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PubMed1992

[Supervision as quality assurance--examplified on the continuous education in psychiatry].

Regular supervision is now compulsory for all medical specialties. This provides a good opportunity to follow the interns through their entire period of specialization, and could therefore be a good tool for quality assurance. If supervision is to function as quality assurance, firm frameworks will have to be established. The content must cover learning of practical skills and improve possibilities for reflection about one's own work and about ethical choices. The supervisor must be competent to understand the supervision as a pedagogic process, not only as an extension of knowledge nor as a purely control function. The supervisor must be open to mutual evaluation and take the responsibility to evaluate the intern's fitness for the specialty. The psychiatric specialist education is used as an example of the different aspects of supervision.

Clinical Competence↗
PubMed1993

The epidemiological and economic consequences of AIDS clinical trials.

The Food and Drug Administration (FDA) must manage the delicate balance between speed and safety in the evaluation and approval of new drugs. To explore how these competing obligations might be formalized with respect to the AIDS epidemic, we present a simple decision-theoretic optimization model of the clinical trials process against a backdrop of HIV transmission. Our framework sheds light on such issues as the economic consequences of decisions, the potential savings of a new therapy, the costs to society of delay, the value of better information, and how and when to undertake a clinical trial. We believe that this article represents a first effort to unravel the tangled web of epidemiological, economic, and statistical considerations that plague this policy issue.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Enhancing teacher health literacy in school health promotion: a vision for the new millennium.

While the National Health Education Standards focused interest and attention on student (consumer) health literacy, equal attention should be given to teacher (provider) health literacy. Teacher health literacy may be defined as "the capacity of teachers to obtain, interpret, and understand basic health information and services, with the competence to use such information and services in ways that enhance the learning of health concepts and skills by school students." This paper reviews a traditional model for school health teacher preparation, then presents an alternative, university field-tested model for enhancing health literacy in teacher education. This new model presents an innovative instructional paradigm, the Child and Adolescent Health (CAH) Logic Framework. This training model (vision) illustrates and emphasizes the link between child and adolescent health research and theory, CAH information, and application to health education, public policy, medical care, and health advocacy.

Adolescent↗
PubMed1998

Incorporating the service accomplishments into pre-registration curriculum to enhance reflective practice.

Much emphasis is being placed on the importance of reflective practice as a means to ensure that practitioners are competent in their practice. It is therefore important to ensure that student nurses acquire these reflective skills as part of their development throughout pre-registration curricula. Although reflective practice is seen as a major part of curricula activity, the style in which reflection is advocated takes many different formats. Strategies for developing reflection which focus on outcomes for students can become subjective and fail to place healthcare practice within the context of social structures and values. This paper offers a framework for reflection that promotes an outlook which is both objective and subjective, based on Mezirow's six levels of reflection (as adapted by Powell 1989) and O'Brien's (1987) five service accomplishments. Focus of reflection within the wider context of society and healthcare policy should enable development of a practitioner who is both competent in practice and can analyse and evaluate their practice.

Aged↗
PubMed2001

The parturient woman: can there be room for more than 'one person with full and equal rights inside a single human skin'?

AIMS OF THE PAPER: The aim of the paper is to raise awareness around the legal and ethical issues involved in the enforcement of caesarean sections on non-consenting women. The paper considers the competing rights of mother and foetus in situations where a mother's wishes may result in harm or death to the foetus. BACKGROUND/RATIONALE: In this light of various court decisions about enforcing caesarean sections, the paper examines the pertinent legal and ethical issues, recognising that health professionals need to operate within an explicit legal and ethical framework. Content. The arguments about a woman's right to autonomous decision-making and a foetus' absolute right to life are examined with the focus throughout being on the legal framework. The need for health professionals to work within this as well as to avoid the temptation to base individual clinical decisions or professional behaviour on subjective moral judgements is emphasized. The attitudes of the judiciary are considered along with recent legal developments. There is an analysis of the way in which established legal principle is sometimes circumvented to override a woman's right to autonomy. The part played by lawyers and health professionals in denying a woman's competence to consent in order to achieve an outcome of which they approve is critically appraised. The basis for the decisions in these cases is deconstructed, along with a discussion of the role of health professionals in contributing to the dilemmas highlighted. CONCLUSION: It is essential that nurses or midwives caring for pregnant women have a full understanding of the legal and ethical issues surrounding this complicated and emotive area and where they, as health professionals, fit within this. The subject matter is also a useful arena for debating such ethical and legal issues as capacity and competence to consent as well as the extent of the right of any patient to full autonomy.

