National Service Frameworks: producing quality cardiac care.
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Heart Diseases↗
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Results for “Competency framework”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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A framework for your development.
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Career Mobility↗
Developing leaders for the health service of the future: the experience in Ireland.
How can we identify and then develop the people who will provide the leadership in our health services in the next ten to fifteen years? That was the question the Office of Health Management addressed in 1997. The paper outlines the leadership competencies used to select the participants and indicate how they were developed. It will also describe the programmes content and design, the issues that arose in the course of the programme and the evaluation framework. It concludes with an assessement of the obstacles the potential young leaders are likely to encounter and gives an indication of how it is proposed to continue to support these young people in the future.
Evaluation Studies as Topic↗
Mental practice: an alternative approach to teaching motor skills.
Nursing educators expect that students will learn psychomotor skills and demonstrate competence in these skills. However, current emphasis on cognitive and psychosocial skills concerns nursing educators because psychomotor skills are necessary for safe practice. One possible strategy, based on a holistic framework, is mental practice. This is the same type of practice that athletes use when preparing to perform a sports activity. The purpose of this study was to determine whether mental imaging practice for nursing students affected the learning and performance of giving an intramuscular injection. Findings suggest that mental practice does affect learning and performance of motor skills.
Adolescent↗
[Clinical research within the German competence net "acute and chronic leukemias"].
BACKGROUND: Leukemias are a challenge and a cost factor to society because of their frequency in all age groups. They also serve as a model for a variety of diseases and possess exemplary relevance for basic research and patient care. Leukemia research and therapy have achieved high standards and even a leading position in Germany with regard to clinical trials, standardization of diagnostics and molecular studies of prognostic factors, signal transduction and gene expression. Progress is hampered, however, by fragmentation of leukemia trial groups, diagnostic approaches and treatment research activities. GOALS: A network was therefore created to integrate the leading leukemia trial groups on chronic myeloid leukemia (CML), acute myeloid leukemia (AML), acute lymphatic leukemia (ALL), myelodysplastic syndromes (MDS) and chronic myeloproliferative diseases (CMPD) and their interdisciplinary partners (diagnostics, treatment research, biometry) in cooperation with basic research and pharmaceutical industry to foster advancements in leukemiarelated research and health care through clinical trials, promotion of translational research, introduction of standards for diagnostics and therapy, and development of evidence-based guidelines. ACHIEVEMENTS: Achievements include establishment of central information, communication and management structures, creation of an AML intergroup comprising five study groups, formation of an MDS study group and establishment of platforms for diagnostics, genomics and proteomics, and medical informatics. Exchange of scientific progress is mediated by intra- and internet, biannual newsletters, regular project group meetings, and annual network symposia. PERSPECTIVES: On the basis of experience with the Competence Network "Acute and chronic leukemias" with its management, communication and information structures, the "European LeukemiaNet" (ELN) has been established within the 6th Framework Program of the European Union. The ELN integrates 78 leading leukemia trial groups (AML, ALL, CML, CLL, MDS, and CMPD), their 83 interdisciplinary partner groups (diagnostics, treatment research, registry, guidelines), industry and SMEs (small- and medium-sized enterprises) across Europe to form a cooperative network for advancements in leukemia-related research and health care.
Acute Disease↗
[Prevention of diseases and health monitoring by the local public health services. Tasks and prospects].
For many years prevention of disease and health promotion have been central activities of the public health services in Germany. But especially within these areas of activity there have been difficulties in understanding "old"versus"new"in relation to public health. Previously it was not possible to generate common standards for the public health service for prevention, health promotion and health monitoring due to the regional diversity of legislation within the single provinces. However, these activities could demonstrate the strength of public health services in these fields. The forthcoming law on prevention provides a framework for strengthening the public health services through defining qualitative standards for eligible preventive measures and at the same time making clear the competences of public health services that should be available. Thus public health services could become one of the central players at the local level in the strengthening of prevention and health promotion in the future. The quality of planning and outcome of eligible preventive measures will strongly depend on the local health monitoring system. If the forthcoming law does not make use of the competence of public health services in identifying healthy and socially disadvantaged settings, a white-collar orientation of preventive and health promotion activities may be expected.
