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A report of the American Association of Colleges of Pharmacy Study Committee on the Preparation of Students for the Realities of Contemporary Pharmacy Practice is presented. The development of the committee and its charge are described. The report includes a description of the purpose and essential elements of contemporary pharmacy practice, and the barriers restricting their achievement that arise within the profession, society, and pharmacy education. Recommendations of the committee regarding curricular offerings, instructional strategies for developing problem-solving, communication, and self-learning skills, types of post-entry-level education and training programs, career counseling, student recruitment, pharmacy faculty, and intra- and interprofessional relations are discussed. The report calls for a combined effort on behalf of practitioners and educators to prepare graduates to enter practice in community, hospital, or long-term care pharmacy, and emphasizes the need to match these efforts to the dynamics of contemporary pharmacy practice.
Excellent methods of examining infants neurologically have been described and used in studies with follow-up to preschool or early school years. Few children discharged from NICUs returned with major neurologic abnormalities that were not noted on the infancy examinations, unless there had been an intervening event such as meningitis, head injury, or a difficult seizure disorder. Approximately 20 per cent of infants who were discharged from NICUs had lesser neurologic abnormalities on the infancy examinations, and these were transient. These children are at risk for lesser neurologic sequelae in the preschool years and school years, specifically hyperactivity, emotional immaturity, and a variety of learning disorders. There has been a tendency in follow-up studies of children from the NICU to fucus on the severe neurologic sequelae, but the bulk of the sequelae will become obvious when the school system requires compliance for behavior, rewards advancement in learning skills, and draws attention to deficits in complex coordination. For the teachers and parents of these children, these are frustrating years. In our follow-up study of school-age children, while not markedly abnormal, were not normal either. They demanded patience and extra attention that often wore thin by the time the child reached age six or seven. Early recognition of problem children by health care professionals may increase understanding and aid in early identification of children who need special services for behavior modification, remedial reading, and other school-related skills. It should also encourage much needed family support and counseling.
Prehospital critical care provided by specially trained ambulance attendants in New Westminster, BC during a 27-month period was studied. Although the most important benefit of the improved care was the prevention of sudden death in a large proportion of persons with crises due to coronary artery disease, the skills learned to provide basic life support are applicable to a wide variety of other disorders that can result in death before the patient reaches hospital.
Providing exposure for family practice residence to all aspects of community medicine is a common goal of training programs. The Antelope Valley Hospital Medical Center Family Practice Program has initiated an innovative project which involves residents serving as team physicians for local college athletic teams. This provides a valuable opportunity for residents to learn skills they can be expected to need in their future practice. The team physician's role offers educational potential for family practice residents through experience with acute orthopedic problems as well as the preventive and psychological aspects of sports medicine. This role also serves as an example of physician responsibility for health-related activities in the acommunity.
From the above results of the evaluation survey it can be concluded that the participants of the 'AHVA' desktop publishing company, who are with multiple and physical disabilities and who have initiated and run their own enterprise, perceived their first year of operation as beneficial. They mastered new technical skills, learned new work-related behaviours, expanded their interpersonal competencies and felt personal growth. They all developed high motivation to make their operation successful. The case study of 'AHVA' desktop publishing company, initiated and run by a group of multiply and physically disable persons, is unique and demonstrates the positive trend for the future. It is an example of personal and group commitment to build a competitive enterprise. It is self determination rather than the actual outcome of services provided, that is the driving force behind their efforts. The team members demonstrated that persons with disabilities can indeed take charge of their lives, be masters of their own destinies, and lead a productive and meaningful life. Here, inclusion is not a one-sided process in which service providers and rehabilitation experts try to integrate persons with disabilities into the community and regular employment. Inclusion is to integrate persons with disabilities into the community and regular employment. Inclusion is achieved here by the self initiative of a group of persons with disabilities. They have created an extraordinary enterprise according to their own special needs. Non-disabled people interact with them on an equal level, as partners in a business, sharing mutual interests of quality production.(ABSTRACT TRUNCATED AT 250 WORDS)
OBJECTIVES: To identify the values and agendas underlying reports advocating the reform of medical education and to account for their similarity and repeated promulgation. DATA SOURCES: Major reports regarding undergraduate medical education reform published between 1910 and 1993 were identified through a manual bibliographic search. STUDY SELECTION: Nineteen of a total of 24 reports met the two inclusion criteria: they directly addressed undergraduate medical education and contained a coherent body of recommendations. DATA EXTRACTION: Content analysis of 19 reports. DATA SYNTHESIS: All the reports articulate a specifically social vision of the medical profession, in which medical schools are seen as serving society. The reports are remarkably consistent regarding the objectives of reform and the specific reforms proposed. Core objectives of reform include the following: (1) to better serve the public interest, (2) to address physician workforce needs, (3) to cope with burgeoning medical knowledge, and (4) to increase the emphasis on generalism. Proposed reforms have tended to suggest changes in manner of teaching, content of teaching, faculty development, and organizational factors. Reforms such as increasing generalist training, increasing ambulatory care exposure, providing social science courses, teaching lifelong and self-learning skills, rewarding teaching, clarifying the school mission, and centralizing curriculum control have appeared almost continuously since 1910. CONCLUSION: The similarity of the reports' objectives and reforms results not only from a similar body of problems, but also from the reaffirmation of similar values. The reports have two implicit agendas that transcend the reform of medical education: the affirmation of the social nature of the medical profession and self-regulation of the profession. These agendas help account for the reports' similarity and their repeated promulgation.
