Shared resources: a collaborative approach to continuing education.
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Cost-Benefit Analysis↗
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Results for “shared approaches”
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.
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Sharing knowledge: an interdisciplinary approach in prevention of urinary tract infection.
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Humans↗
New approaches to job-sharing of training posts in the North Thames region.
This paper proposes a new way of managing the provision of flexible training opportunities by job-sharing. It shows how the difficulties of implementing job-sharing can be overcome, and gives an example of implementation of job-sharing in the context of flexible training.
Education, Medical, Graduate↗
A randomized controlled trial of shared decision making for prostate cancer screening.
OBJECTIVE: To evaluate a patient-educational approach to shared decision making for prostate cancer screening. DESIGN: Randomized controlled trial with preoffice visit assessment and 2-week follow-up. SETTING: University-based family practice center. PATIENTS: Men aged 45 through 70 years with no history of prostate cancer or treatment for prostate disease (N = 160). Two patients were unavailable for follow-up. INTERVENTION: Twenty-minute educational videotape on advantages and disadvantages of prostate-specific antigen (PSA) screening for prostate cancer. MAIN OUTCOME MEASURES: A measure of patients' core knowledge of prostate cancer developed for this study, reported preferences for PSA testing, and ratings of the videotape. RESULTS: Patients' core knowledge at baseline was poor. At 2-week follow-up, subjects undergoing videotape intervention showed a 78% improvement in the number of knowledge questions answered correctly (P = .001), and knowledge increased about mortality due to early-stage prostate cancer, PSA screening performance, treatment-related complications, and disadvantages of screening. No overall change was observed for control subjects. At follow-up, 48 (62%) of 78 intervention patients planned to have the PSA test compared with 64 (80%) of 80 control patients (18.5% absolute reduction; 95% confidence interval, 4.6%-32.4%; P = .009). Intervention subjects rated favorably the amount of information provided and the clarity, balance, and length of the videotape and would recommend the videotape to others. CONCLUSIONS: Patient education regarding the potential benefits and harms of early detection of prostate cancer can lead to more informed decision making. Incorporating the PSA videotape into the periodic health examination for asymptomatic men aged 50 years and older is recommended.
Aged↗
Lisa's lessons: a case study of mental health teaching and learning.
Practical approaches to the educational preparation of mental health nurses need to be shared in order to contribute to discipline development. This paper presents the results of an ethnographic study using case study and educational criticism to explore mental health classrooms and share practical approaches to teaching.
Anthropology, Cultural↗
The management of erectile dysfunction in the community.
Erectile dysfunction (ED) is a widely occurring benign disorder that affects men of all ages. The prevalence and severity of ED increases with age and results in considerable distress and impact on quality of life for those who suffer from it. As ED is associated with a wide variety of underlying conditions and co-morbidities there is a requirement for diversity of treatment options beyond those currently available. In the management of the ED patient both primary care and specialist physicians have an important role to play. This article reports on a stepwise approach for the diagnosis and treatment of ED, with an emphasis on a 'shared care' approach. The suitability of apomorphine SL (Uprima) for the front line management of the ED patient is described.
Erectile Dysfunction↗
Disease management: new wine in new bottles?
Cost pressures are driving the reorganization of the health care delivery system in the United States, causing health care delivery organizations to become larger and more diversified. These new health care delivery entities are arriving at the same time as a new approach to clinical care: commercial population-based medicine. This approach is sharing an increasing amount of space with the traditional physician-patient-based approach and offers strategies for managing a population's risk, demand, diseases, and outcomes. Although commercial population-based medicine strategies such as disease management may use many of the same tools as traditional public health approaches, they focus on the relatively short-term health needs of defined populations because of the underlying economic incentives facing payers. Population-based-medicine promises better use of resources and a systems approach to health care delivery, but it also presents the pitfalls of subversion by the needs of commercial companies, unanticipated adverse effects, and wide application without adequate preparation.
Case Management↗
Toward a representation format for sharable clinical guidelines.