Germany↗
Evaluating science outside the trial box: applying Daubert to the Federal Sentencing Guidelines' criminal history score.
A limited amount of research exists examining the ability of the Criminal History Score of the Federal Sentencing Guidelines (Guidelines) to achieve one of its most essential objectives: prediction of recidivism. Building on the work of Schopp [Schopp, R. (2001). Competency, condemnation, and commitment: An integrated theory of mental health law. Washington D.C.: American Psychological Association], it is suggested that the scientific admissibility framework and the underlying principles announced by the United States Supreme Court in Daubert v. Merrell Dow Pharmaceutical [Daubert v. Merrell Dow Pharmaceuticals Inc., 507 U.S. 579, 113 S.Ct. 2786 (1993)] should be expanded beyond the constraints of the evidentiary admissibility phase of trial and should apply to legislative and administrative rules that have: a) an empirically testable purpose and b) a substantial impact on the rights of individuals. Such an analysis offers a useful mechanism for understanding the strengths and weaknesses of social science being used by legal institutions. Based upon a hypothetical Daubert analysis, the scientific validity of the Guidelines' Criminal History Score is assessed and demonstrated to be insufficient. The law and policy implications of this finding are discussed.
Crime↗
Toward a social ecology of the home-care household.
I examined the relation between household parameters of size, composition, and temporal variability and indicators of care-giver and elder well-being. Two discrete groups of 20 care-giver-elder pairs were included in the study: (a) a group in which elders were moderately to severely cognitively impaired, but physically well, and (b) a group in which elders were moderately to severely physically disabled, but cognitively unimpaired. Care givers and elders were interviewed and assessed in their homes, and the care giver completed a 3-day log of home-care activities. Results indicated that care-giver and elder well-being are related to opposite values of the same household parameters in the two groups. The study demonstrates the utility of a social-ecological framework for research on home care, and suggests that the degree of fit of any particular household arrangement is relative to the competence-disability profile of the elder in care.
Activities of Daily Living↗
Rational use of psychoactive drugs in the geriatric patient.
It is impossible in an article such as this to present every aspect of psychopharmacology for the geriatric patient. Pharmacists occupy a unique position in the health care system that enables them to monitor and provide input into the pharmacotherapy of the elderly. The reader is encouraged to maintain competency in this important area of practice. Only by diligent attention to the problems experienced by the geriatric patient can we produce a framework of knowledge upon which to make rational therapeutic decisions.
Aged↗
Clinical integration and nursing leadership across an integrated delivery system.
As new health systems struggle to combine in today's challenging health care market, mechanisms that facilitate and enhance integration become increasingly important. This article describes the use of clinical paths in an integrated delivery system (IDS) as a methodology to establish a single standard of high-quality care. Through education and sharing of staff development resources across the IDS, the system nurse executive at one large IDS promotes professional practice. As clinical paths are developed across the system, the best clinical practice is put to paper, providing a framework for outcome-driven care. The nurse manager assesses staff's use of clinical paths as an evaluation of their skills and competency and to identify new educational and growth opportunities.
Benchmarking↗
Activation of vesicular stomatitis virus fusion with cells by pretreatment at low pH.
