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Results for “Competency framework”

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At least 613 records · Page 34Linked to original sources

PubMed1999

Preventive practicum training in healthcare organizations. The Meharry model.

BACKGROUND: Practicum training for preventive medicine residents often occurs in agencies whose community is geographically defined and whose governance is closely linked to public election. We were unsure about the financial ability of such departments to support training and are concerned that over-reliance on traditional health departments might not be best for either medically indigent populations or preventive medicine. We, therefore, sought to apply a public health model--based on a strategic partnership between nursing and preventive medicine--to a large health care organization. The result was formation of a mini-health department, suitable for fully accredited preventive medicine practicum training, within the Alvin C. York Veterans Affairs Medical Center, Murfreesboro, TN. This Center serves a defined population of 21,594 patients and about 1600 employees. The theoretical framework for the new department was based on demonstration of a close fit between the competencies expected of preventive medicine physicians by the American College of Preventive Medicine (ACPM) and activities required by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Because of JCAHO requirements, many healthcare organizations already pay for preventive medicine services. CONCLUSIONS: By placing preventive medicine training faculty into existing budget slots at our institution, systemwide personnel costs for prevention decreased by about $36,000 per year, even as personnel funding for preventive medicine physicians increased from about $24,000 to $376,000 per year. Moreover, there was dramatic, sustained improvement in 17 indicators of preventive care quality as determined by an external peer review organization. In addition to providing a new venue for training, this model may also improve the quality and reach of preventive services, decreased fixed costs for service delivery, and yield new employment opportunities for preventive medicine physicians.

Delivery of Health Care↗

PubMed2004

PROSPER community-university partnership model for public education systems: capacity-building for evidence-based, competence-building prevention.

This paper presents a model to guide capacity-building in state public education systems for delivery of evidence-based family and youth interventions-interventions that are designed to bolster youth competencies, learning, and positive development overall. Central to this effort is a linking capacity agents framework that builds upon longstanding state public education infrastructures, and a partnership model called PROSPER or PROmoting School-community-university Partnerships to Enhance Resilience. The paper presents an overview of the evolving partnership model and summarizes positive results of its implementation over a 12-year period in an ongoing project.

Community-Institutional Relations↗

PubMed2002

Structure of the SRP19 RNA complex and implications for signal recognition particle assembly.

The signal recognition particle (SRP) is a phylogenetically conserved ribonucleoprotein. It associates with ribosomes to mediate co-translational targeting of membrane and secretory proteins to biological membranes. In mammalian cells, the SRP consists of a 7S RNA and six protein components. The S domain of SRP comprises the 7S.S part of RNA bound to SRP19, SRP54 and the SRP68/72 heterodimer; SRP54 has the main role in recognizing signal sequences of nascent polypeptide chains and docking SRP to its receptor. During assembly of the SRP, binding of SRP19 precedes and promotes the association of SRP54 (refs 4, 5). Here we report the crystal structure at 2.3 A resolution of the complex formed between 7S.S RNA and SRP19 in the archaeon Methanococcus jannaschii. SRP19 bridges the tips of helices 6 and 8 of 7S.S RNA by forming an extensive network of direct protein RNA interactions. Helices 6 and 8 pack side by side; tertiary RNA interactions, which also involve the strictly conserved tetraloop bases, stabilize helix 8 in a conformation competent for SRP54 binding. The structure explains the role of SRP19 and provides a molecular framework for SRP54 binding and SRP assembly in Eukarya and Archaea.

Amino Acid Sequence↗

PubMed2000

Managing conflict/employee counseling.

Managers and nurse leaders can enhance skills and techniques to manage conflict and subsequent counseling of employees in the workplace. Stress, conflict, issues of miscommunication, and a poor job performance can be handled in a focused, orderly manner. Corrective action plans and documentation of counseling sessions are suggested. A framework for managers to perform self-assessment in counseling performance is provided. Developing specific competency checklists for managers and completing them on an annual basis validates important aspects of the role of nurse managers.

Conflict, Psychological↗

PubMed1999

Polyhazard models for lifetime data.

We propose a polyhazard model to deal with lifetime data associated with latent competing risks. The causes of failure are assumed unobserved and affecting individuals independently. The general framework allows a broad class of hazard models that includes the most common hazard-based models. The model accommodates bathtub and multimodal hazards, keeping enough flexibility for common lifetime data that cannot be accommodated by usual hazard-based models. Maximum likelihood estimation is discussed, and parametric simulation is used for hypothesis testing.