Clinical guidelines are being developed for the purpose of reducing medical errors and unjustified variations in medical practice, and for basing medical practice on evidence. Encoding guidelines in a computer-interpretable format and integrating them with the electronic medical record can enable delivery of patient-specific recommendations when and where needed. Since great effort must be expended in developing high-quality guidelines, and in making them computer-interpretable, it is highly desirable to be able to share computer-interpretable guidelines (CIGs) among institutions. Adoption of a common format for representing CIGs is one approach to sharing. Factors that need to be considered in creating a format for sharable CIGs include (i) the scope of guidelines and their intended applications, (ii) the method of delivery of the recommendations, and (iii) the environment, consisting of the practice setting and the information system in which the guidelines will be applied. Several investigators have proposed solutions that improve the sharability of CIGs and, more generally, of medical knowledge. These approaches can be useful in the development of a format for sharable CIGs. Challenges in sharing CIGs also include the need to extend the traditional framework for disseminating guidelines to enable them to be integrated into practice. These extensions include processes for (i) local adaptation of recommendations encoded in shared generic guidelines and (ii) integration of guidelines into the institutional information systems.
Computer Simulation↗
Motion detectors in the locust visual system: From biology to robot sensors.
Motion detectors in the locust optic lobe and brain fall into two categories: neurones that respond selectively to approaching vs. receding objects and neurones that respond selectively to a particular pattern of image motion over a substantial part of the eye, generated by the locust's own movements through its environment. Neurones from the two categories can be differentiated on the basis of their response to motion at a constant velocity at a fixed distance from the locust: neurones of the first category respond equally well to motion in any direction whereas neurones in the second category respond selectively to one preferred direction of motion. Several of the motion detectors of the first category, responding to approaching objects, share the same input organisation, suggesting that it is important in generating a tuning for approaching objects. Anatomical, physiological, and modelling studies have revealed how the selectivity of the response is generated. The selectivity arises as a result of a critical race between excitation, generated when image edges move out over the eye and delayed inhibition, generated by the same edge movements. For excitation to build up, the velocity and extent of edge motion over the eye must increase rapidly. The ultrastructure of the afferent inputs onto the dendrites of collision sensitive neurones reveals a possible substrate for the interaction between excitation and inhibition. This interpretation is supported by both physiological and immunocytochemical evidence. The input organisation of these neurones has been incorporated into the control structure of a small mobile robot, which successfully avoids collisions with looming objects. The ecological role of motion detectors of the second category that respond to image motion over a substantial part of the visual field, is discussed as is the input organisation that generates this selective response. The broad tuning of these neurones, particularly at low velocities (<0.02 degree/s), suggests they may have a role in navigation during migratory flights at altitude. By contrast, their optimum tuning to high-image velocities suggests these motion detectors are adapted for use in a fast flying insect, which does not spend significant time hovering.
Animals↗
A neural-network approach for visual cryptography and authorization.
In this paper, we propose a neural-network approach for visual authorization, which is an application of visual cryptography (VC). The scheme contains a key-share and a set of user-shares. The administrator owns the key-share, and each user owns a user-share issued by the administrator from the user-share set. The shares in the user-share set are visually indistinguishable, i.e. they have the same pictorial meaning. However, the stacking of the key-share with different user-shares will reveal significantly different images. Therefore, the administrator (in fact, only the administrator) can visually recognize the authority assigned to a particular user by viewing the information appearing in the superposed image of key-share and user-share. This approach is completely different from traditional VC approaches. The salient features include: (i) the access schemes are described using a set of graytone images, and (ii) the codebooks to fulfil them are not required; and (iii) the size of share images is the same as the size of target image.
Algorithms↗
Predictive modeling plus intensive case management deliver solid results for Medicaid plan.
That's what happened to AmeriHealth Mercy, a Medicaid health plan based in Harrisburg, PA. And it resulted in skyrocketing costs and runaway utilization. However, the health plan devised a comprehensive approach to managing the population that has worked so well that developers are now interested in sharing the approach with other Medicaid health plans.
Case Management↗
Shared geriatric mental health care in a rural community.
INTRODUCTION: A pilot project in shared mental health care was initiated to explore opportunities to increase the capacity of the rural primary care system as a resource for older people with mental health needs. This was done within a framework for the delivery of best practices in geriatric mental health outreach. METHODS: Shared-care strategies combining education and clinical consultation between mentor psychiatrists and family physicians were implemented and then evaluated after one year to identify key factors in the success of approaches to shared mental health care for older people in a rural setting. RESULTS: Results provided new insights into shared care between primary care and specialty geriatric mental health services, rural geriatric mental health service delivery, developmental phases in service learning approaches, and building knowledge networks to promote continuing best practices. CONCLUSION: The results from the project's process evaluation have been integrated into the development of a permanent shared geriatric mental health care service for the rural setting. Preparation for an outcome evaluation that will focus on the impact on patient care has also been initiated.
Aged↗
The inverse effects of load transfer and load sharing on axial compressive stiffness.