Fusion of vesicular stomatitis virus (VSV) with Vero cells was measured after exposure of the virus to low pH under a variety of experimental conditions. The method of relief of fluorescence self-quenching of the probe octadecylrhodamine was used to monitor fusion. Incubation of the virus at pH 5.5 prior to binding to cells led to significant enhancement of fusion at the plasma membrane, whereas fusion via the endocytic pathway was inhibited. Fusion of pH 5.5-pretreated VSV showed a similar pH threshold for fusion as nontreated virus, and it was blocked by antibody to VSV G protein. Activation of VSV by pretreatment at low pH was only slightly dependent on temperature. In contrast, when VSV was first bound to target cells and subsequently exposed at 4 degrees C to the low pH, activation of the fusion process did not occur. The pH 5.5-mediated activation of VSV could be reversed by returning the pH to neutral in the absence of target membranes. The low pH pretreatment also led to aggregation of virus; large aggregates could be pelleted by low speed centrifugation and only the effects of the supernatant, which consist of single virions and/or microaggregates, were considered. The data were analyzed in the framework of an allosteric model according to which viral spike glycoproteins undergo a pH-dependent conformational transition to an active (fusion-competent) state. Based on that analysis we conclude that the conformational transition to the active state is rate-limiting for fusion and that the viral spike glycoproteins are fusion-competent only in their protonated form.
Allosteric Regulation↗
Fraying connections of caring women: an exemplar of including difference in the development of explanatory frameworks.
While research exploring diverse groups enhances understanding of their unique perspectives and experiences, it also contributes to the exclusion of such groups from mainstream frameworks and solutions. The feminist grounded theory method allows for inclusion of marginalized groups through theoretical sensitivity to feminist theory and theoretical sampling. This paper demonstrates how this approach results in an explanatory framework that accounts for diverse realities in a study of women's caring. Fraying connections were identified as women's initial response to competing and changing caring demands. The range of dimensions and properties of fraying connections was identified through theoretical sampling guided by the emerging themes and theoretical sensitivity to issues of gender, culture, age, ability, class, and sexual orientation.
Adaptation, Psychological↗
Evaluating health information systems: an assessment of frameworks.
The rapid increase in investments for computerised systems is a major concern for all health organisations. Questions about these investments arise as information technology is only one of the areas that are competing for a finite amount of resources. There is also some concern that some of the failures of information technology would have been detected if proper evaluation of information systems were conducted. The state of the art of evaluating information systems shows changes from a very positivist approach to more comprehensive approaches that would incorporate multiple methods. This paper presents an assessment of the techniques and methods for information systems evaluation, followed by an application to a case study in community health to illustrate the value of the contextualist approach to evaluation. The paper argues for the use of longitudinal, contextualist approaches to information systems evaluation if decision-makers seek to improve the situation of information systems in the health industry.
Australia↗
Ethics and cultural diversity--a framework for decision-making.
Believing that healthcare outcomes will be more satisfying if the patients' cultural knowledge and values are understood and integrated appropriately in care planning, the author proposes a culturally competent ethical decision making model based on human rights--the fundamental right of individuals, families, groups, and populations to healthcare that is meaningful, supportive, and beneficial--and a reconceptualization of ethical principles to include the values and assumptions of clients. The ideal result is culturally congruent healthcare in which practitioners learn about their clients' lifeways and work with them to find satisfying ways to resolve clinical and ethical issues.
Cultural Diversity↗
The Structured Clinical Operative Test (SCOT) in dental competency assessment.
INTRODUCTION: This paper describes a method of assessment of invasive clinical procedures which are currently being devised, and which are perceived to be a method that may be used to complement OSCEs in overall clinical skills assessment. OBJECTIVE: The objective of the Structured Clinical Operative Tests (SCOT) is to introduce a greater level of objectivity to the assessment of operative clinical skills. Invasive or irreversible clinical operative procedures from a large part of dental undergraduate training and are by their very nature precluded from OSCE scenarios. It is also important to test intraoperative skills, communication skills and contingency management, and performance of these with awareness of the psychosocial context and ethical framework. The paper describes the use of checklists in the monitoring of clinical operative skills in a more authentic clinical situation using the SCOT. FORMATIVE ASSESSMENT: Continuous assessment should a) record achievement of competency in as objective a manner as possible and b) should encourage continuous self-evaluation. In the SCOT the students reflect on their clinical performance and in consultation with their supervisors record their plans to improve their competence in that skill or procedure in the future. This is done immediately on completion of a clinical task while the experience is still fresh in the mind. This encourages deep reflective learning as opposed to superficial factual learning which is characteristic of the more traditional curriculum, and is described as supervisor validated self-assessment. DISCUSSION: The discussion outlines how SCOTs can be practically implemented and integrated into the undergraduate curriculum and an example of a SCOT is appended to the paper. The scope for using SCOTs in postgraduate assessment such as in VT/GPT is also described.
