SEARCH · PubMed Health

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.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 991 records · Page 55Linked to original sources

PubMed2003

[Individual and collective facilitators of and barriers to the use of clinical practice guidelines by physicians: a literature review].

BACKGROUND: The effectiveness of Clinical Practice Guidelines (CPG) diffusion to physicians depends on local barriers or facilitators related to the CPG, to the individual clinician and the professional context. Our project aimed to retrieve, by a literature review, all the facilitators of and barriers to physician's adherence to CPG and propose a classification of these barriers and facilitators. METHOD: A comprehensive review of the literature. We searched in Medline, Healthstar, Current contents, Cochrane library databases, consulted experts in the domain of CPG implementation and reviewed study bibliography to retrieve all original reports studying facilitators of and barriers to physician's adherence to CPG (inclusion criteria). The article selection followed a two stepped procedure: first, quick reading of the retrieved articles, then reading in depth of the potentially appropriate articles. RESULTS: Fifty nine studies published between 1986 and 2001 were eligible. The majority (29 studies) used a quantitative design, having studied the statistical association between some a priori defined barriers or facilitators (collected by questionnaires or by record audits) and CPG use. The others have used a qualitative design (barriers and facilitators collected through qualitative methods or open-ended questions in questionnaires) (21 studies) or a mixed design (qualitative and quantitative) (8 studies). Study samples sizes ranked between 10 and 1878 physicians. The CPG were mostly about prevention or curative care. The retrieved barriers or facilitators were classified into three categories: 1) the CPG characteristics (form, compatibility, trialability, scientific basis, observability, adaptability, legal implications) (27 articles), 2) the physician characteristics (knowledge about CPG, attitude and agreement to CPG, psychological and socio-demographic and economic characteristics, job satisfaction, training) (38 articles), 3) the physician environment (divided into 3a the physician human environment--the patient influence and the pairs influence (16 articles)--and 3b the physician organizational environment--the internal environment and the external environment (33 articles). CONCLUSION: The interpretation of the results is hampered by the absence of previous conceptual framework of the barriers or facilitators and by the absence of multifactorial analysis.

Clinical Competence↗

PubMed2003

Advocacy training for pediatricians: the experience of running a course in leeds, United kingdom.

Given the critical role of pediatricians in child advocacy, it is important to understand how to train pediatricians to speak out to improve the health and well-being of children. This article describes the experience of developing and implementing a 5-day child advocacy course at the University of Leeds, which formed part of a master's program. Eight community pediatricians and pediatric registrars participated in the initial course. The material from the course has been published in Archives of Disease in Childhood.(1) This exercise was about the only time as a teacher that I also started at the same level as the students in the course. We started off by defining what we meant by advocacy. The definition that we chose was "the active support of a cause or course of action," and we applied this to any child problem for which the system was at fault and use of action was required. What is needed to be an effective advocate? One must have an awareness of issues confronting children, in particular on the local level and not only on the national and international levels. One then needs to gain an understanding of the political framework of the issue, how change can occur, and how one can contribute to bringing about the necessary change. Then follows the identification and acquisition of the practical skills and competencies related to effecting these changes. Finally, one needs to have a successful experience tackling a particular issue to realize that one can be effective.

Child↗

PubMed1983

Heterogeneity of human NK cells: comparison of effectors that lyse HSV-1-infected fibroblasts and K562 erythroleukemia targets.

