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PubMedDate not supplied

Addressing limited English proficiency and disparities for Hispanic postpartum women.

The National Institutes of Health Office of Minority Health challenges health providers to eliminate health disparities for Hispanic women, especially those women with limited English proficiency. This article addresses this challenge by identifying areas of health disparities for low-risk postpartum Hispanic women with limited English proficiency, by describing the legal basis for improving language access, and by proposing implementation of Office of Minority Health national guidelines. Health providers can use a social equity framework to support improvements in communication practices when language differs.

Attitude to Health↗

PubMed1990

Caring in nursing: analysis of extant theory.

Caring in nursing as a substantive area of nursing science has been the focus of considerable scholarly effort. Based on the assumption that caring is the central concept in nursing and is uniquely known and expressed in nursing, this paper focuses on an analysis of major theoretical works related to the concept. Five categories of questions provide a framework for the analysis: ontological, anthropological, ontical, epistemological, and pedagogical.

Altruism↗

PubMed1997

Asian, American, and deaf: a framework for professionals.

The authors present a multicultural framework for thinking about, assessing, and working with Deaf people from Asian and Asian Deaf backgrounds. Emphasis is placed on cultural awareness and cultural competence for professionals and on building bridges across cultural networks.

Asian↗

PubMed2003

Assessment of homogeneity vs. heterogeneity of residual variance in random regression test-day models in a Bayesian analysis.

Test-day first-lactation milk yields from Holstein cows were analyzed with a set of random regression models based on Legendre polynomials of varying order on additive genetic and permanent environmental effects. Homogeneity and heterogeneity of residual variance, assuming three and 30 arbitrary measurement error classes of different length were considered. Unknown parameters were estimated within a Bayesian framework. Bayes factors and a checking function for the cross-validation predictive densities of the data were the tools chosen for selecting among competing models. Residual variances obtained from 30 arbitrary intervals were nearly constant between d 70 and 300 and tended to increase towards the extremes of the lactation, especially at the onset. In early lactation, the temporary measurement errors were found to be larger and highly variable. A high order of the regression submodels employed for modeling the permanent environmental deviations tended to strongly correct the heterogeneity of the residual variance. Accordingly, the assumption of homogeneity of residual variance was the most plausible specification under both comparison criteria when the number of random regression coefficients was set to five. Otherwise, the heterogeneity assumption, using three or 30 error classes, was better supported, depending on the criterion and on the order of the submodel fitted for the permanent environmental effect.

Analysis of Variance↗

PubMed1983

Eleanor Clarke Slagle Lectureship--1983; clinical reasoning: the ethics, science, and art.

As I join the roster of Eleanor Clarke Slagle lecturers, I am keenly aware of the privilege and responsibility of being so honored by my professional colleagues. Since my selection for the award was based on a recognition of a synthesis of skills in occupational therapy practice, education, and research, it seemed fitting for me to pursue a topic that would in some way enable me to reflect this synthesis. Thus, in developing the theme of clinical reasoning, I have taken a practice issue, studied it from an educational perspective, and formulated a conceptual framework for guiding the development of a clinical science of occupational therapy.

Clinical Competence↗

PubMed1997

HMOs and the efficiency of healthcare delivery.

HMOs and other forms of managed care continue to grow rapidly and remain the centerpiece of this nation's policies for health system reform. Despite a growing public and legislative backlash at managed care, there is no comprehensive theory of HMOs to guide policymakers and analysts. It is not yet clear whether managed care improves society's allocation of resources to and within the health sector. After examining HMOs within the context of Coase's theory of the firm, I argue that HMOs share characteristics with collective goods. This framework, and the expanded agency role of physicians under managed care, is used to evaluate the equity and efficiency characteristics of a system of competing HMOs. Other concerns that are increasingly associated with managed care also are addressed.

Delivery of Health Care↗

PubMed1989

Evaluating the optometric literature: the educated clinician.

The purpose of this article is to present a framework for reader evaluation of optometric literature. The elements of a research article are outlined. Suggestions are presented that clinicians can use to develop competence in evaluating research literature. Also presented is an annotated bibliography of research references. Better patient care and increased professional growth will result when clinicians evaluate and make use of the research literature.

Education, Continuing↗

PubMed1979

The first pelvic examination: helping students cope with their emotional reactions.

The author has conducted seminars with small groups of medical students beginning their training on an obstetrics and gynecology service. Six characteristic responses of students to performing their first pelvic examination are described. Within the framework of the seminar discussion, an attempt is made to help the students cope with those reactions that could impair their ability to perform competent gynecological examinations.

Emotions↗

PubMed1996

Ethical and legal issues in nursing home care.

Physicians who provide care for nursing home residents are regularly challenged by ethical and legal issues. Because nursing home care is complicated by numerous regulations and because nursing home residents have complex medical and social problems, some issues are unique to the long-term care setting and others present in unfamiliar ways. Some issues frequently encountered in this context are discussed: advance directives, competence and decision-making capacity, decisions about life-sustaining treatment, resident abuse, restraints, psychotropic medications, risk management, participation in research, and ethics committees. With knowledge of the legal and ethical framework and understanding of some of the common, complicated issues that arise, physicians should be better equipped to provide optimal care for nursing home residents.