Animals↗

PubMed2005

The clinical activity of mental health nurse lecturers.

Concerns have been expressed about the ability of mental health lecturers to prepare practitioners with the skills, knowledge and attitudes needed to implement the National Service Framework for mental health. Specifically mental health nurse lecturers have been criticized for lacking clinical competence and credibility, and for being out of touch with developments in service delivery. This paper presents a selection of findings from a recent review into the clinical activity of mental health lecturers in higher education institutions in England. The issues discussed include roles in practice, questioning the value of face-to-face clinical work, the benefits of being clinically active, the difficulties of clinical academic roles, barriers to maintaining clinical activity, questioning the quality of the clinical workforce, and finally strategies to facilitate clinical activity. Whilst there is support among mental health nurse lecturers for the need to engage with practice at some level, there are inconsistencies in the ways that this is being achieved. Lecturers are, however, getting together to debate how best to keep up with changes in mental health practice and delivery.

Clinical Competence↗

PubMedDate not supplied

Improving diagnostic accuracy using an evidence-based nursing model.

PURPOSE: To propose an evidence-based model (EBM) to improve diagnostic accuracy in nursing. DATA SOURCES: Published literature, experience, and expertise of authors. DATA SYNTHESIS: Using an EBM directs clinicians on how to use the best available evidence from the literature to determine the best fit between cues and diagnoses, integrate this evidence with clinician expertise and patient preferences, and conduct a self-evaluation of the process. CONCLUSIONS: Use of an EBM to teach nurses how to ask relevant diagnostic questions and provide a framework for nurse educators to teach evidenced-based practice may lead to developing more competent diagnosticians and improving diagnostic accuracy in nursing.

Clinical Competence↗

PubMed2006

Developments in Australian general practice 2000-2002: what did these contribute to a well functioning and comprehensive Primary Health Care System?

BACKGROUND: In recent years, national and state/territory governments have undertaken an increasing number of initiatives to strengthen general practice and improve its links with the rest of the primary health care sector. This paper reviews how far these initiatives were contributing to a well functioning and comprehensive primary health care system during the period 2000-2002, using a normative model of primary health care and data from a descriptive study to evaluate progress. RESULTS: There was a significant number of programs, at both state/territory and national level. Most focused on individual care, particularly for chronic disease, rather than population health approaches. There was little evidence of integration across programs: each tended to be based in and focus on a single jurisdiction, and build capacity chiefly within the services funded through that jurisdiction. As a result, the overall effect was patchy, with similar difficulties being noted across all jurisdictions and little gain in overall system capacity for effective primary health care. CONCLUSION: Efforts to develop more effective primary health care need a more balanced approach to reform, with a better balance across the different elements of primary health care and greater integration across programs and jurisdictions. One way ahead is to form a single funding agency, as in the UK and New Zealand, and so remove the need to work across jurisdictions and manage their competing interests. A second, perhaps less politically challenging starting point, is to create an agreed framework for primary health care within which a collective vision for primary health care can be developed, based on population health needs, and the responsibilities of different sectors services can be negotiated. Either of these approaches would be assisted by a more systematic and comprehensive program of research and evaluation for primary health care.

Journal Article↗

PubMed2006

Selecting promising ALS therapies in clinical trials.

Riluzole is the only approved medication that extends survival for patients with amyotrophic lateral sclerosis (ALS). While other potential neuroprotective agents have been evaluated in randomized clinical trials, none has shown unequivocal success and none has been approved by regulatory agencies. Few symptomatic therapies have been tested in ALS. Effectiveness for drugs with modest benefit can be established only through large phase III randomized clinical trials. With numerous potential agents but limited resources, priority should be given to agents that show promise in phase II trials before proceeding to evaluation in phase III trials. In this article, we review drug development in early phase ALS trials and introduce novel designs. First, to maximize the therapeutic potential of the test medication, we need to identify the highest dose that produces a tolerable level of side effects. Second, candidate treatments should be ranked by conducting randomized selection trials between competing new treatments. The selection paradigm adopts a statistical viewpoint different from the hypothesis testing framework in conventional trials. We exemplify this approach by describing a group-sequential selection design developed for a phase II, randomized, multicenter trial of two combination treatments in patients with ALS, and illustrate the sample size reduction from a conventional trial.

