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PubMed2005

Continuing professional development--supporting the delivery of quality healthcare.

Patients and the general public have a right to expect that doctors remain up to date and are professionally competent. The ultimate aim of continuing professional development (CPD) is to contribute to high-quality patient care. The General Medical Council in the UK has published guidance in relation to standards for CPD, appraisal and revalidation. Doctors in the UK participate in an annual appraisal, the outcome of which is the development of the Personal Development Plan. This paper describes a framework for effective CPD and includes methods of self-assessment of clinical practice. Contributions to effective CPD come from 3 sources--doctors, CPD providers and accrediting bodies. The CPD system of recording credits currently in use by the Royal Colleges of Physicians in the UK is also described.

Education, Medical, Continuing↗
PubMed1995

Alternate site testing. The regulatory perspective.

This article provides a high-level overview of federal, state, and accrediting body requirements for laboratory testing outside the traditional laboratory environment. The Clinical Laboratory Improvement Amendments of 1988 provide a framework for most state and accrediting-body regulations. The stand taken by all regulators at this point is that testing wherever it is performed must conform to the same standards. The most variety in regulation is seen at the state level in the area of who can perform what tests and under what circumstances. All regulation focuses on the training and competency of the staff, adequate direction and supervision of the testing, and mechanisms for assessing the reliability of test results.

Accreditation↗
PubMed1996

Eliciting the views of experienced midwives about the assessment of competence in midwifery.

OBJECTIVE: to investigate the views of the English National Board for Nursing, Midwifery and Health Visiting (ENB) Professional Midwifery Advisory Network (PMAN) members about the assessment of competence in midwifery. DESIGN: initial questionnaire followed by a group discussion of a summary of the data from the completed questionnaires. PARTICIPANTS: 54 PMAN midwives representing education, management, research, practice and supervision; plus six ENB Education Officers (midwifery). FINDINGS: the response rate to the questionnaires was 75%. In the group discussion the PMAN members commented particularly on: the large number of items identified as needing assessment in practice and by written work; lack of total agreement on the assessment in practice of normal delivery; differences in practitioners' perceptions of assessment; the number and range of areas to be assessed; differences in expectation of 'task' assessment versus 'holistic' assessment; lack of assessment in simulation; heavy reliance on written work in assessment. CONCLUSIONS: the group's discussion of the questionnaire data revealed further interesting data, which added considerably to the initial analysis and overview. Some participants had misinterpreted the instructions and found that what they had filled in did not accurately reflect their beliefs about assessment. General consensus was reached on the need for a national standard or framework for assessment and more emphasis to be placed on assessing students in the practice setting whilst ensuring this includes knowledge and understanding and not merely psycho-motor skills. The major implications include effective preparation of assessors and more teacher involvement in practice to support the midwife assessors.

Attitude of Health Personnel↗
PubMed1990

A social stress model of substance abuse.

The social stress model provides a framework for detecting protective factors that may contribute to adolescents' resiliency when confronted with compelling influences to engage in substance abuse. Parameters of the model were tested in 2 urban high school samples (N = 124) of Black (78%), White (16%), and Hispanic (6%) adolescents aged 12-14 years. Pretest and posttest measures, designed to detect the relative influence of stress, social networks, social competencies, and community resources on levels of students' usage, were completed at the beginning and end of the school year. The parameters of the model, estimated using LISREL7, indicated that the pathway from family characteristics to usage and from assertion to usage were significant. The paths from the remaining hypothesized variables were not significant. Implications for the design of prevention programs that facilitate youths' resiliency are discussed.

Adolescent↗
PubMed1998

Development of a comparative genetic linkage map for Armigeres subalbatus using Aedes aegypti RFLP markers.