Advance Care Planning↗

PubMed1996

A study of preceptor roles in clinical teaching.

Acknowledging the continuing use of preceptors for clinical teaching in undergraduate nursing programs, this study examined the role of preceptors, criteria for selection, and knowledge and skills they require to undertake clinical teaching in baccalaureate (BSN) programs. All National League for Nursing (NLN)-accredited BSN programs in the Midwest were surveyed (N = 142) using an instrument developed by the investigator; 84 instruments were returned, for a response rate of 59.2%. Most nursing programs (74.7%) used preceptors from affiliating clinical settings for teaching senior-year clinical courses (90.9%) such as leadership and management, community health nursing, and critical care. Across the majority of nursing programs two important responsibilities of the preceptor were selecting patients for care by students and teaching students in the clinical setting. Findings also revealed that certain responsibilities were shared by faculty and preceptors, including assessing students' learning needs and evaluating learning in the clinical settings. Although preceptors played an important role in teaching students, only half of the programs had a written position statement that described the role. Selection criteria for preceptors were educational preparation at the BSN level (75.8%) and experience as a staff nurse (59.7%). Respondents also identified the knowledge and skills required by preceptors to undertake clinical teaching and content included in preceptor-preparation programs, providing a framework for faculty to use when preparing preceptors for this important role.

Clinical Competence↗

PubMed1999

Competence for assembly of sister chromatid cores is progressively acquired during S phase in mammalian cells.

Condensed sister chromatids possess a protein scaffold or axial core to which loops of chromatin are attached. The sister cores are believed to be dynamic frameworks that function in the organization and condensation of chromatids. Chromosome structural proteins are implicated in the establishment of sister chromatid cohesion and in the maintenance of epigenetic phenomena. Both processes of templating are tightly linked to DNA replication itself. It is a question whether the structural basis of sister chromatid cores is templated during S phase. As cells proceed through the cell cycle, chromatid cores undergo changes in their protein composition. Cytologically, cores are first visualized at the start of prometaphase. Still, core assembly can be induced in G1 and G2 when interphase cells are fused with mitotic cells. In this study, we asked if chromatid cores are similarly able to assemble in S-phase cells. We find that the ability to assemble cores is transiently lost during local replication, then regained in chromosome regions shortly after they have been replicated. We propose that core templating occurs coincident with DNA replication and that the competence for the assembly of the sister chromatid cores is acquired shortly after passage of replication forks.

Animals↗

PubMed2006

The training/service continuum: exploring the training/service balance of senior house officer activities.

BACKGROUND: The continued reduction in junior doctors' hours in the UK has made it necessary to re-examine traditional assumptions about the synonymous natures of training and service. This paper researches senior house officers' (SHOs) perceptions of 'service' and 'training', with reference to where they place activities along the training/service continuum, and the factors that lead them to classify these activities in the way they do. METHODS: Questionnaires were sent to all identified SHOs at Plymouth Hospitals NHS Trust (40% response rate). Three focus groups were held with 5 SHOs, 3 consultants and 2 clinical tutors. Quantitative data derived from the questionnaires were analysed using spss. Qualitative data collected in the focus groups was coded with the aid of n6, which facilitated the thematic analysis of transcripts. RESULTS: Analysis of the quantitative data allowed the construction of the training/service continuum diagram. Identified factors affecting the perceived training/service balance of SHO activities included: frequency, time, type and nature of work, number of patients, supervision, interaction, other commitments, purpose and focus of the activity, the individual trainee and trainer, and experience and competence. DISCUSSION: It is no longer appropriate to assume that all junior doctor activities represent either training or service individually: activities are perceived differently along the training/service continuum depending on their execution and their relation to the SHOs' learning curves. Within the reduced hours framework, it is necessary to match this balance to experience, in order for both training and service requirements to be satisfied.

Attitude of Health Personnel↗

PubMed2005

Workforce planning and education: mapping competencies, skills and standards in mental health.

This paper aims to identify and critically analyse the provision and commissioning of relevant training for multidisciplinary mental health practitioners in the South West region of England. Data were collected from 45 education and training providers across the region. A total of 132 courses were examined through analysis of a questionnaire and a further 82 courses were studied in more depth through interviews and focus groups, alongside a textual analysis of course documents. Data generated from the analyses were mapped against the competencies and skills outlined in The Capable Practitioner [SCMH, 2001. The Capable Practitioner, Sainsbury Centre for Mental Health, London.] document and National Occupational Standards for Mental Health [Skills for Health, 2004. National Occupational Standards for Mental Health. Available from: (last accessed 17.11.04).]. The findings confirmed that significant gaps exist in training and education. While some aspects of The Capable Practitioner and National Occupational Standards for Mental Health are covered well by courses provided for mental health practitioners in the region, other aspects are missed completely. Recommendations are made for further research, with the suggestion of using an action research and co-operative enquiry method to identify with participants if courses should be developed to cover these areas or if the standards themselves should be adapted. Reflections on the methodological framework and subsequent limitations of the study are outlined.

