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Recruiting African American men for cancer screening studies: applying a culturally based model.

In a study of psychosocial factors related to prostate cancer screening (PCS) of African American men, researchers achieved significant success in recruitment. Key strategies included addressing specific barriers to PCS for African American men and placing recruitment efforts in a conceptual framework that addressed cultural issues (PEN-3 model). To conduct cancer prevention research in the African American community, to engage in health promotion in collaboration with churches, and to recruit African American men, a culturally competent approach that incorporates the values of the community is essential. Implications for addressing specific barriers to recruitment and building partnerships in health promotion research are discussed.

Black or African American↗

[Participation in the design of a political pedagogical project in nursing].

This paper reports an experience tracing the route of the academic community pursuing a Nursing Degree at Federal University of Santa Maria, while designing their Political-Pedegogical Project. The methodology used for creating this project was the promotion of seminars, which brought together professors, students, civil servants, and nurses who work in practice classes and supervised internships. For the organization of the project, referential, conceptual, and structural landmarks have been used, adapted from Saupe and Alves. This nursing undergraduate program is on the process of designing its framework, and is planning on seminars to discuss teaching methodology, besides designing a follow-up and evaluation plan for the implementation of their Political Pedagogic Project, as well as for the improvement of faculty competency.

Brazil↗

Dynamical interactions between multiple cancers.

Multiple tumors in a patient have the possibility to interact with each other, through the competition for new blood supply which is required for growth and progression (angiogenesis). The multiple tumors can be independent, multiple primary cancers. Alternatively, they can be metastases which originate from one primary tumor. This paper uses mathematical models to investigate such dynamical interactions between multiple cancers. We start with a model which describes the growth of a single angiogenic tumor, and then generalize this model to include multiple tumors which compete for circulating endothelial progenitor cells in order to build new blood vessels. We explore under which conditions multiple tumors can coexist, and when one tumor can exclude other tumors from growing. Based on this framework, we discuss the circumstances under which independent multiple primary tumors can arise. We further discuss the inefficiency of metastatic cells to grow successfully, and suggest an explanation for the occurrence of multiple metastases with an unknown primary cancer.

Humans↗

Measurement of perceived competence in Dutch children with mild intellectual disabilities.

BACKGROUND: Little research has been conducted on the perceived competence of children with mild intellectual disabilities (MID). One of the reasons for the marked absence of research appears to be the lack of reliable and clearly valid measurement instruments for this particular group of children. In the present study, it was examined whether a pictorial scale originally designed to measure perceived competence in typically developing children could successfully be used with children with MID. METHODS: The pictorial scale was administered to a group of 106 children with MID. The construct validity, reliability and stability of the scale were investigated. RESULTS: The results of the exploratory factor analyses and the confirmatory factor analyses supported the conceptual framework proposed. The construct validity was also supported by the pattern of intercorrelations between the subscales. The scale had adequate internal consistency and the stability analyses showed sufficient stability across a 4-month period. CONCLUSIONS: The findings show the psychometric properties of the pictorial scale to justify its use with children with MID.

Child↗

A framework for understanding visits by frequent attenders in family practice.

OBJECTIVE: Our purpose was to develop a typology of outpatient visits between family physicians and adult "frequent attender" patients. STUDY DESIGN: This was a cross-sectional observational study using qualitative analysis of family physician visits. Three family physician researchers reviewed detailed field notes for each patient based on direct observation of a single office visit to determine major themes and characteristics of physician-patient encounters. POPULATION: Non-pregnant adults in the top 5% for visit frequency, and age-and sex-mated non-frequent attenders were identified from among 1194 adult patients in 18 Midwestern family practice offices as part of The Prevention and Competing Demands in Primary Care Study. RESULTS: Visits by 62 patients who had made at least 25 visits in the previous 2 years were selected (frequent attender visits). Three major dimensions emerged to distinguish different encounter types: (1) biomedical complexity, (2) psychosocial complexity, and (3) the degree of dissonance between the patient and the physician. These 3 dimensions were used in a descriptive framework to characterize visit types as: simple medical, ritual visit, complicated medical, the tango, simple frustration, psychosocial disconnect, medical disharmony, and the heartsink visit. CONCLUSIONS: The discovery of a wide variation of encounter types among adult frequent attenders and the resulting descriptive framework laid a foundation for defining the appropriateness of outpatient health care utilization, for designing interventions to reduce inappropriate utilization, and for educating physicians regarding effective management of frequent attender patients.