Cesarean Section↗
PubMed2006

Competency-based training for patient handling.

A technique-training approach has traditionally been used to address the problem of back pain associated with patient handling. This project aimed to investigate whether different levels of safety culture, based on competency-based training, resulted in different behaviour (physical and cognitive) for patient handling tasks. Sixteen healthcare organisations in the UK participated from the acute and primary healthcare sectors. Archival data for each organisation were benchmarked against the Royal College of Nursing competencies for manual handling. Behavioural data were collected on two patient handling tasks: (1) sitting-to-standing and (2) repositioning-in-sitting using observations (postural analysis) and interviews (verbal protocol analysis). The data were analysed for each organisation and then grouped by task and method into larger data sets. These data sets were triangulated using the key decision-making points (from the interview data) as the framework. The results showed that in organisations with a more positive safety culture the nursing staff demonstrated more complex decision-making about the patient handling tasks and had lower levels of associated postural risk.

Back Pain↗
PubMedDate not supplied

Health promotion community development and the tyranny of individualism.

Economic evaluation of health promotion poses few major difficulties when the theoretical approach of the programme and the evaluation of cost and benefits are confined within the context of the individual. Methodological individualism has a long history in economics and the techniques of microeconomics are well suited to the examination of individually focused behaviour change programmes. However, new developments in community health promotion pose special challenges. These programmes have the community, not the individual, as the focus of programme theory and "community' means something completely different from the sum of individuals. Community empowerment and promotion of the community's capacity to deal with health issues are the goals of such programmes. To reflect these notions, sense of community and community competence should be considered as "functionings', an extra-welfarist constituent of well-being. Their inclusion as outcomes of community health promotion requires a shift from individualist utilitarian economics into a communitarian framework which respects the programme's notion of community. If health economics fails to develop new constructs to deal with these new approaches in health promotion, the application of existing techniques to community programmes will mislead health decision makers about their value and potential.

Bias↗
PubMed2000

Development of clinical assessment criteria for postgraduate nursing students.

This paper explores the development and implementation of specific criteria to determine the level of clinical performance of postgraduate nursing students during the first year of a Master of Nursing course. The authors describe two commonly used clinical skill assessment tools and identify limitations of these tools for postgraduate nursing students. As a result of these limitations, Clinical Assessment Criteria (CAC) utilising the framework of Benner (1984) was developed. Inherent within the CAC is four levels of clinical nursing performance, which enable the nurse teacher and student to monitor the progression from novice to proficient levels of practice within a specialty area. Following a successful pilot study, the CAC was incorporated into clinical assessments in nine specialty postgraduate courses. Furthermore, the framework developed for the CAC can also be integrated into a variety of professional development domains.

Clinical Competence↗
PubMed2000

Nursing students' early exposure to clinical practice: an innovation in curriculum development.

This paper describes a pilot study addressing issues surrounding the balance and status given to both theory and practice in the foundation part of a pre-registration programme. Contemporary thinking seems to suggest that there is a need to reverse recent trends which have placed an emphasis on theory. To facilitate this a framework for clinical learning was adapted to guide students' early exposure to clinical practice. The focus was to develop the students' observational and reflective skills whilst also providing the students with a frame of reference within which they could explore their theoretical studies. The information and experiences gained as a result of this study have led to the integration of an Orientation Framework to support students' early clinical experiences in a pre-registration programme.

Clinical Competence↗
PubMed1996

Use of a versatile axial dorsonasal musculocutaneous flap in repair of the nasal lobule.

We present our 17 years of experience in using a sliding axial musculocutaneous flap from the nasal dorsum in the repair of 53 nasal lobular defects (follow-up 3 to 212 months, mean 47.3 months). This flap is a modification of the classic Rintala flap but is based on a greater understanding of surgical anatomy, the biomechanical properties of skin, and physiology of flaps, all of which allow a more aesthetically satisfactory closure of very distal nasal lobular defects. After excising the tumor, two parallel incisions are made along the sides of the nasal dorsum, and flap is raised in the gliding plane deep to the fibromuscular layer of the nose and superficial to the cartilage and bone and then advanced over the defect, which can be as large as the entire nasal lobule. The flap is very reliable (no failure in our series) and easy to perform; furthermore, it is a fast, one-step reconstructive procedure that leaves the scars in areas of natural shadow. This flap makes use of a wide dorsal and glabellar undermining to recruit sufficient skin; it takes advantage of the mild tension exerted by the underlying nasal framework to lengthen the flap reliably without the need for an extra incision or Burow's triangles, as originally described by Rintala. Neither tip rotation nor glabella flattening has ever been found to be a real problem in our series because the flap elongates in a period of 2 to 6 weeks and tip always comes down, provided that the nasal framework is not modified. We believe that the axial musculocutaneous sliding flap has distinct advantages over other alternative local flaps in the repair of lobular nasal defects; moreover, although this simple operation cannot compete with the quality of the aesthetic results achieved by very skilled masters using frontal flaps, it is an easy, quick, one-step procedure that allows acceptable and reliable aesthetic results to be achieved by the majority of surgeons, and it does not harm the precious forehead donor site, which may become essential in case of the need for further reconstruction.

