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PubMed2006

Training competent and effective Primary Health Care Workers to fill a void in the outer islands health service delivery of the Marshall Islands of Micronesia.

BACKGROUND: Human resources for health are non-existent in many parts of the world and the outer islands of Marshall Islands in Micronesia are prime examples. While the more populated islands with hospital facilities are often successful in recruiting qualified health professionals from overseas, the outer islands generally have very limited health resources, and are thus less successful. In an attempt to provide reasonable health services to these islands, indigenous people were trained as Health Assistants (HA) to service their local communities. In an effort to remedy the effectiveness of health care delivery to these islands, a program to train mid-level health care workers (Hospital Assistants) was developed and implemented by the Ministry of Health in conjunction with the hospital in Majuro, the capital city of the Marshall Islands. METHODS: A physician instructor with experience and expertise in primary health care in these regions conducted the program. The curriculum included training in basic health science, essentials of endemic disorders and their clinical management appropriate to the outer islands. Emphasis was given to prevention and health promotion as well as to the curative aspects. For clinical observation, the candidates were assigned to clinical departments of the Majuro hospital for 1 year during their training, as assistants to the nursing staff. This paper discusses the details of the training, the modalities used to groom the candidates, and an assessment of the ultimate effectiveness of the program. RESULTS: Out of 16 boys who began training, 14 candidates were successful in completing the program. In 1998 a similar program was conducted exclusively for women under the auspices of Asian Development Bank funding, hence women were not part of this program. CONCLUSION: For developing countries of the Pacific, appropriately trained human resources are an essential component of economic progress, and the health workforce is an important part of human resources for sustainable progress and development.

Journal Article↗
PubMedDate not supplied

Faculty development: a transcultural experience.

A collaborative education program between Schools of Nursing at the Jordan University of Science and Technology and the University of Windsor, funded by the Canadian International Development Agency (CIDA), provides advanced clinical and theoretical education for Jordanian faculty and thus enriches the education of nursing students. This article describes the preparation of the faculty development proposal and the implementation of the project in a transcultural context, and identifies strengths and limitations of the project. Recommendations for effective strategies regarding international development in nursing education are made and a discussion of the benefits that ensued to both faculties is included.

Canada↗
PubMed1995

Comparison of performance of students in an accelerated baccalaureate nursing program for college graduates and a traditional nursing program.

Currently, many schools of nursing across the country have implemented various models of post-baccalaureate nursing education. There has been minimal published evaluation of this type of nursing education. In September 1989, a large urban university in the Midwest instituted a baccalaureate program for non-nurse college graduates. After completion of prerequisite science and other liberal arts courses, students complete the nursing program within a 13-month period. This study compared the performance, measured by Schwirian's 6-Dimension Scale (1978), and academic achievement of students in the accelerated nursing program for students with college degrees (N = 27) and students in a traditional nursing program (N = 29). Data also were collected on selected demographic variables. Findings indicated significant differences between the groups. Students in the accelerated group scored higher on nursing performance and passing rate on state board examination. The traditional group reported significantly more hours worked and less hours studied. There were no significant differences between the groups in terms of age, gender, and grade point average.

Achievement↗
PubMed1983

Occupational health and safety in Finland.

The tradition of Finnish legislation on occupational health and safety began 180 years ago. The renewal cycle of the principal acts has been about 20 to 30 years. At present the Finnish occupational health and safety legislation meets the Scandinavian standard well, though the structure of the Finnish legislation meets the Scandinavian standard well, though the structure of the Finnish legislation is more fragmented. The organization and manpower resources of occupational health and safety comprise more than 100,000 persons (5% of the labor force), and the number of full-time experts is about 3,600. The finances amount to 0.3% of the gross national product. Although intensive reforms for strengthening legislation, research, and practice were carried out during the 1970s, one-third of the labor force still works under daily health and safety risks. Several occupational and nonoccupational risk consequences cummulate into one and the same high risk population. Accident risk still remains the most prevalent and severe type of risk in the Finnish work environment. Three major national programs (National Occupational Health and Safety Program, National Occupational Health Service Program and National Program for Science Policy) were established so that the needs of occupational health and safety can be met. The programs are designed to respond not only to current problems, but also to those which can be expected in the future (caused, eg, by the large-scale implementation of new technology).

Accident Prevention↗
PubMed1993

Regulation: threat or opportunity?