Although a change in career can be frightening, a nurse can reap many benefits in a change to home care nursing. With the health care environment changing, home care is increasing and offers a nurse a chance to refresh her enthusiasm for individual patient care and put to use her collective skills learned along the way.
In summary, the predominate role of surgery as the definitive treatment modality for the vast majority of intradural pathology provides a unique opportunity to improve outcome through continued advances in microsurgery. There is also, however, the added responsibility that comes with the treatment of benign and generally nonlife-threatening pathology, that is, an increasing expectation of cure and anticipation of preserved neurologic function. Successful intervention is maximized by the surgeon who recognizes that microsurgical technique and judgment are learned skills obtained only through experience but developed within a framework of anatomic principles and an understanding of how anatomy is altered by specific pathologic processes.
The ophthalmic nurse practices in a wide variety of settings. One unique area of practice is in the aeromedical environment. Here, the nurse cares for a wide variety of patients. Patients might have ocular trauma or routine ocular conditions, such as cataracts, glaucoma, or macular degeneration. The opportunity to adapt learned skills and provide the same quality of care in an aircraft environment offers additional challenges to the ophthalmic nurse because of the effects of altitude physiology and stresses of flight. However, the patients' perceptions of pain and fear, due to the possibility of surgery and total blindness, are a common thread for all patients with ocular trauma and disease. Aeromedical evacuation of ophthalmic patients provides yet another challenging and rewarding role for the ophthalmic nurse.
How a patient responds to a diagnosis of HIV disease depends on personality and coping skills learned throughout life. Health care professionals are seriously challenged to meet the psychosocial needs of HIV patients and their networks of partners, families, and friends. We find great satisfaction in being able to help these patients.
Academies of Medicine now should see their educational mission as concern with all stages of medical education in the nation. Traditionally, National Academies have tended to regard Postgraduate Training as their proper educational responsibility. Such limitation is no longer defensible, particularly because medical education is now accepted as a continuum and, moreover, is viewed as lifelong. Discontinuities between basic education, specialist training and continuing education are now considered detrimental, and have to be eliminated. The Medical School Curriculum must be required to equip future doctors with the self-learning skills now essential for specialist training. The longest and most critically important phase of training has unquestionably become continuing medical education. It is argued therefore that basic medical education, specialist training and continuing education have all to be concerns of National Academies. National Academies in Europe, inevitably, have come to have profound international obligations now that free movement of doctors is legally established in the European Community.
During a 3-month deployment to Silopi, Turkey, for Operation Provide Comfort, the 39 TACG Air Transportable Hospital (ATH) managed 32 cases of severe military trauma. Fifty-two operations were necessary, 78% of which were performed at the ATH. Advanced Trauma Life Support (ATLS) protocols were applied to all of the patients. Only 14% of the 52 procedures were ATLS-learned skills. Also, only 30% of the patients could be managed solely by ATLS in the first 6 hours, the average time of ATH responsibility. ATLS alone is insufficient wartime readiness preparation for the military physician.
Vanderbilt University Medical Center (VUMC) developed a model training program to prepare current and future health sciences librarians for roles that are integrated into the diverse fabric of the health care professions. As a complement to the traditional and theoretical aspects of a librarian's education, this mixture of supplemental coursework and intensive practical training emphasizes active management of information, problem-solving skills, learning in context, and direct participation in research, while providing the opportunity for advanced academic pursuits. The practical training will take place under the auspices of an established Integrated Advanced Information Management Systems (IAIMS) library that is fully integrated with the Health Center Information Management Unit and Academic Biomedical Informatics Unit. During the planning phase, investigators are analyzing the model's aims and requirements, concentrating on (a) refining the current understanding of the roles health sciences librarians occupy; (b) developing educational strategies that prepare librarians to fulfill expanded roles; and (c) planning for an evaluation process that will support iterative revision and refinement of the model.