Aged↗
PubMed2005

The evolving portrait of cancer metastasis.

The phenomenon of cancer metastasis remains poorly understood. We discuss here various conceptual frameworks that attempt to rationalize the mechanisms by which tumors acquire metastatic ability. Portrayal of cancer as a somatic Darwinian process occurring within a tissue fails to fully explain the phenomenon of metastatic competence. The biology of pre-neoplastic cells also complicates this picture, since the phenotypes of normal cellular precursors are clearly relevant to metastatic behavior following transformation. Recent experimental results help to shed light on these and other considerations regarding the molecular mechanisms of malignant progression.

Animals↗
PubMed2007

Simulators for use in anaesthesia.

There are many simulators available for use in anaesthetic-related education and research. Those who wish to purchase a simulator or to establish a simulation facility face a daunting task in understanding the differences between simulators. Recent reviews have focused on narrower areas of simulation, such as airway management or basic life support, or on the application of simulators. It would be difficult to deal in detail with every simulator ever made for anaesthesia, but in the present review we cover the spectrum of currently available anaesthetic simulators, provide an overview of different types of simulator, and discuss a selection of simulators of particular interest, including some of historical significance and some examples of 'home made' simulators. We have found no common terminology amongst authors for describing or classifying simulators, and propose a framework for describing (or classifying) them that is simple, clear and applicable to any simulator.

Anesthesiology↗
PubMed1997

An overview of adolescent eating behavior barriers to implementing dietary guidelines.

Adolescents continue to report food and nutrient intake and physical activity levels that conflict with the U.S. Dietary Guidelines and the Year 2000 objectives. Some of the barriers to healthier eating and exercise are related to factors within the adolescent's environment, such as access to healthy food choices or availability of preventive nutritional guidance as part of routine health care. Many barriers, though, fit into the theoretical framework that attempts to describe determinants of other risky behaviors of adolescents. These include (1) adolescent and peer subgroup norms that devalue healthy eating behavior; (2) participation in other risky behaviors; (3) low competency (actual and perceived) in sports, food selection, and food preparation; and (4) familial and cultural expectations. Implications were discussed for intervention approaches and policy recommendations that help confront these barriers.

Adolescent↗
PubMed2006

Ethical issues involving the right hemisphere stroke patient: to treat or not to treat?

The management of patients with right hemisphere damage (RHD) presents a challenge to the allied health clinician. In addition to impairments in specific cognitive areas, some patients may not be aware of the presence or extent of their deficits or the impact of these deficits on everyday activities. This article briefly describes two related models of awareness/unawareness that may help guide the assessment and treatment process in patients with neurological damage including RHD. Then, some clinical care decisions regarding patients with decreased awareness are presented together with a framework for organizing and evaluating the various factors associated with a case.

Cognition Disorders↗
PubMed2005

Improving the ICU: part 2.

ICUs are a vital but troubled component of modern health-care systems. Improving ICU performance requires that we shift from a paradigm that concentrates on individual performance, to a systems-oriented approach that emphasizes the need to assess and improve the ICU systems and processes that hinder the ability of individuals to perform their jobs well. This second part of a two-part treatise establishes a practical framework for performance improvement and examines specific strategies to improve ICU performance, including the use of information systems.

APACHE↗
PubMed1991

Real life learning. Alternative to clinical skills development.

1. Pressure from educational institutions on clinical facilities necessitates the creation of alternative strategies that enable students to develop clinical skills outside the artificial atmosphere of a nursing laboratory or the formal clinical setting. 2. Assignments covering grief and loss experienced by the elderly; problems in performing activities of daily living experienced by the non-elderly; and existential anxieties experienced by the elderly help students to realize that such problems are not confined to those residing in institutional settings. 3. Each of these assignments sensitizes students to the practical reality of a variety of theoretical frameworks, which provides students with the opportunity of applying theory to practice in a nonthreatening environment.

Adaptation, Psychological↗