Adult↗

Teaching psychiatry in an integrated medical curriculum.

OBJECTIVE: Efforts to improve the psychiatric competence of the general medical workforce must include an appraisal of how psychiatry is taught in medical schools. As a contribution to this appraisal a description is given of psychiatric education in the innovative undergraduate medical curriculum at the University of Newcastle. METHOD: An outline of the features which characterise medical education at Newcastle is provided and the way in which the teaching of psychiatry is organised within this framework is presented. RESULTS: The characteristics of the Newcastle undergraduate program in psychiatry include its integration with teaching in other clinical and basic science disciplines, continuity throughout the entire five years of the course, and the emphasis on skills acquisition and their assessment. CONCLUSIONS: The relative merits and disadvantages of the Newcastle approach to undergraduate psychiatry education are presented and the problem of assessing the effectiveness of this approach by outcomes measurement, particularly of integrated competencies and their application in general medical settings, is discussed.

Clinical Competence↗

Latin American Cancer Research Coalition. Community primary care/academic partnership model for cancer control.

The Latin American Cancer Research Coalition (LACRC) was funded by NCI as a Special Populations Network to 1) provide training to clinic staff in cancer control and foster development of Latino faculty training, 2) conduct a needs assessment with the community clinics, 3) enhance the ability of the clinics to promote healthy lifestyles, 4) collaborate on research projects to improve use of early detection, and 5) explore partnerships to increase access to culturally competent cancer care. The LACRC developed a model for cancer control focused on community-based clinics as the focal point for in-reach and community outreach targeted to Latinos to reduce cancer disparities. This framework was designed to link the community to local hospitals and academic centers, build capacity, and promote diffusion of innovations directly into delivery systems. Eight research projects submitted by junior investigator/clinic teams have been funded by NCI. These research projects range from recruiting for clinical trials to prevention to survivorship. The LACRC has trained 6 cancer control coordinators from partner sites and educated 59 undergraduate minority student interns in aspects of cancer control research. Central to LACRC's success to date has been the creation and maintenance of an infrastructure of trusting relationships, especially those developed between clinician/investigators and individuals within the greater Latino community. Community clinics can be effective agents for cancer control among Latinos. Latinos are likely to participate in research conducted by culturally representative teams of researchers using culturally appropriate recruiting strategies. Cancer 2006. (c) 2006 American Cancer Society.

Central America↗

Clinical Prevention and Population Health Curriculum Framework: the nursing perspective.

The Clinical Prevention and Population Health Curriculum Framework (Curriculum Framework) was developed by the Healthy People Curriculum Task Force comprised of representatives from allopathic and osteopathic medicine, dentistry, nursing and nurse practitioners, pharmacy and physicians assistants. This multidiscipline Task Force was covened to address the Healthy People 2010 objective of increasing the health promotion/prevention content in health professional education. A focus on clinical prevention and population health activities is central to the goal of improving the health status of the nation and offers the greatest potential to reduce many leading causes of death and improve quality of life across diverse populations. The Curriculum Framework provides a set of 4 components (evidence base for practice, clinical preventive services, health systems/health policy and community aspects of practice) and 19 domains for organizing and implementing the curriculum. The title "Clinical Prevention and Population Health" includes both individual and population focused health promotion and prevention efforts. The role of nursing in developing the Curriculum Framework, and the tailoring and implementation of the Curriculum Framework for undergraduate and graduate programs in nursing is discussed.