BACKGROUND CONTEXT: The goal of spinal instrumentation is to stabilize involved motion segments while fusion occurs. Although some degree of load sharing is necessary for fusion, the ability of the instrumentation system to transfer the load may vary. PURPOSE: The purpose of this study is to formulate a mathematical relationship between load sharing and load transfer of specific spinal instrumentation systems using a well-accepted mechanical model. STUDY DESIGN/SETTING: Forty-eight American Society for Testing Materials standard ultra high molecular weight polyethylene cylinders were used as per designation F 1717-96, standard test methods for static and fatigue for spinal implant constructs in a corpectomy model. METHODS: Twenty-four spinal assemblies consisting of anterior plates, anterior rod, and posterior rods were subjected to compression bending tests using a MTS Bionix servo-hydraulic material testing apparatus. Each implant was tested in compression bending with and without the addition of a titanium load-sharing cage. The force applied was the independent variable, and the displacement was the dependent variable. The stiffness was determined for each setup with and without the addition of an anterior load-sharing cage. RESULTS: The average axial compressive stiffness of a system increased by a factor of 8.5 with the addition of the load-sharing cage. An inverse relationship existed between the compressive stiffness of the construct and its relative increase achieved with the addition of the load-sharing cage. The compressive stiffness of the system with the addition of the load-sharing cage approached that of the anterior device itself as the system flexibility increased. The ability of instrumentation systems to load share or load transfer and their respective stiffness was determined. CONCLUSIONS: The 5-mm rod screw posterior system was compared with the 7-mm Ti posterior system with the addition of one and two devices for transverse traction (DTTs). The rods with the increased diameter had a stiffness of 1723 n/mm with one DTT and 1815 n/mm with two DTTs. The addition of an anterior cage had little effect on the stiffness of these systems. Anterior plate and screw/rod systems were analyzed and showed similar mechanical behavior to the 5-mm posterior rod/screw systems. A significant increase in stiffness was realized with the addition of an anterior cage. A means to determine the load sharing/transferring properties of a spinal instrumentation system is presented. This technique will allow the amount of load transferred from the fusion mass to the instrumentation to be predicted.
Compressive Strength↗
An e-consent-based shared EHR system architecture for integrated healthcare networks.
OBJECTIVES: Virtual integration of distributed patient data promises advantages over a consolidated health record, but raises questions mainly about practicability and authorization concepts. Our work aims on specification and development of a virtual shared health record architecture using a patient-centred integration and authorization model. METHODS: A literature survey summarizes considerations of current architectural approaches. Complemented by a methodical analysis in two regional settings, a formal architecture model was specified and implemented. RESULTS: Results presented in this paper are a survey of architectural approaches for shared health records and an architecture model for a virtual shared EHR, which combines a patient-centred integration policy with provider-oriented document management. An electronic consent system assures, that access to the shared record remains under control of the patient. A corresponding system prototype has been developed and is currently being introduced and evaluated in a regional setting. CONCLUSION: The proposed architecture is capable of partly replacing message-based communications. Operating highly available provider repositories for the virtual shared EHR requires advanced technology and probably means additional costs for care providers. Acceptance of the proposed architecture depends on transparently embedding document validation and digital signature into the work processes. The paradigm shift from paper-based messaging to a "pull model" needs further evaluation.
Computer Communication Networks↗
Shared learning for shared care.
This is an account of a pilot multidisciplinary course in geriatric care for medical, nursing and physiotherapy students at The Middlesex Hospital, London. The course organization, content and evaluation methods are described. A problem-solving approach to shared learning is discussed and the author argues for the development of similar teaching programmes.
Curriculum↗
Objects and mappings: incompatible principles of display design - a critique of Marino and Mahan.
Representation aiding (and similar approaches that share the general orientation) has a great deal of utility, predictive ability, and explanatory power. Marino and Mahan (2005) discuss principles that are critical to the RA approach (configurality, emergent features, and mappings) in a reasonable fashion. However, the application of these principles is far from reasonable. The authors explicitly realize the potential for interactions between nutrients: "The nutritional quality of a food product is a multidimensional concept, and higher order interactions between nutrients may exist" (p. 126). However, they made no effort to discover the nature of these interactions: "No attempt was made to identify contingent interactions between nutrients" (p. 126). Despite not knowing the nature of the interactions between nutrients, they purposely chose a highly configural display that produced numerous emergent features dependent upon these interactions: "A radial spoke display was selected because of the strong configural properties of such display formats (Bennett & Flach, 1992)" (p. 124). Finally, the authors show apparent disdain for the specific mappings among domain, agent, and display that are fundamental to the RA approach: "[O]ther configural display formats could have been used" (p. 124). It is impossible to reconcile these statements and the RA approach to display design. However, these statements make perfect sense if a perceptual object is a guiding principle in one's approach to display design. Marino and Mahan (2005) draw heavily upon the principle of a perceptual object in their design justifications, experimental predictions, and interpretations of results. As we have indicated here and elsewhere (Bennett & Flach, 1992), we believe that these two sets of organizing principles for display design (i.e., objects and mappings) are incompatible. Display design will never be an exact science; there will always be elements of art and creativity. However, the guiding principles have moved well beyond the simple strategy of throwing variables into a geometric object format and relying upon the human agent's powerful perceptual systems to carry the design.