In this study, we compared the natural killer (NK) cells that lyse HSV-1-infected NK(HSV-1) or uninfected [NK-(FS)] fibroblasts to those that lyse K562 erythroleukemia cells [NK(K562)]. Activity against all three targets was found in Percoll gradient fractions enriched for large granular lymphocytes, which suggests that these effector cells have a common morphology. In competition studies between 51Cr-labeled targets and unlabeled targets, both the infected and the uninfected fibroblasts competed for lysis of NK(HSV-1) and NK(FS) activity, whereas K562 cells competed poorly. In contrast, when 51Cr-labeled K562 cells were used, the unlabeled K562 cells competed well, but HSV-1-infected and uninfected fibroblasts competed poorly. Panning studies and complement elimination experiments using monoclonal antibodies were performed to describe cell surface markers on the NK cell populations. Treatment with an antibody to an la framework antigen reduced NK(HSV-1) but not NK(K562) activity. In contrast, the majority of NK(K562) effectors were recognized by antibodies to the E-rosette receptor (Lyt-3 and OKT11A), whereas NK(HSV-1) activity was much less sensitive to this antibody. OKM1, OKT10, and Leu-7 (HNK-1) markers were found on a portion, but not all, of the cells that lysed both the HSV-FS and K562 targets, while treatment with HLA plus complement totally abrogated both NK activities. Taken together, these data are consistent with the concept that human NK cells are heterogeneous and that we are dealing with at least three subpopulations of effector cells--one that kills the infected or uninfected fibroblasts; one that kills K562 cells; and a third population that may be able to kill all three targets. Patient studies provide additional evidence for heterogeneity within the NK cells that lyse the fibroblasts and K562 cells. We have studied a number of individuals who have normal NK activity with one target (HSV-FS or K562) but have low or no activity against the other. These patients provide strong evidence not only that NK cells are heterogeneous but also that these NK subpopulations can be regulated independently of each other in vivo.

Adult↗

PubMedDate not supplied

Nursing assistive personnel in acute care. Framework for staff development.

Increasing numbers of nonlicensed personnel in acute care facilities are requiring staff development educators to examine their role in relation to the demands created by these positions. Continued pressures on healthcare delivery are causing nursing departments to redefine and restructure nursing care using assistive personnel positions. Interpreting standards, providing education for role implications and performance, and participating actively in change can influence outcomes for the nursing staff members affected. In this article, the author offers a framework for staff development educators to assess, organize, and plan activities for these workers.

Acute Disease↗

PubMed1994

[Toward a European health reporting system--starting points and developmental perspectives].

This article first offers a brief introduction to the development of the EC health policy mandate from a competence restricted to health protection at the working place to a wider competence embracing health promotion and disease prevention, albeit still based on the principle of self-responsibility of the Member states. Possible focal points of health reporting within the EC framework are worked out on the basis of suggestions made by the EC commission in respect of priority areas of EC activities in the public health sphere and the commission's own priority criteria. It is then examined whether and to what extent the presently available health databases (especially of WHO and OECD) would cover these requirements. As a result, it is argued, that there is no getting around setting up an own health reporting system that would promote and support the development of an EC public health policy. An important task of such health reporting will be to supply users not only with data but also with adequate knowledge on how to interpret them, in view of the multitude of problems involved in bringing the various national health data under one roof; this cannot be achieved either at short notice or on a medium-term basis. Finally, a few alternatives are given in respect of possible organisational structures of EC health reporting, pointing out decision criteria and practical conditions which would be essential of assessing the usefulness of such organisational setups.

Disease Notification↗

PubMedDate not supplied

Emerging licensing issues in Canada and the US.

Health care is under scrutiny. Governments and regulators are examining the way in which health care is delivered within a framework of public accountability. Licensing authorities are faced with issues such as legislative reform, undefined scopes of practice, increased lay involvement in licensing, specialty licensing and the measurement of continuing competence. The protection of the public and preservation of the professionalism of self-regulation are the principles that should guide decision-making. While economics are behind much of the top-down initiatives to change, there is also a real grassroots demand for preventive services, choice of alternative therapies and increased responsiveness by healthcare providers to community needs for primary health care, which includes convenient times and locations, at costs affordable by everyone.

Canada↗

PubMed1997

Ethical dilemmas faced by mental health nurses.

This paper considers the dilemmas faced by mental health nurses when they encounter difficult ethical decisions. Using a case study, the author analyses the patient's right to autonomy and the nurse's duty of care. Theories of decision-making are assessed for their relevance to the work of mental health nurses. The author proposes that Hare's (1981) theory of universal prescriptivism offers an appropriate framework and examples from clinical practice are described to support this argument.

Decision Making↗

PubMed1996

An integrative model for the study of developmental competencies in minority children.

