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At least 919 records · Page 51Linked to original sources
PubMed2003

Training the transdisciplinary scientist: a general framework applied to tobacco use behavior.

The complexity of public health problems, including the problem of tobacco use behaviors, calls for formal efforts to train transdisciplinary scientists. These scientists can approach problems by using new conceptual frameworks and methodological tools that integrate different disciplinary perspectives. Transdisciplinary training focuses on developing strong scientists with superb core skills while protecting against creating scientists who are "jack of all trades, master of none." Transdisciplinary training is relatively new, with no accepted training model in place. In this paper, we provide a general framework for transdisciplinary training at the advanced graduate and postgraduate levels, with particular reference to tobacco use behaviors. We identify the core attitude, knowledge, and skills competencies that are essential to conducting tobacco use research with a transdisciplinary approach. We outline the structural components of transdisciplinary training that allow for the development of the competencies and discuss what facilitates the transdisciplinary training process. We also discuss the numerous challenges and obstacles to transdisciplinary training. These include the readiness of early-career trainees to undergo transdisciplinary training, professional development risks taken by trainees, administrative and budgetary obstacles inherent in traditional academic institutional structures, and the limited opportunities established scientists have for transitioning their research programs in a transdisciplinary direction. If these obstacles can be overcome, the potential exists for a new generation of transdisciplinary scientists to be trained and be well positioned to make important and unique advances in our understanding of tobacco use and other public health problems.

Career Mobility↗
PubMed1994

The role of risk adjustment in national health reform.

Efforts to contain health insurance costs through competitive strategies are undermined by the economic incentive facing buyers and sellers to avoid high-risk individuals. To deal with this problem, proponents of competitive strategies, in which cost containment would be achieved by having consumers move to the most efficient health plans, suggest developing risk-assessment methods and using them to make transfer payments from plans enrolling relatively healthier people to plans with relatively sicker ones. Effective risk adjustment is also of interest to payers such as Medicare, large employers offering multiple-choice programs, and risk-bearing providers seeking fair compensation. So far, however, the ability to predict the variability of future medical costs on an individual basis is very limited. In a market in which individuals are free to change plans annually, the potency of current risk-adjustment technology would leave plans with ample incentive to attract healthier people and to avoid sicker people. The state of current risk-assessment methods leads some analysts to advocate a mixed payment system, partly based on a risk-adjusted prospective payment and partly based on retrospective adjustments made once competing plans' actual experiences are known. New York State is trying such an approach. Many analysts emphasize the importance of other insurance reforms and the institutional framework in which risk adjustments might be made as key factors in helping such a process succeed.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed2003

Learning disabilities, professionalism, and the practice of medical education.

The authors use the interface of learning disabilities (LDs) and medical education to explore several issues relevant to medical professionalism and the training of future physicians. First, they examine arguments given by Little (in the preceding article) that a successful suit for accommodations on a state bar exam is generalizable to LDs and medical education, and suggest ways in which this may not be true. They then explore two frameworks for understanding medical education: (1) as a process of academic achievement linked to degree attainment, and (2) as a process of professional acculturation linked to competencies. Within this dichotomy, they then explore (1) the legitimacy accorded to different types of accommodations, (2) differing meanings of a "level playing field," and (3) the legal standard of "otherwise able." They also examine the use of intermediaries (e.g., a reader) as a "leveling" strategy and how, in clinical settings, this might violate core standards of autonomous decision making. The authors investigate the nature of "technical standards" in training across medicine and nursing and find a number of differences, particularly in the intent and levels of detail of standards. Across these two domains, they observe a status hierarchy, medical hubris, and the emergence of a "right to fail" as one travels down that hierarchy. The authors also examine medicine as an undifferentiated degree and consider arguments that medical school course requirements should be unbundled. They close by insisting that medical schools have a social responsibility to shift their pedagogic gaze from identifying handicaps in individuals to understanding how the education of physicians can become, quite literally, "handicapping."

