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At least 127 records · Page 7Linked to original sources
PubMed1991

Pharmacists and the mandate of pharmaceutical care.

Implementing the mandate for delivery of drug therapy to achieve definite outcomes that improve a patient's quality of life is discussed from the perspective of the changes currently needed in both practice and education. Specifically, changes in practice should include: (1) a managerial framework that continuously supports clinical activities in everyday practice, (2) recognition of competence in clinical practice, and (3) documentation of and reimbursement for clinical service. Changes in education should include: (1) teaching of problem-solving skills to students by faculty/practitioners, and (2) redirecting the curricular content to provide the minimum knowledge base required for competent clinical practice. Pharmacists will begin to accept the mandate of pharmaceutical care when there is widespread training and use of technicians, implementation of problem-based education in the schools, and adequate problem-solving support for pharmacists in practice.

Drug Therapy↗
PubMed1989

Ethics in obstetric ultrasound.

The authors provide an overview of ethics, medical ethics, and obstetric ethics. An ethical framework is developed using the beneficence and autonomy models of moral responsibility in obstetric care. In terms of this framework, four ethical issues common to all ultrasound examinations are examined: (1) competence to perform obstetric ultrasound and referral to specialists, (2) routine ultrasound screening, (3) disclosure of results, and (4) confidentiality.

Beneficence↗
PubMed1976

[Timing of the orthodontic treatment in patients with cleft lip and cleft palate].

There is now a general concensus of opinion that the specific care of patients with congenital clefts should be performed in the framework of their rehabilitation in large centres. The values of timely and competent care is deduced from results obtained from 100 orthodontic patients. In cleft patients orthodontic treatment must begin several years earlier than in patients without clefts.

Age Factors↗
PubMed1992

[Assessment of IDF physicians in in-field trauma].

The system of care delivery of in-field trauma was assessed, leading to suggestions for improving the system and military medical training. This study reports the feasibility and validity of various methods of assessing the performance of Israel Defense Force physicians in administering trauma care. The methods included a standardized medical debriefing with filling in of a report form by a senior traumatologist, his review of the physician's performance, self-assessment by the physician, and a written test. 5 senior traumatologists with extensive experience in military trauma care were trained to assess the physicians' performance within 24-48 hours of incidents involving moderate to severe trauma injuries. 75 physicians who had been involved in the care of the in-field trauma patients during a 1-year period, November 1988 to October 1989, were assessed. Analysis of the results clearly indicated 2 areas for assessment: a) knowledge, mainly levels of comprehension and application in relevant areas of trauma and b) performance, including immediate diagnosis, treatment skills, and triage. The best method for evaluating knowledge was the written test, not peer review nor self-evaluation. However, the traumatologist's evaluation of care performance was highly correlated with the physician's self-assessment. For comprehensive assessment of in-field care it is advisable to integrate the 2 methods: performance review by a traumatologist and a comprehensive written test. Information gained from such assessment could improve the planning of in-service trauma training and the posting of physicians within the military framework.

Clinical Competence↗
PubMedDate not supplied

Nurse practitioner research: selected literature review and research agenda.

Selected literature is reviewed to illustrate current conceptual and methodological issues in nurse practitioner research. Concepts of style of practice, acceptance, satisfaction, and outcome are discussed. Methodological issues are linking process to outcome, complexity measures, use of existing data, and the effect of nurse practitioner education and experience on interpretation of findings. A research agenda with two objectives is proposed: studies designed to improve rather than evaluate practice and studies designed with a policy framework in mind.

Clinical Competence↗
PubMed2026

Identifying stakeholder behaviors for competency-based pharmacy education: A stage 1 behavior change wheel analysis.

INTRODUCTION/OBJECTIVES: Competency-Based Pharmacy Education (CBPE) is a strategic priority for preparing graduates to meet evolving healthcare needs. However, efforts to implement CBPE can stall due to behavioral challenges among faculty, administrators, preceptors, and learners. This study aimed to apply Stage 1 of the Behavior Change Wheel (BCW) to identify stakeholder-specific behaviors and associated determinants needed to implement the five core components of CBPE. METHODS: A multi-method approach grounded in the BCW, the Capability, Opportunity, Motivation - Behavior (COM-B) model, and the Theoretical Domains Framework (TDF) was used. Data were gathered through (1) targeted literature review; (2) structured focus groups with competency-based education experts and pharmacy education stakeholders; and (3) an iterative consensus process. Behaviors were mapped to the five CBPE components: (1) defined competencies, (2) developmental progression, (3) tailored instruction, (4) authentic experiential learning, and (5) programmatic assessment, and then mapped to COM-B and TDF constructs. RESULTS: Over fifty stakeholder-specific behaviors were identified and specified across the CBPE framework. This revealed shared barriers such as limited instructional design knowledge (psychological capability), insufficient assessment of infrastructure (physical opportunity), and misaligned professional identity (reflective motivation). Key TDF domains included knowledge, environmental context, beliefs about capabilities, and professional roles. The behavioral problem statements, specifications, and determinants were identified to support future intervention planning. CONCLUSION: This Stage 1 analysis provides a behaviorally grounded foundation for CBPE implementation by identifying stakeholder behaviors and conditions that enable change. These findings will inform the development of readiness-to-change assessments and targeted interventions (BCW Stages 2 and 3), supporting scalable and sustainable CBPE transformation in pharmacy education.