There are those in the medical device manufacturing industry who consider the new regulatory system in Europe to be a burden that will reduce profitability. In this article, the author makes a case for the benefits that can be gained by implementing the new procedures, particularly for the many small companies that make up the European medical device industry. By using implementation of the new system as an opportunity to take a fresh look at product development and manufacturing processes, profitability can be increased.

European Union↗
PubMed2000

A library-based bioinformatics services program.

Support for molecular biology researchers has been limited to traditional library resources and services in most academic health sciences libraries. The University of Washington Health Sciences Libraries have been providing specialized services to this user community since 1995. The library recruited a Ph.D. biologist to assess the molecular biological information needs of researchers and design strategies to enhance library resources and services. A survey of laboratory research groups identified areas of greatest need and led to the development of a three-pronged program: consultation, education, and resource development. Outcomes of this program include bioinformatics consultation services, library-based and graduate level courses, networking of sequence analysis tools, and a biological research Web site. Bioinformatics clients are drawn from diverse departments and include clinical researchers in need of tools that are not readily available outside of basic sciences laboratories. Evaluation and usage statistics indicate that researchers, regardless of departmental affiliation or position, require support to access molecular biology and genetics resources. Centralizing such services in the library is a natural synergy of interests and enhances the provision of traditional library resources. Successful implementation of a library-based bioinformatics program requires both subject-specific and library and information technology expertise.

Computational Biology↗
PubMed1999

[Methods most frequently used in the diagnosis of renal diseases leading to nephrectomy].

In the past few years, the progress of science and technology, and introduction of new diagnostic and treatment methods (echography, isotope study, computerized axial tomography, renovasography, magnetic resonance imaging and others) have contributed greatly to early detection and timely treatment of pathological processes involving the kidney (ZK El-Zein, 1995). After practical implementation of new clinical methods of examination it becomes possible to gain better insight into the undelying causes and character of renal diseases (T. Patrashkov, 1982). The study covers 388 patients subjected to nephrectomy for various diseases of the kidneys and urether, diagnosed and treated in the Department of Urology-University Hospital "Alexandrovska", over the period 1990 through 1995. The commonest diagnostic methods used to make diagnosis prior to nephrectomy include: 1. Survey roentgenography of kidneys, urethers and urinary bladder (KUB)--364 (93.81%). 2. Venous urography--320 (82.47%). 3. Echography--302 (77.83%). (Antegrade pyelography--2 (0.51%). 4. Isotope nephrogram (ING)--212 (54.63%). 5. Scintography of kidneys--126 (32.47%). 6. Computerized axial tomography (CAT)--82 (21.13%)/(70.68%) among 116 renal tumor nephrectomies. 7. Renovasography--82 (21.13%). 8. Retrograde pyelography--48 (12.37%). 9. Gamma-camera--10 (2.57%). 10. Cystoscopy--6 (1.54%). 11. Ureterorenoscopy--2 (0.51%). Presumably, apart from the new "noninvasive" methods of study (computerized axial tomography--CAT and echography), the conventional venous urography has by no means lost its popularity.

Adult↗
PubMed2001

Public health in Bosnia and Herzegovina.

It has been presented flow of socio-medical development and implementation on former Yougoslavia and Bosnia and Herzegovina territory in last thirty years. The names of those who are deserved for socio-medical development and its insufficiency on the organization on health system and some specific parts of it. Doubtlessly, the social medicine, as science and profession, and specially that one in Bosnia and Herzegovina, had high level among other disciplines, but also as profession per se, specially at the International level. There is huge evidence of numerous projects, congress papers, recognized by indigenous and international audience.

Bosnia and Herzegovina↗
PubMed1998

Weaning patients with dysphagia from tube feeding to oral nutrition: A proposed algorithm.

In acute rehabilitation, weaning patients from tube feeding to oral nutrition is a primary nutrition goal. In the Neurocognitive and Neuromuscular Unit at the Chedoke Campus of the Hamilton Health Sciences Corporation, this goal becomes particularly challenging in the presence of dysphagia. This paper presents a proposed two-phase algorithm intended to offer the dietitian a guide for weaning such patients. The algorithm comprises the Preparatory Phase (medical and nutritional stability, swallowing assessment and implementation of an intermittent tube feeding schedule) and the Weaning Phase (covering progress from stimulation feeds through to full oral nutrition and tube withdrawal). The importance of monitoring for aspiration, aspiration pneumonia and dehydration is stressed. Feeding and swallowing strategies, dietary modifications and behavioural and cognitive characteristics necessary for oral intake are described. Withdrawal of the feeding tube post-weaning may enhance quality of life, patient comfort and may maximize options for discharge environments.