Clinical Competence↗
Humanization of KC4G3, an anti-human carcinoma antibody.
We have previously constructed a chimeric version of KC4G3, a murine antibody that reacts with several human epithelial cancers and binds to the human breast epithelial mucin. We have now successfully humanized KC4G3 using positional consensus data, previously compiled after examining several other antibody structures, listing residues in the VH and V kappa frameworks that could influence antigen binding. We have previously showed that a fraction of the kappa chains of murine and chimeric KC4G3 migrates abnormally on SDS-PAGE most likely due to N-linked glycosylation in V kappa. The glycosylation signal has now been removed from V kappa, as a consequence of humanization. As expected, the humanized kappa chain migrates normally on SDS-PAGE. We detected no significant differences either in the affinities (1.6 x 10(9) M-1 vs. 1.4 x 10(9) M-1, respectively) or in the ability to compete for antigen binding, between the murine and the humanized antibodies. The humanized version is an IgG1, kappa immunoglobulin produced by mouse myeloma SP2/0-Ag14 cells and is designated HuKC4v2. The HuKC4v2 frameworks conform to the V kappa II and VHIII human consensus in all but six positions in V kappa and three positions in VH.
Amino Acid Sequence↗
Being a midwife or doing midwifery?
As a profession, we need to be more conscious of the way in which our discipline has been subsumed into techno-rational science and away from our 'with women' focus. The ACMI Philosophy says that we value 'being with' women as the foundation for midwifery practice, therefore the concept 'being with' should be a competency which is reflected in the ACMI Professional Standards and Competencies. Currently, there is no Professional Standard for "Being With Women": all midwifery care has been subsumed under the rubric of problem-solving. The problem-solving approach is part of the modernist, techno-rational approach to human life experiences. Problem-solving, I am claiming, has been over-generalised and imposed upon human experiences where it is not appropriate. This paper argues against adopting problem-solving as the framework for practice because this means that every aspect of midwifery care has to be problematised. This paper concludes by suggesting one way in which our philosophy could be honoured in our professional standards and competencies.
Australia↗
Ethical issues in emergency care.
The ethical framework established for most health care decision making should apply to elderly patients in the ED, i.e., the authority to decide should rest either with the competent patient or, in case of incapacity, with the patient's surrogate. Whenever possible, ethical dilemmas in the ED should be prevented from occurring through the judicious use of advance directives crafted in the doctor's office. DNR orders should be based upon the wishes of a competent patient or upon a surrogate's estimation of the patient's values and best interests. Because advanced age is a predictor of poor outcome for most hospitalized elderly patients, physicians should educate themselves about the actual benefits and burdens of CPR in this population and share this information with patients and surrogates. In case physicians determine that CPR would be futile in a strict sense, they have no ethical or legal obligation to administer it, even if requested to do so; however, they have an ethical obligation to inform the patient or family of the reasons for the decision and should offer the family the option of dispute mediation in case of disagreement. If the patient arrives in the ED capable of making decisions but lacking an advance directive, it is the responsibility of physicians and nurses to educate the patient concerning the respective merits and drawbacks of the living will and health care proxy. Except for those elderly patients who lack family or friends or who do not wish to burden others with such decisions, the health care proxy, supplemented perhaps to some extent by oral or written specific directives, appears to be the best approach. Attention to these important problems bearing on the substance and procedures for life and death decision making in the ED should not obscure the manifest injustice of the context in which these decisions are often made. At many inner-city hospitals serving a largely poor and elderly clientele, the ED has become nothing short of a torture chamber for many critically ill elderly persons. An ethical framework for decision making, no matter how urgently needed, will not address the unnecessary pain and confusion of frail elderly patients subjected to an impersonal, overcrowded, and depersonalizing environment.
Advance Directives↗