A patient with left alien hand syndrome (AHS) accompanied by leg symptoms due to right anterior cerebral artery territory infarction is reported. Magnetic resonance imaging demonstrated that the responsible lesion involved the right anterior cingulate gyrus, supplementary motor area, medical prefrontal cortex and corpus callosum extending from the genu to the isthmus. The leg symptoms included: 1) motor perseveration manifesting as compulsive straight walking with difficulty stopping on command; 2) dissociation between mind and action resulting in going to unintended places with subsequent complaints of poor memory not due to spatial disorientation; 3) discrepancy between verbal and actual leg motor responses to auditory verbal suggestions; and 4) movement dissociation between the legs resulting in transient standing still or brief sticking to the ground, a situation simulating akinesia. As the legs usually perform together to coordinate movements of standing and walking, unlike the hands performing well-learned, skilled unimanual or bimanual coordinating movements, the counterpart in the leg of the alien hand sign in AHS was not manifested. Nevertheless, in the presence of AHS, the associated leg symptoms bear similar neurobehavioral features and should be dealt with on equal terms.
The Genevan neurologist and psychologist Edouard Claparède is not well enough known to present-day neuropsychologists However, at the beginning of the century he developed certain modern concepts by introducing the notions of "implicit" and "explicit" into the study of memory. Edouard Claparède applied the saving method in relearning, initiated by Ebbinghaus, in the assessment of abilities retained by patients suffering from Korsakoff's syndrome. He described the two implicit-memory phenomena which are today called "priming effects" and "skill learning". Edouard Claparède also showed the influence of the implicit and explicit memories in recognition. His approach places him in the tradition of the multisystem theories of the memory: he made a distinction between habits and memories and then integrated the idea of familiar knowledge in this architecture of the memory, which is very close to that of Tulving (1985). Moreover, the importance that he gaves to perceptive data in recognition and the self in voluntary recall bring to mind the more recent distinction between data-driven and concept-driven processes in functional theories of memory. This integration of the two approaches, the structural and functional, must place Edouard Claparède among the most important precursors of the theories of human memory.
This report demonstrates the use of Lot Quality Assurance Sampling (LQAS) to evaluate the technical competence of two cohorts of family planning service providers in Kenya trained with a new curriculum. One cohort had just finished training within two months of the study. The other cohort was the first group trained with the new curriculum about one year before the study. LQAS was adapted from industrial and other public health applications to assess both the individual competence of 30 service providers and the competence of each cohort. Results show that Cohorts One and Two did not differ markedly in the number of tasks needing improvement. However, both cohorts exhibited more tasks needing improvement in counseling skills as compared with physical examination skills or with all other skills. Care-givers who were not currently providing services accounted for most service-delivery problems. This result suggests that providers' use of their skills explains their ability to retain service-delivery skills learned in training to a greater degree than does the amount of time elapsed since they were trained. LQAS proved to be a rapid, easy-to-use empirical method for management decisionmaking for improvement of a family planning training curriculum and services.
UNLABELLED: Differences in the success rates of the pre-hospital or in-hospital resuscitation attempts seem to be attributable to the skill of the various rescuers. Whereas the definite success rate for pre-hospital resuscitation is 7%, the corresponding rate for in-hospital settings is 15%. In this context, the resuscitation skills and the self-assessment of CPR methods of hospital staff were investigated. METHODS: during 53 CPR refresher courses offered to nursing staff members, the individual skills and competence in CPR procedures of 425 nurses were examined according to the standards and guidelines of the German Medical Association. During the first part of the study the participants were asked to subjectively rate their proficiencies in CPR followed by a practical assessment of their manual CPR skills by an independent observer. Scores were calculated for artificial ventilation and chest compression. Quality criteria were defined, grouped and analysed statistically by the chi-squared test. RESULTS: 16.2% of the participants felt sufficiently trained to perform CPR independently and 77.2% did not. Thirty-six percent estimated their CPR skills to be sufficient or good. Only four participants (0.9%) were able to perform all standard CPR procedures as recommended by the guidelines and 71.8% failed to perform effective CPR manoeuvres. The CPR skills did not differ with regard to the nurses' educational degree, professional experience, previous CPRs performed or work area within the hospital. Of the nursing staff, 6.6% were found to have good skills in artificial ventilation. The attempts at artificial ventilation made by 58.6% were completely inadequate. Correct chest compression was performed by 14.1%. The majority of the test group (44.7%) failed to carry out effective cardiac message. CONCLUSIONS: CPR skills of hospital staff are inadequate, mainly because of lack of manual dexterity. Obviously the special skills learned in CPR courses are lost in spite of a positive self-assessment after a relatively short time. The results, however, do not suggest completely inadequate handling of CPR procedures in a hospital setting. Indeed, an increasing rate of successful resuscitations inside the hospital (up to 27%) has been reported in the literature. As a consequence of our findings, refresher courses in specific CPR techniques must be demanded, which should be made compulsory for nursing staff every 2 years.