Journal Article↗
PubMedDate not supplied

[Qualitative research in evaluation of health promotion programs in the context of health and disease paradigms].

The authors analyse selected aspects of evaluation research in relation to the changing paradigms of health and disease. The process of change in the biomedical paradigm, gradually becoming the biopsychosocial (socioecological), holistic model, is discussed. A short description of the two paradigms is given, including a critique of the biomedical model of health and disease based on evidence from social science research. In particular the wide definition of evaluation and the effectiveness of evaluation studies in health promotion are discussed. Selected practical consequences of accepting the democratic role of evaluation are analysed. The significance of the formative aspects of evaluative procedures for creating, modifying and implementing health promotion programmes is discussed. Another issue included in this analysis is the problem of objectivity of evaluation studies and the status of the evaluator in relation to other persons involved in programme implementation. The effectiveness of evaluation studies in relation to the biomedical and biopsychosocial paradigms are discussed in the context of differences between quantitative and qualitative evaluation methods. More detailed discussion concerns qualitative evaluation using selected methods, in particular participatory observation and, to a lesser degree, individual and group interviews. The reasons for the relatively low popularity of qualitative evaluation studies in health promotion programmes, especially in the field, are analysed. Moreover, the relation between health promotion and prevention (the so-called problem prevention) in relation to the biopsychosocial paradigm is analysed; also a short reference is made to the issue of the changing status of the patient (from "object" to " subject" ) in contacts with medical institutions, in context of the changing image of health and disease.

Health Promotion↗
PubMed2000

Impairment evaluation in pain management: physician, or attorney in white coat?

Impairment and disability evaluations have become a growth industry in the United States. Impairment evaluation is sometimes termed independent medical evaluation, or IME. So-called independent medical experts are hired guns to provide opposite opinions, similar to attorneys in this case. IME is the practice of medicine on one hand. On the other hand, it is the practice of law in white coats. Impairment is defined as the loss of a physiologic function or of an anatomic structure. Disability, however, is defined as an inability or altered ability to successfully accomplish a given task. For successful implementation of various disability systems, the essential medical/legal interface can be successfully achieved only if the physician has at least a minimum level of understanding of the legal system, and the attorney has an adequate understanding of the medical facts and the limits of medical science. Many physicians approach impairment ratings and disability evaluations by extrapolating from the knowledge and experience gained in their specialties. However, there are numerous fundamental differences between the standard medical evaluation and impairment/disability evaluation. Important aspects of impairment evaluation include medical evaluation, analysis of findings, and comparison of the results. In impairment evaluation, it is crucial to establish causal relationship and decide on maximum medical improvement, apart from providing the impairment rating. This review will discuss various aspects of impairment evaluation.

Journal Article↗
PubMed2006

[Contribution of Lu Zhi-jun to the undertakings of acupuncture and moxibustion].

Comrade LU Zhi-jun, a famous surgeon and acupuncture expert, was a leading cadre in health field with outstanding achievements, and a leader of western medicine doctors learning traditional Chinese medicine in the Chinese Communist Party, and also he was a main establisher of The China Academy of Chinese Medical Sciences and a founder of TCM scientific researches and integrated Chinese and western medicine in new China. The present paper reviews the course of LU Zhi-jun in learning and applying acupuncture and moxibustion therapy and a part of works carried out in faithfully implementing our party's policies for uniting Chinese and Western medicine, and in development of TCM including acupuncture and moxibustion in past tens years.

Acupuncture Therapy↗
PubMed2002

Intersessions: covering the bases in the clinical year.