Education, Pharmacy↗
PubMed1987

[Evolution of the communicative function].

This presentation of recent developments in child language research attempts to show that communicative competence is not built solely upon purely linguistic foundations. The development of communicative competence cannot be considered to begin with the first words. There is a growing body of evidence showing that functional communication appears long before the child's first uses of meaning-bearing sound sequences based on the adult language. Adult-child interaction, both during prelinguistic and early linguistic stages, provides an essential framework upon which verbal communication is based. The acquisition of what can be considered as pragmatic competence, necessary for all communication, begins from the birth.

Child, Preschool↗
PubMed1989

[Rehabilitation and the European Community internal market].

Given the limited competencies of the European Community (EC) in this respect, harmonization of rehabilitation at the level and within the framework of the EC is not expected to occur in the foreseeable future even after completion of the EC internal market. There will however be increased efforts to coordinate existing systems. Moreover, decisions and measures in other fields, with broader competencies on the part of the EC, may affect the field of integration of disabled persons (e.g., transportation, vocational education). In the same manner, the harmonization of technical standards applicable for medical equipment may influence the field of rehabilitation. If, after completion of the internal market, rehabilitative services were sought abroad in countries of the EC, refusal to accept the costs incurred on territorial grounds alone would not seem to be considered admissible any longer.

Persons with Disabilities↗
PubMed1995

[Competence in nursing and its significance for professionalization].

The occupation of nursing is in an advanced stage of change. Demands for autonomy are manifest in the attempt to make nursing scientific. This results in raising the question, among others, of defining what it is about competence which makes it possible to call nursing a profession. Looking at developmental models, at the theory of socialisation one finds, typical of professions, congruence of head, heart and hand (cognitive, moral-communicative and pragmatic competence). An attempt is made to demonstrate that moral competence has the most important place because justice and caring form the nucleus of nursing models, within a framework of advocatorial ethics. Nursing loses its purpose if it is dominated by rationale of outcome and by the pragmatism of routine action. Professionalisation of nursing can make progress if research can provide valid arguments for autonomy, based on the competence paradigm described here.

Ethics, Nursing↗
PubMed1991

Problems of competence-based nurse education.

The system of nurse education in the UK is undergoing a radical shake-up. Many new courses are being designed and implemented along the lines of the Project 2000 framework. New curricula and course structures are required to meet the changing role of the nurse of the future. Many curriculum design teams are adopting a competence-based model of curriculum to meet these needs. This approach is receiving central encouragement (UKCC 1986). In this paper it is argued that this strategy is faulty and ill-conceived; the inherent difficulties of the competence-based model of curriculum design are highlighted. These issues are of fundamental concern to nurse educators and students in the UK.

Clinical Competence↗
PubMed2026

Estimating protein isoform abundances with [Formula: see text].

A single gene can encode multiple versions of a protein, dubbed isoforms, with varying functionality. Cellular control of isoform abundances is critical for multiple aspects of biology and is only partially regulated by transcript levels. While long-read sequencing facilitates transcript quantification, quantifying the resulting protein isoforms on a large scale is a major challenge, complicating biological interpretation of transcript alterations. Standard "bottom up" mass spectrometry can assess only short portions of isoforms called peptides, and these peptides often map onto more than one isoform. We introduce [Formula: see text] (Protein isoform Abundance Quantification), a Bayesian method that leverages multiomic information from the peptidome and transcriptome to provide accurate estimates of isoform abundance even when peptide mapping is ambiguous. [Formula: see text] offers several advantages over existing methods in a unified framework. It provides uncertainty quantification, integrates multiomic information for improved accuracy, and provides a rigorous framework for hypothesis testing. Extensive simulations show that [Formula: see text] consistently outperforms competing methods in detecting differentially abundant protein isoforms and estimating their abundances. We use [Formula: see text] to investigate differences in isoform abundance levels between people with schizophrenia and control subjects, confirming a long-held hypothesis that levels of the C4A isoform of Complement Component 4 are increased in schizophrenia while C4B is not. These results demonstrate that [Formula: see text] can identify significant variations in isoform abundance levels not previously possible.

Protein Isoforms↗
PubMed1986

Recent advances in the pathogenesis and pathophysiology of bacterial meningitis.