Clinical Competence↗

ProteinShop: a tool for interactive protein manipulation and steering.

We describe ProteinShop, a new visualization tool that streamlines and simplifies the process of determining optimal protein folds. ProteinShop may be used at different stages of a protein structure prediction process. First, it can create protein configurations containing secondary structures specified by the user. Second, it can interactively manipulate protein fragments to achieve desired folds by adjusting the dihedral angles of selected coil regions using an Inverse Kinematics method. Last, it serves as a visual framework to monitor and steer a protein structure prediction process that may be running on a remote machine. ProteinShop was used to create initial configurations for a protein structure prediction method developed by a team that competed in CASP5. ProteinShop's use accelerated the process of generating initial configurations, reducing the time required from days to hours. This paper describes the structure of ProteinShop and discusses its main features.

Computational Biology↗

Nurses' communication skills: an evaluation of the impact of solution-focused communication training.

AIMS: This paper describes the evaluation of a short training course in solution-focused brief therapy (SFBT) skills. This evaluation examined the relevance of SFBT skills to nursing and the extent to which a short training course affected nurses' communication skills. BACKGROUND: Nurses' communication skills have been criticized for many years, as has the training in communication skills that nurses receive. The absence of a coherent theoretical or practical framework for communication skills training led us to consider the utility of SFBT as a framework for a short training course for qualified nurses, the majority of them are registered nurses working with adults. DESIGN AND METHODS: Quantitative and qualitative data were collected: the former using pre- and post-training scales, the latter using a focus group conducted 6 months after the training. Data were analysed using the Wilcoxon signed-rank test and content analysis. RESULTS AND FINDINGS: Quantitative data indicated positive changes in nurses' practice following the training on four dimensions, and changes in nurses' willingness to communicate with people who are troubled reached levels of significance. Qualitative data uncovered changes to practice, centred on the rejection of problem-orientated discourses and reduced feelings of inadequacy and emotional stress in the nurses. CONCLUSIONS: There are indications that SFBT techniques may be relevant to nursing and a useful, cost-effective approach to the training of communication skills. Solution focused brief therapy provides a framework and easily understood tool-kit that are harmonious with nursing values.

Attitude of Health Personnel↗

Evaluating research literature: the educated clinician.

The purpose of this article is to present a framework for reader evaluation of research literature. The elements of a research article are outlined by citing examples from the January 1984 issue of Physical Therapy. We present concrete suggestions that clinicians can use to develop competence in evaluating research literature and include an annotated bibliography of research references. Better patient care and increased professional growth will result when clinicians learn to evaluate and make use of the research literature.

Bibliographies as Topic↗

Psychoeducation: a basic psychotherapeutic intervention for patients with schizophrenia and their families.

Psychoeducation was originally conceived as a composite of numerous therapeutic elements within a complex family therapy intervention. Patients and their relatives were, by means of preliminary briefing concerning the illness, supposed to develop a fundamental understanding of the therapy and further be convinced to commit to more long-term involvement. Since the mid 1980s, psychoeducation in German-speaking countries has evolved into an independent therapeutic program with a focus on the didactically skillful communication of key information within the framework of a cognitive-behavioral approach. Through this, patients and their relatives should be empowered to understand and accept the illness and cope with it in a successful manner. Achievement of this basic-level competency is considered to constitute an "obligatory-exercise" program upon which additional "voluntary-exercise" programs such as individual behavioral therapy, self-assertiveness training, problem-solving training, communication training, and further family therapy interventions can be built. Psychoeducation looks to combine the factor of empowerment of the affected with scientifically founded treatment expertise in as efficient a manner as possible. A randomized multicenter study based in Munich showed that within a 2-year period such a program was related to a significant reduction in rehospitalization rates from 58% to 41% and also a shortening of intermittent days spent in hospital from 78 to 39 days. Psychoeducation, in the form of an obligatory-exercise program, should be made available to all patients suffering from a schizophrenic disorder and their families.