OBJECTIVE: At most medical schools students spend the core clerkship year entirely in clinical settings, geographically dispersed, and assigned to separate teams. Because of the immediacy of experiential learning in the clinical environment, this year is often the highlight of medical school. However, the intensity of the experience and the dispersion of students poses serious challenges to student well being and professional development, and to meeting important educational objectives best taught in the clinical year but difficult to implement in competition with direct patient care. To address these challenges in a way that does not interfere with the clinical experiences, we developed and are implementing three one-week intersessions. These are designated weeks between clerkship rotations when all third-year students are "off rotations" and studying together in an integrative, collaborative and reflective manner. DESCRIPTION: We identified themes for the intersession course from several sources. In response to strong documentation by past students of isolation and insufficient opportunity to reflect on their experiences during the core clerkships we placed a high priority on students gathering together as a class and on professional development. Additionally, based on knowledge gaps identified in the AAMC Graduation Questionnaire and our commitment to integrating basic science teaching into the clinical year, we developed the following five themes: evidence-based medicine, ethics, health systems (quality; resource allocation), advances in science (recent advances that fundamentally shift clinical practice), and professional development. Each intersession week consists of 20 hours of structured contact time; 75% is devoted to small-group learning. The weeks rely heavily on student directed and collaborative learning to complete required readings and assignments. All sessions build on the clinical experiences students have had during clerkships and enhance the students' skills for upcoming rotations. DISCUSSION: In 1999-2000, we restructured the clinical core year into eight-week modules allowing us to gather the entire class, in between clerkships, for intersessions. We phased in two intersession weeks in 2000-2001 and are implementing three intersession weeks in 2001-2002 (October, February, and June). In the evaluations of the first year's intersessions students valued the opportunity to gather together, to process their clinical experience, and to utilize their clinical experience to drive learning in important, clinically relevant areas that are not consistently taught in the clerkships. Evaluations from the first intersession of the second cycle further underscore the preference for learning experiences that are highly relevant to the clinical year (e.g., practicing efficient search strategies to quickly answer clinical questions, utilizing systematic reviews, discussing ethics cases from the students' experiences) and the benefits of faculty facilitated small-group discussions over lecture time. The advances in science sessions are most effective when they focus on advances in diseases that students are likely to have encountered. In our next phase, we will use Web-based interfaces to collect cases from students on clerkships and to promote discussion of topics in anticipation of the next intersession. As we continue to refine intersessions, our experience so far provides good evidence to support intersessions as a successful curricular innovation.

Clinical Clerkship↗
PubMed1992

The space life sciences strategy for the 21st century.

In the past, space life sciences has focused on gaining an understanding of physiological tolerance to spaceflight, but, for the last 10 years, the focus has evolved to include issues relevant to extended duration missions. In the 21st century, NASA's long-term strategy for the exploration of the solar system will combine the assurance of human health and performance for long periods in space with investigations aimed at searching for traces of life on other planets and acquiring fundamental scientific knowledge of life processes. Implementation of this strategy will involve a variety of disciplines including radiation health, life support, human factors, space physiology and countermeasures, medical care, environmental health, and exobiology. It will use both ground-based and flight research opportunities such as those found in current on-going programs, on Spacelab and unmanned biosatellite flights, and during Space Station Freedom missions.

Aerospace Medicine↗
PubMed1994

Implementing CQI: measuring levels of service quality at physiotherapy clinics.

The purpose of this study was to provide a profile of patient perceptions of the service quality delivered by a back pain rehabilitation clinic. Data were gathered and analyzed at the clinic level in twelve different locations across Canada. Measurement techniques were based on validated survey methods and developed from a growing stream of social science research. Results provided clinic managers with a profile of perceived service quality in terms of three key aspects: administrative support, quality of therapy received, and satisfaction with the results. The results also provided each clinic with benchmarks so that on-going service quality measurements can be incorporated into a system of continuous quality improvement. This process can assist rehabilitation clinics (and other health care providers) in improving service as well as ultimately reducing the costs of providing treatments involving physiotherapy.

Back Pain↗
PubMed1995

Investigative approach to frog gastrocnemius laboratory: potential impact on animal use in teaching laboratories.

With growing concern over the use of animal experimentation in the teaching of physiology, many biology departments are reassessing the use of animal experiments in the teaching lab. However, it may be just as important to assess how animal experimentation is used in the undergraduate teaching laboratory rather than simply assessing if animal experimentation should be used at all. In our study, sophomore-level life science students enrolled in a core organismal biology course undertook a laboratory exercise designed to elucidate properties of muscles and neuromuscular communication following two protocols: 1) a standard demonstrational model wherein students were told to undertake the exercise as a means to understand physiological processes that they had been exposed to previously in lecture or 2) an investigative model wherein the use of the gastrocnemius preparation was a logical next step in an ongoing investigation, the content of which was driven by student-generated hypotheses. We have observed a significant decrease in a number of the negative comments concerning the use of animals in experimentation (25.6 vs. 3.6%) since the implementation of the investigative approach to the laboratory, suggesting that curricular approaches to the use of animals in the teaching laboratory may have an impact on student attitudes concerning animal experimentation.

Animal Welfare↗