Clinical Competence↗
PubMed1997

Service quality of Chinese traditional medicine in Taiwan: a comparative study.

A consensus is growing that measuring service quality level based on patients' perceptions is crucial for continuous improvement. This work involved a questionnaire survey to evaluate the gap of perceived service quality level between Chinese traditional medicine and Western medicine in Taiwan. The ten dimensions of service quality proposed by Parasuraman et al. (1985) were adopted as a framework to design an instrument. The results of data analyses indicated that significant differences arise in perceived quality level between the two systems in four dimensions: competency, tangibles, courtesy, and communication. Managerial implications of the results were discussed. We recommend that the two systems learn from each other to enhance patient satisfaction.

Adult↗
PubMed2006

Cultural sensitivity and supportive expressive psychotherapy: an integrative approach to treatment.

Cultural sensitivity is a concept that has become increasingly important in psychotherapy research and practice. In response to the growing ethnic minority population and the increased demand for psychological services among minority clients, many therapists and researchers have attempted to identify competencies and guidelines for providing culturally sensitive approaches to treatment. However, many cultural sensitivity concepts are theoretical and have rarely been integrated into an established psychotherapeutic framework. The purpose of this manuscript is to operationalize the concepts of cultural sensitivity into specific therapeutic techniques using a manual-guided Supportive Expressive Psychotherapy approach. Developing these strategies may serve to further assist therapists with the delivery of mental health services to ethnic minority clients.

Black or African American↗
PubMed2005

Palliative and end-of-life care for patients with cardiopulmonary diseases: American College of Chest Physicians position statement.

Acute and chronic pulmonary and cardiac diseases often have a high mortality rate, and can be a source of significant suffering. Palliative care, as described by the Institute of Medicine, "seeks to prevent, relieve, reduce or soothe the symptoms of disease or disorder without effecting a cure... Palliative care in this broad sense is not restricted to those who are dying or those enrolled in hospice programs." The American College of Chest Physicians strongly supports the position that such palliative and end-of-life care of the patient with an acute devastating or chronically progressive pulmonary or cardiac disease and his/her family should be an integral part of cardiopulmonary medicine. This care is best provided through an interdisciplinary effort by competent and experienced professionals under the leadership of a knowledgeable and compassionate physician. To that end, it is hoped that this statement will serve as a framework within which physicians may develop their own approach to the management of patients requiring palliative care.

Advance Care Planning↗
PubMed2001

Immunoregulatory effects of L-arginine and therapeutical implications.

Arginine, initially classified as a non-essential amino acid, participates to multiple biological processes including release of several hormones, collagen synthesis during wound healing, antitumor and antibacterial activities and non-specific immunity. Nitric oxide synthase and arginase competes for L-arginine as a substrate and this event appears to play a key role in the regulation of the inflammatory process. In this framework recent studies have identified complex patterns of interactions among these enzymes. This review will emphasizes some effects of L-arginine on immune cell functions, including triggering of L-arginine-nitric oxide and arginase pathways, its biological properties and therapeutical applications.

Animals↗
PubMed2004

OptStrain: a computational framework for redesign of microbial production systems.

This paper introduces the hierarchical computational framework OptStrain aimed at guiding pathway modifications, through reaction additions and deletions, of microbial networks for the overproduction of targeted compounds. These compounds may range from electrons or hydrogen in biofuel cell and environmental applications to complex drug precursor molecules. A comprehensive database of biotransformations, referred to as the Universal database (with >5700 reactions), is compiled and regularly updated by downloading and curating reactions from multiple biopathway database sources. Combinatorial optimization is then used to elucidate the set(s) of non-native functionalities, extracted from this Universal database, to add to the examined production host for enabling the desired product formation. Subsequently, competing functionalities that divert flux away from the targeted product are identified and removed to ensure higher product yields coupled with growth. This work represents an advancement over earlier efforts by establishing an integrated computational framework capable of constructing stoichiometrically balanced pathways, imposing maximum product yield requirements, pinpointing the optimal substrate(s), and evaluating different microbial hosts. The range and utility of OptStrain are demonstrated by addressing two very different product molecules. The hydrogen case study pinpoints reaction elimination strategies for improving hydrogen yields using two different substrates for three separate production hosts. In contrast, the vanillin study primarily showcases which non-native pathways need to be added into Escherichia coli. In summary, OptStrain provides a useful tool to aid microbial strain design and, more importantly, it establishes an integrated framework to accommodate future modeling developments.