In this article a conceptual model for the study of child development in minority populations in the United States is proposed. In support of the proposed model, this article includes (a) a delineation and critical analysis of mainstream theoretical frameworks in relation to their attention and applicability to the understanding of developmental processes in children of color and of issues at the intersection of social class, culture, ethnicity, and race, and (b) a description and evaluation of the conceptual frameworks that have guided the extant literature on minority children and families. Based on the above considerations, an integrative conceptual model of child development is presented, anchored within social stratification theory, emphasizing the importance of racism, prejudice, discrimination, oppression, and segregation on the development of minority children and families.

Black or African American↗

PubMed1999

The nurse teacher's clinical role now and in the future.

The role of the nurse teacher in relation to the clinical setting has been debated for 20 years, yet it has been the subject of relatively few large studies. Recent studies led to inconclusive results, hence the nurse lecturer's clinical role remains an area of long-standing dispute. Changes in nurse education United Kingdom Central Council (UKCC) and the amalgamation of nurse education into higher education as part of the Strategy for Nursing, as well as the expansion of supernumerary status for student nurses, gave impetus to the search for a new clinical role for nurse lecturers. Research suggests that nurse teachers wish to maintain clinical contact, but the nature of this contact is vigorously debated at present. Lee, in reviewing the literature, concluded that this topic is highly contentious in terms of its nature, extent and purpose. She goes as far as to suggest that there is a need for empirical research to address the question as to whether there is a role for nurse lecturers in the clinical area. This paper examines some of the factors which influence the development of the clinical aspect of the role of nurse lecturers, explains how the author performed this role and the perceived benefits to students, mentors and the lecturer. It proposes a clinical role model based on the literature and the author's own personal experience as a 'clinical liaison lecturer' since the integration of nursing education into higher education. Key points The clinical role of the nurse teacher remains an area of long standing dispute Nurse lecturers wish to maintain clinical contact and maintain clinical competence, but in reality no consensus exists as to its meaning The mentor's role can be complemented by a clinically competent nurse lecturer who arguably should be able to teach in the classroom and the practice settings Using a triangular approach to reviewing student's experience, lecturers can update their clinical knowledge, demonstrate credibility, promote education-practice relations and ensure classroom teaching is relevant to current practice The establishment of guiding principles (recognized and agreed upon by service and educational managers) serves as a framework which nurse teachers can use to establish their own clinical role for each of their 'link' areas The nurse lecturer is in a good position to influence and maintain standards in nursing practice.

Clinical Competence↗

PubMed2006

Energy and charge transfer dynamics in fully decorated benzyl ether dendrimers and their disubstituted analogues.

We examine the photophysics of a series of molecules consisting of a benzthiadiazole core surrounded by a network of benzyl ether arms terminated by aminopyrene chromophores, which function as both energy and electron donors. Three classes of molecules are studied: dendrimers whose peripheries are fully decorated with aminopyrene donors (F), disubstituted dendrimers whose peripheries contain only two donors (D), and linear analogues in which a pair of benzyl ether arms link two donors to the central core (L). The electronic energy transfer (EET) and charge transfer (CT) rates are determined by fluorescence lifetime measurements on the energy donors and electron acceptors, respectively. In all three types of molecules, the EET time scales as the square root of the generation number G, consistent with the flexible nature of the benzyl ether framework. Transient anisotropy measurements confirm that donor-donor energy hopping does not play a major role in determining the EET times. The CT dynamics occur on the nanosecond time scale and lead to stretched exponential decays, probably due to conformational disorder. Measurements at 100 degrees C confirm that conformational fluctuations play a role in the CT dynamics. The average CT time increases with G in the L and D molecules but decreases for the F dendrimers. This divergent behavior as G increases is attributed to the competing effects of larger donor-acceptor distances (which lengthen the CT time) versus a larger number of donors (which shorten the average CT time). This work illustrates two important points about light-harvesting and charge-separation dendrimers. First, the use of a flexible dendrimer framework can lead to a more favorable scaling of the EET time (and thus the light-harvesting efficiency) with dendrimer size, relative to what would be expected for a fully extended dendrimer. Second, fully decorated dendrimers can compensate for the distance-dependent slowdown in CT rate as G increases by providing additional pathways for the CT reaction to occur.