Amyotrophic Lateral Sclerosis↗

PubMed2000

The need to ensure that the globalization of information and telematics does not destabilize health-care worldwide.

Modern telecommunication transcends institutional, organizational and cultural boundaries. In the context of health-care, this means that information, enquiries, demands and service provision can be routed anywhere, free of institutional or natural control. The Internet makes information available to anyone regardless of its quality, source or intention. Organizationally initiated applications such as telemedicine are usually intended to reinforce local systems, but their very design and intention indicate a potential rapidly to transcend inherited but electronically ineffectual boundaries. The consequences of such uncontrolled globalization of health-care activities will range from beneficial empowerment and quality improvement, to detrimental effects such as overloading of experts, and undermining of stable health-care systems. The major unplanned societal re-engineering effects in a paper-based culture are likely to be significant and global institutions need to respond by creating positive global frameworks and policies.

Clinical Competence↗

PubMed1992

The liberating effects of RN-to-BSN education.

This study investigated whether postlicensure baccalaureate education was associated with decreased acceptance of oppressed status for nursing and the self, with behavioral changes in job performance, and in joining a professional organization. Selected writings of Freire (1970a, 1970b, 1973) concerning education of the oppressed were used to form the conceptual framework. Baccalaureate education was conceptualized as a means of overcoming oppression-related behaviors and attitudes in nurses. The criterion measures were self-reports of job performance, joining the American Nurses Association (ANA), self-concept measurements, and perception of nursing measured by a semantic differential. Except for self-concept, which remained unchanged, all the findings were in the predicted direction supporting the conceptual framework.

Adult↗

PubMedDate not supplied

Citizen empowerment: a developmental perspective.

Since the late 1970s, the notion of empowerment has appeared with increasing frequency in discussion of preventive social and community intervention. While the idea of empowerment is intuitively appealing both for theory and practice, its applicability has been limited by continuing conceptual ambiguity. Based on a small N study of emerging citizen leaders in grassroots organizations, this article proposes a view of empowerment as a necessarily long-term process of adult learning and development. In this framework, empowerment is further described as the continuing construction of a multi-dimensional participatory competence. This conception encompasses both cognitive and behavioral change. Implications for practice are also addressed.

Community Participation↗

PubMed1993

[Need for social medicine competence of ambulatory care physicians in the treatment and management of diseases].

There is a great demand for sociomedical competence of general practitioners who as "family doctors" must be consulted by the patient first before consulting a specialist (so-called "primärärztliche Versorgung" according to German compulsory statutory sickness insurance legislation). Special and continuing education of general practitioners is sadly neglected within the legislative framework governing medical studies and training. The biopsychic care concept can be translated into reality only by means of high-level sociomedical competence. Increase in competence seems possible only if medical sociology is liberated from its preclinical isolation.

Adaptation, Psychological↗

PubMed2026

KG-Microbe: Building modular and scalable knowledge graphs for microbiome and microbial sciences.

BACKGROUND: The integration of many disparate forms of data is essential for understanding the microbial world and its interaction with the environment and human health. Doing so is particularly challenging in the context of microbe-host and microbe-microbe interactions that contribute to health or environmental outcomes. There are thousands of relevant microbial species, and millions of interactions among those microbes and with their environment or host. Integrated information (e.g., about host and microbial physiology, genetics, and metabolism) facilitates deeper understanding of complex mechanisms and helps interpret correlative results. RESULTS: The KG-Microbe construction framework is a novel approach to harmonizing bacterial and archaeal data in the form of a findable, accessible, interoperable, reusable and AI-ready knowledge graph (KG). Starting from a core KG with organismal traits, environments, and growth preferences and the integration of established ontologies, the framework generates a hierarchy of related KGs targeting specific use cases, including the human microbiome in the context of disease, or environmental microbiomes. The framework supports customizable taxa subsets representing communities or clades of interest. Evaluations of the KG-Microbe KGs through a series of competency questions demonstrate the accuracy and effectiveness of the data harmonization, and the utility of the resulting KGs in studies of inflammatory bowel disease and Parkinson's disease. Finally, the predictive and environmental capabilities of the KGs are demonstrated by predicting growth preferences using graph features. CONCLUSIONS: The KG-Microbe framework unifies microbial contexts in a single resource to support integrative analyses across biomedical, host, and environmental domains. KG-Microbe is a flexible, modular enabling technology for humans and machine learning methods to uncover candidate mechanistic explanations of microbial associations.