Algorithms↗
PubMed2004

The impact of evidence-based education on a perinatal capacity-building initiative in Macedonia.

CONTEXT: The perinatal mortality rate (PMR) in Macedonia is among the highest in Europe. The World Bank supported a consultant (HEJ) to collaborate with a Macedonian team to develop a national perinatal strategy with the goal of reducing the PMR. Education was given priority in the form of a hospital-based initiative to develop the capacity of health professionals to introduce evidence-based perinatal practice into 16 participating hospitals. A "train the teachers" approach was used, with trainees introduced to modern education and clinical practice in Sydney and subsequently supported to train their colleagues in Skopje. OBJECTIVES: To describe the development, implementation and evaluation of the educational intervention. METHODS: A curriculum, based on specific Macedonian needs, was developed in order to integrate teaching in the knowledge, skills and attitudinal domains of learning, using small group, interactive techniques. Twenty-five Macedonian doctors and nurses participated in 4-month (phase 1a) and 6-month (phase 1b) teaching programmes at a tertiary perinatal unit in Sydney. Australian staff conducted 4 2-week modules for 36 trainees in Macedonia (phase 2). The phase 1 trainees conducted 8 modules for 57 colleagues in Skopje (phase 3). The intervention was evaluated by trainee questionnaires, assessments of competence, changes in hospital practice and pre- (1997-99) and post-intervention (2000-01) comparisons of PMR. RESULTS: A total of 115 doctors and nurses graduated from the programme. Positive responses to the education programme exceeded 80%. Evidence-based practice in 16 participating hospitals (covering 91% of all Macedonian births) was verified in 6 key areas of neonatology. The PMR fell significantly from 27.4 to 21.5 per 1000 births (RR 0.79, 95% CI 0.73, 0.85). The early neonatal death rate in babies weighing over 1000 g fell by 36%. CONCLUSIONS: The intervention has increased the capacity of Macedonians to practise best-evidence perinatal medicine and improve outcomes. Sustainability is predicted by the "train the teachers" approach, with concurrent strengthening of the infrastructure and organisational framework.

Clinical Competence↗
PubMed1999

Neuropsychological frameworks for understanding autism.

Neuropsychological theories have traditionally attempted to provide a unifying account of the complex and diverse behavioral manifestations of autism in terms of their underlying psychological mechanisms and associated brain bases. This article reviews three competing neuropsychological theories of autism: the executive dysfunction hypothesis, the weak central coherence hypothesis, and the limbic system hypothesis. Each theory is evaluated critically with regard to the primary neuropsychological deficit hypothesized and the research findings that have been offered in support of it. In a concluding section, some of the metatheoretical assumptions informing attempts to identify a "core" neuropsychological impairment in autism are outlined and questioned, and new approaches to a neuropsychological understanding of autism are suggested.

Journal Article↗
PubMed2003

A framework for the biomedical informatics curriculum.

The problem of developing a curriculum for biomedical informatics is highly dependent on how we choose to define and practice the field. Numerous authors have questioned how to position biomedical informatics along the continuum of formal, empirical and engineering disciplines. A concern with current educational programs in biomedical informatics is that students finish without a clear understanding of the relation between theory and practice, or worse, with the impression that the field does not possess any theoretical basis. In this paper, we propose that biomedical informatics curricula explicitly address skills and competencies at three levels: formal, empirical, and applied. We posit that that knowledge of formalization is necessary to build testable empirical models, and that model-driven approaches are necessary for deploying information systems that can be evaluated in a meaningful way. A curricular framework is proposed that identifies a set of methods, techniques and theories that have broad applicability within the domain of biomedicine, and which can span a wide range of application areas: bioinformatics, imaging informatics, clinical informatics and public health informatics. A stronger linkage between theory and practice will result in students who are empowered to create effective and lasting solutions to biomedical problems.