Journal Article↗

PubMedDate not supplied

An alternative framework for teacher preparation in nursing.

Little nursing research has been done to explore the effectiveness of teacher preparation models. Nursing still uses traditional survey-type teacher preparation programs, yet educational research using these same models shows limited success in promoting students' teacher competence and confidence, limiting their desire to teach. However, current educational research reveals that courses designed around a constructivist model have had success in getting students to feel competent and confident to take on the teacher role and to incorporate new ideas of teaching into their teaching repertoire. The Experimental Teaching Course: Models of Teaching and Learning is designed to enhance graduate nursing students' competence and confidence as they identify and develop their own personal educator models for teaching and learning.

Attitude of Health Personnel↗

PubMed2003

Psychological aspects of traumatic injury in children and adolescents.

Each year millions of children are exposed to some form of extreme traumatic stressor. These traumatic events include natural disasters (e.g., tornadoes, floods, hurricanes), motor vehicle accidents, life-threatening illnesses and associated painful medical procedures (e.g., severe burns, cancer, limb amputations), physical abuse, sexual assault, witnessing domestic or community violence, kidnapping, and sudden death of a parent. During times of war, violent and nonviolent trauma (e.g., lack of fuel and food) may have terrible effects on children's adjustment. The events of September 11, 2001 and the unceasing suicidal attacks in the Middle East underscore the importance of understanding how children and adolescents react to disasters and terrorism. The body of literature related to children and their responses to disasters and trauma is growing. Mental health professionals are increasing their understanding about what factors are associated with increased risk (vulnerability) and affect how children cope with traumatic events. Researchers recognize that children's responses to major stress are similar to adults' (reexperiencing the event, avoidance, and arousal) and that these responses are not transient. A review of the literature indicates that PTSD is the most common psychiatric disorder after traumatic experiences, including physical injuries. There is also evidence for other comorbid conditions, including mood, anxiety, sleep, conduct, learning, and attention problems. In terms of providing treatment, CBT emerges as the best validated therapeutic approach for children and adolescents who experienced trauma-related symptoms, particularly symptoms associated with anxiety or mood disorders. The best approach to the injured child requires injury and pain assessment followed by specific interventions, such as pain management, brief consultation, and crisis intervention immediately after the specific traumatic event. Family support also may be necessary to help the family through this difficult period. The main conclusion that arises from the research on resilience in development is that extraordinary resilience and recovery power of children depend on basic human protective systems operating in their favor. This finding has produced a fundamental change in the framework for understanding and helping children at high risk or already in trouble. This shift is evident in a changing conceptualization of the goals of prevention and intervention that currently address competence and problems. Strategies for fostering resilience described in this article should be tested in future controlled psychotherapy trials to verify their efficacy on children's protective factors.

Adolescent↗

PubMed1995

The development of a diploma in complementary medicine.

This paper describes the rationale for the development of a Diploma in Complementary Medicine, validated by the University of London and offered by The Centre for Complementary Medicine North West, School of Nursing and Health Studies, Stockport College of Higher and Further Education. The Diploma in Complementary Medicine is in part a considered response to the recent BMA (1993) report evaluating the current status of complementary medicine in the UK and recommendations for training proposed by the RCN (RCN CTINSIG 1993, 1994). The course team perceived and identified a need for a common theoretical framework, validated at University level, to set precedent for the development of educational standards in the field of complementary therapies. It is suggested that in order to facilitate the development of competent clinical practitioners it is necessary to establish a common educational foundation from which to develop practice skills.

Complementary Therapies↗

PubMed2001

Bayesian value-of-information analysis. An application to a policy model of Alzheimer's disease.

