories. METHODS: After reviewing background relevant to family systems interventions, a five-step protocol (referral, assessment, collaboration, outcome) for consultation is presented, using case examples from our pediatric oncology service, to illustrate joining, focusing, promoting competence and collaboration with patients, families, and staff. RESULTS: Using protocols based on family systems frameworks, pediatric psychologists can offer systems-oriented consultation to patients, families, and healthcare teams. CONCLUSIONS: Further development and evaluation of family systems protocols are necessary to understand the efficacy of these approaches and their role in training and practice.
Child↗