Computational Biology↗
PubMedDate not supplied

Evaluating a continuing education program.

This study evaluated an innovative program designed to assist registered nurses to achieve professional competency in a role that was introduced in the career structure and was new to Western Australian nurses. Quantitative and qualitative methods were used to determine formative and summative aspects of the program. The framework for data processing was Stake's Countenance Model. Data were collected from participants and preceptors over one year. A variety of instruments were used including interviews, questionnaires, document reviews and observations. Findings indicate that the program facilitated development of professional behaviours and that the participants found it worthwhile. The method of evaluation was able to demonstrate that the program outcomes were logically and empirically contingent upon transactions and antecedents and were congruent with the program's intentions.

Career Mobility↗
PubMed2005

Skill needs for nurses in their role as health informatics professionals: a survey in the context of global health informatics education.

In the process of developing global health informatics education, a common understanding of educational outcomes is required. Therefore, an educational framework for health informatics professionals is desirable to support student mobility, trans-national and borderless education. Nurses form a significant part of the health workforce and need to be properly educated for their roles in health informatics. To ascertain their perceptions of needs and priorities, we developed a web-based questionnaire and surveyed Australian nurses on the preferred knowledge/skills set for health informatics professionals. Among others, the questionnaire is based on the International Medical Informatics Association's (IMIA) set of recommendations on education and IMIA's scientific map. Benner's five levels of competencies were applied to measure the degree of competency required for each skill/knowledge. Altogether, 82 Australian nurses completed the questionnaire. The nurses' perceived degree of competency required for a total of 74 specific skills and knowledge in five skill categories is presented in this paper as well as the overall results for each of the five categories. Further, significant differences between the nurses' primary roles and primary interest in health informatics are discussed. The development of a comprehensive health informatics education framework needs to take into account nurses as well as other health professionals. Repeating the survey in other countries and for various professions is essential to develop an international educational framework.

Adult↗
PubMed1993

[Developing social medicine competence in medical education--goals in social medicine education for the practicing physician from the viewpoint of mandatory public insurance].

The social obligation of medicine is not limited to the application of technical-curative methods. It rather also encompasses prevention, rehabilitation as well as cooperation with other health professions. Furthermore, medicine is tied into a social, economical and legal framework which has a direct impact on medical practice. Training in social medicine within the medical curriculum has to address these relationships. Moreover, the interaction between the ecological, occupational and social environment and the causes of diseases and disabilities should be a central focus of the subject.

Clinical Competence↗
PubMed2003

Goodness-of-fit ethic for informed consent to research involving adults with mental retardation and developmental disabilities.

This article reviews current theory and research on informed consent policies for adults with mental retardation within a relational ethics framework that re-conceptualizes consent vulnerability in terms of the goodness-of-fit between participant decisional capacities and the specific consent context. Conceptualizing informed consent competence as a product of the relationship between person and consent context shifts assessment of decisional capacity away from an exclusive focus on a research participant's cognitive deficiencies to (a) an examination of those aspects of the consent setting that are creating or exacerbating consent vulnerability and (b) consideration of how the setting can be modified to produce a consent process that best reflects and protects the hopes, values, concerns, and welfare of adults with developmental disabilities.

Adult↗
PubMed1989

The competency quagmire: clarification of the nursing perspective concerning the issues of competence and informed consent.

Selected issues involved in informed consent and the patient's competence to give it are examined. A discussion of tests of competence reveals some of the problems encountered in using them. There are differences in medical and nursing functions and responsibilities in the informed consent process. One nursing framework, self care, is used to discuss whether informed consent should be obtained from patients when they receive specific nursing care.

Attitude of Health Personnel↗