Computer Graphics↗
Genotyping of eight thiopurine methyltransferase mutations: three-color multiplexing, "two-color/shared" anchor, and fluorescence-quenching hybridization probe assays based on thermodynamic nearest-neighbor probe design.
BACKGROUND: The inherited deficiency of thiopurine methyltransferase (TPMT) leads to severe myelosuppression in homozygous patients treated with thiopurine derivatives. One in 300 Caucasians has a homozygous TPMT deficiency with no measurable enzyme activity. To date, eight single-point mutations have been characterized; one group (TPMT*3) accounts for 75% of these. METHODS: We used four LightCycler(TM) capillaries to investigate all eight mutations. The three mutations on exon 10 were detected in one capillary with a single "shared" anchor labeled 5' with Cy5.5 and 3' with fluorescein. A wild-type-compatible 3'-fluorescein-labeled probe 5' adjacent to the anchor covered the TPMT*7 mutation, and a 5'-LC-RED640-labeled probe 3' adjacent to the anchor covered the TPMT*3C mutation. For TPMT*4, the forward amplification primer was internally labeled with a fluorescence quencher [6-carboxytetramethylrhodamine (TAMRA)], and a 3'-fluorescein-labeled antisense wild-type-compatible probe was placed at the mutation. For TPMT*2 and TPMT*3D, located on exon 5, a shared anchor approach was chosen. TPMT*3B and TPMT*6 were detected in multiplex technique and TPMT*5 in conventional manner. Anchors and probes were designed using a thermodynamic nearest-neighbor model. RESULTS: All mutations were detected using four capillaries with one amplification protocol in 40 min. The concentrations of the shared anchors had to be decreased to reduce their intrinsic fluorescence resonance energy transfer signals. The quenching approach using TAMRA produced a very reproducible upside-down-shaped melting curve in channel 1 of the LightCycler. Deviations from wild type were easily detected because the smallest melting point shift for any possible mutation under the core of the probes was 1.5 degrees C. CONCLUSIONS: This total TPMT genotyping approach shows that it is possible to use double site-labeled anchor oligonucleotides, that channel 1 of the LightCycler can be used as detection channel for mutations using a quenching design, and that the designed probes enable detection of wild types with 100% likelihood.
Base Sequence↗
Crosscultural communication in those with airway diseases.
Transcultural consultations are becoming commonplace. Such consultations arise because patients from ethnic groups consult doctors, but also because patients consult doctors from other ethnic backgrounds. Such consultations require a cultural awareness and sensitivity which may be particularly necessary when concerning those with respiratory illnesses which are often long-term and about which there may be considerable stigma. The prevalence of respiratory disease can vary between ethnic groups, most noticeably in tuberculosis and smoking; and in diseases such as asthma, health service usage and treatment can vary significantly with ethnicity. Some of this may represent cultural, rather than disease specific differences. Good communication is essential throughout medical practice, but in transcultural consultations it is especially important that the doctor pays appropriate attention to likely patient beliefs and approaches to shared decision making. Usual negotiation regarding goals and outcomes first requires the clinician to understand how a patient's understanding of illness may vary from a traditional western scientific approach. Special attention needs to be paid to the optimal way of using interpreters and more time is often needed for crosscultural consultations. Specific training is necessary for health practitioners to enable them to acquire the skills for crosscultural care and this involves learning about other cultures and an appreciation of how a change in attitude often needs to be incorporated into the clinical approach. Acquiring these skills and understandings to facilitate optimal transcultural consultation enables transfer of these skills to other similar clinical scenarios such as the approach to those with disability. The global burden of long-term respiratory disease, both infectious and noncommunicable, coupled with increased migration and geographical mobility means that a successful crosscultural approach is now a priority area for attention.
Attitude of Health Personnel↗