Microbiota↗

PubMed1992

A framework for evaluating the work of pharmacists.

This article reviews the major appraisal methods used in health care organizations and offers a competing "systems model" for conducting performance appraisals in pharmacy departments. The value of the proposed appraisal system is that it reminds management not to view the area of performance appraisal as "keep it simple." Rather, management should recognize that performance appraisal should be viewed as a system (more correctly, a subsystem) that interacts with and affects all parts of a pharmacy department's drug use system. The performance appraisal system is complex and dynamic, requiring a significant resource commitment from management and all workers within the department.

Employee Performance Appraisal↗

PubMed2002

Assessing practice of student nurses: methods, preparation of assessors and student views.

AIMS: To describe the methods of measuring progress in achieving competence of preregistration nursing and midwifery students used by institutions of higher and further education in Scotland and to describe the philosophy and approaches to competence assessment in each institution. BACKGROUND: Institutions of higher and further education in Scotland operate a variety of schemes to assess the clinical practice of student nurses. These are based on different philosophies and practices and this raises the question of which are valid and reliable. METHODS: All institutions in Scotland providing validated Diploma of Higher Education programmes for preregistration nursing and midwifery participated in this study. Data were collected by postal questionnaire, review of programme documentation and supplemented with interviews with key stakeholders. The directors of the 13 programmes (seven nursing and six midwifery programmes) were surveyed and also 12 group interviews with students (six nursing and six midwifery student groups) from seven institutions. Students from all four branches were represented and 72 students (36 nurses and 36 midwives) were interviewed. RESULTS: Four key findings were identified and related to competence assessment methods, preparation of practice assessors, consequences of failure to meet expected level of outcome and students' views. CONCLUSIONS: There has been a change in theoretical frameworks of assessment instruments used since the 1992 programmes commenced and only a limited number of approaches to clinical assessment are used in Scotland. Students' views suggested that they had little confidence in methods of clinical competence assessment and there was no formal validity and reliability testing within institutions. A lack of consistency in the training of student assessors in the clinical areas was identified. Some of these issues may be resolved with the development of a national instrument for competence assessment.

Clinical Competence↗

PubMed1999

Contracting-out health care services: a conceptual framework.

Contracting-out has become increasingly prominent in the health-care sector. It has been used in activities ranging from 'internal market' arrangements in which providers compete for funding from government payers to purchases of medical and non-medical inputs by service providers. While contracting-out arrangements for non-medical services have been widely adopted with apparent success, the contracting-out of medical services has met with criticism. Specifically, prominent 'market failures' have been identified which allegedly make contracting-out inefficient and even potentially disruptive to health care delivery. This paper presents and discusses a systematic framework for policymakers to identify and assess potential problems in contracting-out health care services, as well as some generic approaches to mitigating these potential problems. A key to the framework is the notion that conditions contributing to potential market failure problems can often be mitigated by policymakers, and that the strategic choices of policymakers in the 'first stage' of the contracting process should include an analysis of how the contracting-out environment can be changed to mitigate potential market failure problems.

Contract Services↗

PubMed2003

Guidelines for resident training in veterinary clinical pathology. I. Clinical chemistry.

BACKGROUND: The Education Committee of the American Society for Veterinary Clinical Pathology identified a need for improved structure and guidance of clinical pathology resident training in clinical chemistry. OBJECTIVES: The committee's goal was to develop learning objectives and competencies in knowledge, abilities, and skills in clinical chemistry; provide options and ideas for training activities; and identify clinical chemistry resources useful for clinical pathology faculty, training program coordinators, and residents. METHODS: Guidelines were developed and written with the input of Education Committee members and peer experts. RESULTS: The primary objectives of clinical chemistry training are: 1) to accrue a thorough, extensive, and relevant knowledge base of the types, principles, and properties of clinical chemistry tests and concepts of pathophysiology in animals; 2) to develop abilities to reason, think critically, and exercise judgment in clinical chemistry data interpretation, investigative problem-solving, and hypothesis-driven research; and 3) to acquire technical and statistical skills important in clinical chemistry and laboratory operations. CONCLUSIONS: These guidelines define expected competencies that will help ensure proficiency, leadership, and the advancement of knowledge in veterinary clinical chemistry and provide a useful framework for didactic and clinical activities in resident training programs. The learning objectives can readily be adapted to institutional and individual needs, interests, goals, and resources.

Animals↗