Cognition↗

Identifying the management development needs of senior executives in Iran's teaching hospitals.

This research paper reports the findings of the first comprehensive survey of senior executives in Iran's teaching hospitals. It is based on an analysis identifying the continuing professional development (CPD) needs of the total population of the two senior levels of teaching hospitals management-presidents of physician-managers and administrative-managers. Four key areas of management knowledge were selected as the focus of the need identification: operational; financial; human resource; and organization change. The findings reveal a pent up demand for introductory level, formal knowledge in all four areas of management theory, to complement and extend the practical experience they have acquired in managing the complex environment of teaching hospitals. The paper goes on to propose a curriculum design and overall framework of provision to meet these genuinely felt CPD needs.

Curriculum↗

Nurse-initiated thrombolysis: a systematic review of the literature.

This article aims to review, in a systematic manner, the current published evidence base for nurse-initiated thrombolysis. Reasons for this evolution in nursing practice are outlined. Themes emerging from the review are identified. Methodological issues are discussed. This article outlines a conceptual framework for practice evolution. Further research is needed to improve the strength of the evidence base by studies with improved design.

Clinical Competence↗

University Health Network framework for advanced nursing practice: development of a comprehensive conceptual framework describing the multidimensional contributions of advanced practice nurses.

BACKGROUND: The global paradigm shift resulting from radical transformations in knowledge and technology is significantly changing the context of healthcare delivery. In this changing environment, the contributions of health professions are vital in ensuring that the healthcare system adapts to meet the needs of today's patient. Advanced practice nurses (APNs) are clinical scholars and leaders in creating innovative approaches to patient care and organizational and professional leadership. AIMS: To develop a comprehensive conceptual framework for advanced nursing practice at University Health Network that will enhance role clarity by describing the complexity of these nursing roles and the significant contributions they make to patients and the healthcare system. METHODS: A critical review of the literature and a consultative process were undertaken to build consensus and develop a comprehensive framework for advanced nursing practice. RESULTS: The development of the University Health Network Framework for Advanced Nursing Practice (UHN-FANP), which clearly articulates all dimensions of advanced nursing practice roles. CONCLUSION: As clinical leadership roles in nursing continue to evolve, utilization of a conceptual framework facilitates role clarity, role implementation and role evaluation.

Clinical Competence↗

A cognitive task analysis for dental hygiene.

To be an effective assessment tool, a simulation-based examination must be able to evoke and interpret observable evidence about targeted knowledge, strategies, and skills in a manner that is logical and defensible. Dental Interactive Simulations Corporation's first assessment effort is the development of a scoring algorithm for a simulation-based dental hygiene initial licensure examination. The first phase in developing a scoring system is the completion of a cognitive task analysis (CTA) of the dental hygiene domain. In the first step of the CTA, a specifications map was generated to provide a framework of the tasks and knowledge that are important to the practice of dental hygiene. Using this framework, broad classes of behaviors that would tend to distinguish along the dental hygiene expert-novice continuum were identified. Nine paper-based cases were then designed with the expectation that the solutions of expert, competent, and novice dental hygienists would differ. Interviews were conducted with thirty-one dental hygiene students/practitioners to capture solutions to the paper-based cases. Transcripts of the interviews were analyzed to identify performance features that distinguish among the interviewees on the basis of their expertise. These features were more detailed and empirically grounded than the originating broad classes and better serve to ground the design of a scoring system. The resulting performance features were collapsed into nine major categories: 1) gathering and using information, 2) formulating problems and investigating hypotheses, 3) communication and language, 4) scripting behavior, 5) ethics, 6) patient assessment, 7) treatment planning, 8) treatment, and 9) evaluation. The results of the CTA provide critical information for defining the necessary elements of a simulation-based dental hygiene examination.

Algorithms↗