A framework is presented that distinguishes the conceptually separate decisions of which treatment strategy is optimal from the question of whether more information is required to inform this choice in the future. The authors argue that the choice of treatment strategy should be based on expected utility, and the only valid reason to characterize the uncertainty surrounding outcomes of interest is to establish the value of acquiring additional information. A Bayesian decision theoretic approach is demonstrated through a probabilistic analysis of a published policy model of Alzheimer's disease. The expected value of perfect information is estimated for the decision to adopt a new pharmaceutical for the population of patients with Alzheimer's disease in the United States. This provides an upper bound on the value of additional research. The value of information is also estimated for each of the model inputs. This analysis can focus future research by identifying those parameters where more precise estimates would be most valuable and indicating whether an experimental design would be required. We also discuss how this type of analysis can also be used to design experimental research efficiently (identifying optimal sample size and optimal sample allocation) based on the marginal cost and marginal benefit of sample information. Value-of-information analysis can provide a measure of the expected payoff from proposed research, which can be used to set priorities in research and development. It can also inform an efficient regulatory framework for new healthcare technologies: an analysis of the value of information would define when a claim for a new technology should be deemed substantiated and when evidence should be considered competent and reliable when it is not cost-effective to gather any more information.

Alzheimer Disease↗

PubMed2002

Strategic regulation of grain size in memory reporting.

To increase their report accuracy, rememberers may either withhold information that they feel unsure about or provide relatively coarse information that is unlikely to be wrong. In previous work (A. Koriat & M. Goldsmith, 1996c), the authors delineated the metacognitive monitoring and control processes underlying the decision to volunteer or withhold particular items of information (report option) and examined how these processes are used in the strategic regulation of memory accuracy. This article adapts that framework to address control over the grain size (precision-coarseness) of the information that people report. Results show that rememberers strategically regulate the grain of their answers to accommodate the competing goals of accuracy and informativeness. The metacognitive processes underlying this regulation are elucidated.

Attention↗

PubMed2004

Role of comparative risk assessment in addressing environmental security in the middle East.

During the 21st century, environmental challenges are likely to intensify across the world and possibly lead to violent conflicts. Strategies for conflict avoidance will be incomplete unless they recognize, discuss, and mitigate regional environmental stress factors. Comparative risk assessment (CRA) is one of the most critical tools emerging to influence modern environmental policies and is increasingly used to create a common language to help reconcile competing interests in development and environmental disputes around the world. This article considers the environmental challenges facing the Middle East in light of their "transboundary" nature and proposes CRA as a framework for setting environmental priorities and reducing tensions in the region.

Journal Article↗

PubMed2005

Economic evaluation: what does a nurse manager need to know?

This paper considers how health economists can assist nurse managers, using the concepts and tools of economic evaluation. We aim to clarify these and also explode some of the myths about economic evaluation and its role in health care decision-making. Economic evaluation techniques compare alternative courses of action in terms of their costs and consequences. There are four principal methods; cost-minimization, cost-effectiveness, cost-utility and cost-benefit analysis, all of which synthesize costs and outcomes, at different levels of outcome. Economic evaluation is an intrinsic part of national decision-making about the efficient provision of effective treatments and services, and increasingly, organizational matters. In the UK, such technology evaluation is disseminated in guidelines from the National Institute for Clinical Effectiveness (NICE), having a top-down impact on the nurse manager. But economic evaluation is increasingly relevant to the nurse manager at local level, through newer techniques such as Programme Budgeting Marginal Analysis (PBMA), which facilitates explicit, transparent decisions, from the bottom-up. Nurse managers need to weigh up competing demands on resources and decide in ways which maximize health gain. Economic evaluation can help here because it presents evidence to challenge or support existing allocations, and provides a systematic framework to analyse health care decisions. In the current context of competition for scarce resources, we suggest that nurse managers need to embrace these techniques, or be marginalized from the resource allocation process.

Cost Control↗

PubMed2004

[A critical appraisal of an institutional journal: Memórias do Instituto Oswaldo Cruz].

The journal Memórias do Instituto Oswaldo Cruz, founded and maintained over the course of many years for the exclusive publication of research results from one single institution, has undergone changes over the last decade which have resulted in an open journal. Conditions leading to the journal's founding and the excellent role it has played in the dissemination of knowledge produced by the Instituto Oswaldo Cruz are examined. The fact that it has differed from journals published by scientific societies does not diminish its importance. The present option to give this journal an international slant, with possibilities for competing on the foreign market, and which would be facilitated by the preference given to papers written in English, raises some questions about the role of Brazilian specialized journals within the framework of our scientific development.

English Abstract↗