Bacterial meningitis continues to account for worldwide morbidity and mortality despite the advent of effective bactericidal antibiotic therapy. Recent advances over the past 10 years in the development of experimental animal models as well as basic investigation into critical bacterial surface virulence factors have begun to clarify a conceptual framework for understanding the mechanism of meningitis development in humans. Basic observations regarding competing host defenses and bacterial virulence factors have supported a pathogenetic sequence of mucosal colonization with a meningeal pathogen; systemic host invasion with intravascular replication; blood brain barrier penetration and unimpeded CSF proliferation amid the impaired host defenses in the CSF milieu; and pathophysiologic sequelae including vasogenic, cytotoxic, and interstitial brain edema (and other processes) accounting for irreversible neuronal injury and death. Only through continued basic investigation into each of these pathogenetic steps will significant reductions in morbidity and mortality ensue.

Animals↗
PubMed1995

Literature and medicine: contributions to clinical practice.

Introduced to U.S. medical schools in 1972, the field of literature and medicine contributes methods and texts that help physicians develop skills in the human dimensions of medical practice. Five broad goals are met by including the study of literature in medical education: 1) Literary accounts of illness can teach physicians concrete and powerful lessons about the lives of sick people; 2) great works of fiction about medicine enable physicians to recognize the power and implications of what they do; 3) through the study of narrative, the physician can better understand patients' stories of sickness and his or her own personal stake in medical practice; 4) literary study contributes to physicians' expertise in narrative ethics; and 5) literary theory offers new perspectives on the work and the genres of medicine. Particular texts and methods have been found to be well suited to the fulfillment of each of these goals. Chosen from the traditional literary canon and from among the works of contemporary and culturally diverse writers, novels, short stories, poetry, and drama can convey both the concrete particularity and the metaphorical richness of the predicaments of sick people and the challenges and rewards offered to their physicians. In more than 20 years of teaching literature to medical students and physicians, practitioners of literature and medicine have clarified its conceptual frameworks and have identified the means by which its studies strengthen the human competencies of doctoring, which are a central feature of the art of medicine.

Clinical Medicine↗
PubMed1994

Intelligent diagnostic monitoring using trend templates.

In previous work we have defined our trend template epistemology for clinically significant trends and we have illustrated and tested a program TrenDx that monitors time-ordered process data by matching the data to trend templates. Our initial application domain was pediatric growth monitoring. In continuing work we have explored monitoring hemodynamic and respiratory parameters of intensive care unit patients. This application has highlighted the needs for advances in our representation and monitoring algorithms. In particular, we have added reasoning with uncertainty to the trend template epistemology, and a new control structure allowing numerical ranking of competing trend templates. Furthermore, intelligent monitoring in any medical domain requires a coherent framework for diagnostic monitoring. In this paper we show how TrenDx can be extended to a framework including sending alarms, changing clinical context, and filtering data streams.

Diagnosis, Computer-Assisted↗
PubMed1987

Three applications of the Role Delineation Project 1985 Curriculum Framework.

Colleges are beginning to use the Role Delineation Project Curriculum Framework for curricular reform at the graduate and undergraduate levels. This paper describes the efforts of three universities to revise their curricula based on the Framework. At Towson State University, it is being used with other national and state standards to assess health educators. At the University of Alabama at Birmingham, it provided the structure by which the faculty determined the competence of exiting health majors. At the University of Georgia, it was used in strategic planning and graduate education restructuring. The Framework, while lacking material in certain professional development areas, provides the structure for departments to begin the process of health education curricula reform.

Curriculum↗
PubMed1974

Clinical studies on a transformation test for identification of Acinetobacter (Mima and Herellea).

Deoxyribonucleic acid (DNA) from 250 strains of aerobic, nonfermentative, gram-negative coccobacilli and rods were tested for the ability to transform a stable competent auxotroph of Acinetobacter (strain trp E 27) to prototrophy by using the method established by Juni. Several modifications of Juni's original procedure were made to adapt it for use in a clinical diagnostic laboratory. These modifications were directed primarily towards shortening the procedure to allow completion in a time framework consistent with current procedures. The modifications included changes in sterilization temperature, incubation time and temperature of the competent auxotroph and DNA preparation, overnight incubation temperature, and variations in the age of the auxotroph culture when used. Under these conditions, the transformation can easily be performed in 24 h, the final 16 to 18 h being an overnight uninterrupted incubation period. When used in conjunction with the glucose oxidative fermentative basal metabolism test, it provided a rapid highly efficient means for grouping and identifying acinetobacters which is far superior to a biochemical schema. Without exception, the 141 strains of DNA from Acinetobacter species were able to transform the auxotroph to prototrophy. None of the 105 oxidase-positive nonfermenters possessed DNA which was able to transform the Acinetobacter auxotroph to prototrophy.

Acinetobacter↗