Attitude of Health Personnel↗

PubMed2004

Competing values of emergency department performance: balancing multiple stakeholder perspectives.

OBJECTIVE: To describe the performance interests of multiple stakeholders associated with the management and delivery of emergency department (ED) care, and to develop a performance framework and set of indicators that reflect these interests. STUDY SETTING: Stakeholders (1,100 physicians, nurses, managers, home care providers, and prehospital care personnel) with responsibility for ED patients in hospitals in the Canadian province of Ontario. STUDY DESIGN: Sixty-two percent of stakeholders responded to a mail survey regarding the importance of 104 potential ED performance indicators. Descriptive and inferential statistics are used to explore the interests of each stakeholder group and to compare interests across the five groups. PRINCIPAL FINDINGS: Emergency department stakeholders are primarily interested in indicators that focus on their role and capacity to provide care. Key differences exist between hospital and nonhospital stakeholders. Physicians mean ratings of the importance on ED performance measures were lower than mean ratings in the other stakeholder groups. CONCLUSIONS: Emergency department performance interests are not homogeneous across stakeholder groups, and evaluating performance from the perspective of any one stakeholder group will result in unbalanced assessments. Community-based stakeholders, a group frequently excluded from commenting on ED performance, provide important insights into ED performance related to the external environment and the broader continuum of care.

Adult↗

PubMed2006

Preparing the next generation of senior nursing leaders in Canada: perceptions of role competencies and barriers from the perspectives of inhabitants and aspirants.

This paper describes the findings of a two-part study designed to elicit preliminary answers to the questions: "How do incumbents and potential aspirants describe key role functions and competencies associated with senior nursing leadership positions in Canada?" and "What Lessons can be drawn for considerations of leadership succession planning?" The study was undertaken to develop a grounded knowledge framework upon which to develop national and local strategies. Such knowledge may help minimize the impact of an impending crisis by identifying gaps between expectations and reality in order to support proactive succession planning strategies and sustain senior leadership in Canadian nursing.

Attitude of Health Personnel↗

PubMed2004

[Conscious refusal of food and fluids by Dutch nursing home patients in order to hasten death: a matter regarding patient and physician?].

Refusal of food and/or fluids frequently occurs in nursing home patients. If the patient's decision to stop eating and drinking has been taken consciously and with due consideration of the consequences, it is referred to in Dutch as 'versterven'. A mentally competent, 73-year-old male nursing home patient suffering from progressive supranuclear palsy wished, in order to prevent further suffering, to end his life by taking sleeping tablets that he had saved up and by refusing artificial food and liquids. This wish met with a lot of legal and moral objections from the board of directors of the nursing home as well from experts consulted by the nursing home physician. Closer examination afterwards, however, showed that the patient would have been spared a lot of uncertainty if all parties concerned had been better informed as to the legal and moral framework. There are no legal objections as long as the doctors assess the refusal of food and drink with regard to voluntariness, deliberateness and permanence. If we as a society accept that mentally competent patients who are fully aware of the consequences and of possible alternative methods of treatment may take this road, then there would seem to be no moral obstacles either.

Aged↗

PubMed1981

Contralateral laryngoplasty after supraglottic laryngectomy with vertical extension.

Eight patients with supraglottic carcinoma extending onto an arytenoid or true vocal cord have undergone supraglottic laryngectomy with vertical extension including the resection of an arytenoid. In these patients, the contralateral superior thyroid cornua was used to reconstruct the resulting defect. In this technique, the thyroid cornua is mobilized and green-stick fractured across the posterior commissure, maintaining its blood supply by leaving the inferior and middle pharyngeal constrictor attached. This muscle-cartilage pedicle flap provides bulk for the posterior glottis and can be anchored anteriorly to form the framework for a new vocal cord. Hypopharyngeal and pyriform sinus mucosa is then mobilized to cover the newly reconstructed hemilarynx. This reconstruction has provided a competent glottis with a good vocal baffle in every patient in this series. Preservation of airway, voice, and laryngeal sphincter is comparable with that achieved after routine supraglottic laryngectomy without resection of an arytenoid. Using this technique, the surgeon can rely on a pedicle graft with surprising accessibility, bulk, and reach.

Aged↗

PubMed2002

Regulatory issues for clinical trials at EORTC: the way forward. European Organisation for Research and Treatment of Cancer.

Since the Declaration of Helsinki, the performance of clinical trials is subject to ethical and gradually also legal requirements. As the EORTC is performing clinical trials in more then 30 countries, it gained expertise in the field of Regulatory Affairs of all those countries. This paper intends to address the general approach with regard to European Regulatory Affairs. Furthermore, it is focusing on the role of the EORTC at the level of the competent regulatory authorities. As recently things are moving and changing on a European level, it describes the perception of the current and future European regulatory framework, and last, but not least, it is explained in what respect the achievements of the EORTC could be of benefit to society when defining their cancer treatment policies.

Antineoplastic Agents↗