One of the causative agents of lympahtic filariasis is the nematode parasite Brugia malayi that requires a competent mosquito vector for its development and transmission. Armigeres subalbatus mosquitoes rapidly destroy invading B. malayi microfilariae via a defense response known as melanotic encapsulation. We have constructed a genetic linkage map for this mosquito species using RFLP markers from Aedes aegypti. This heterologous approach was possible because of the conserved nature of the coding sequences used as markers and provided an experimental framework to evaluate the hypothesis that linkage and gene order are conserved between these mosquito species. Of the 56 Ae. aegypti markers tested, 77% hybridize to genomic DNA digests of Ar. subalbatus under stringent conditions, with 53% of these demonstrating strain-specific polymorphisms. Twenty-six Ae. aegypti markers have been mapped using an F2- segregating Ar. subalbatus population derived from a cross of strains originating in Japan and Malaysia. Linear order of these marker loci is highly conserved between the two species. Only 1 of these markers, LF92, was not linked in the manner predicted by the Ae. aegypti map. In addition, the autosomal sex-determination locus that occurs in linkage group 1 in Ae. aegypti resides in group 3 in Ar. subalbatus. The Ar. subalbatus map provides a basic genetic context that can be utilized in further genetic studies to clarify the genetic basis of parasite resistance in this mosquito and is a necessary precursor to the identification of genome regions that carry genes that determine the encapsulation phenotype. [The composite map and sequence database information for Ae. aegypti markers can be retrieved directly from the Ae. aegypti Genome Database through the World Wide Web: http://klab.agsci.colostate.edu.]

Aedes↗
PubMed2006

Clinician perceptions of personal safety and confidence to manage inpatient aggression in a forensic psychiatric setting.

Inpatient mental health clinicians need to feel safe in the workplace. They also require confidence in their ability to work with aggressive patients, allowing the provision of therapeutic care while protecting themselves and other patients from psychological and physical harm. The authors initiated this study with the predetermined belief that a comprehensive and integrated organizational approach to inpatient aggression was required to support clinicians and that this approach increased confidence and staff perceptions of personal safety. To assess perceptions of personal safety and confidence, clinicians in a forensic psychiatric hospital were surveyed using an adapted version of the Confidence in Coping With Patient Aggression Instrument. In this study clinicians reported the hospital as safe. They reported confidence in their work with aggressive patients. The factors that most impacted on clinicians' confidence to manage aggression were colleagues' knowledge, experience and skill, management of aggression training, use of prevention and intervention strategies, teamwork and the staff profile. These results are considered with reference to an expanding literature on inpatient aggression. It is concluded that organizational resources, policies and frameworks support clinician perceptions of safety and confidence to manage inpatient aggression. However, how these are valued by clinicians and translated into practice at unit level needs ongoing attention.

Adaptation, Psychological↗
PubMed2004

Medical professionalism and continuing professional development for medical specialists.

The present paper briefly describes a growing trend in continuing professional development (CPD) for medical practitioners, examines some recent published contributions related to professionalism in medicine and describes the theoretical platform of a CPD framework based on medical professionalism that has been developed for use in a variety of medical specialties. The work arises from a project funded by The Commonwealth Department of Health and Ageing and conducted by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists on behalf of the Committee of Presidents of Medical Colleges. Overall, the aim of the project was to design and develop a framework that can be considered 'best practice' in the field of medical specialist CPD, and which could be applicable to a wide variety of medical specialties and practice environments. The project was informed by available literature in areas such as the ways in which medical practitioners learn and the effectiveness of CPD, as well as consultations with a variety of stakeholders in the health-care field, including medical boards, medical defence organisations, health complaints organisations, specialist medical colleges and practising specialists. Overwhelmingly, the primary purpose of specialists participating in ongoing CPD was, according to the project consultations conducted, the maintenance, development and improvement of skills that enable consumers of healthcare to be confident of the level of care that they receive. Coupled with the need to recognise CPD as contributing to the wider context of professional practice, the resulting framework is underpinned by a theoretical platform based on the concept of medical professionalism. It is this theoretical platform, which articulates the nature of and responsibilities associated with the practice of specialist medicine, that enables a CPD framework to be constructed that can accommodate a wide range of specialist disciplines and practice settings, while also framing ongoing education expectations from the viewpoint of a range of stakeholders, rather than a single perspective; that of practitioners themselves.

Australia↗
PubMedDate not supplied

Quality issues in access device management.

Patients are moving more rapidly from one healthcare setting to another. Often these patients have more complicated therapies and access devices and more potential for adverse occurrences. To provide care for these patients across healthcare settings, institutions need to plan a framework for delivery of quality care and services while minimizing the potential for complications. This article describes methods, tools, and other resources useful for promoting quality care in patients with more complex parenteral routes of administration.

Catheters, Indwelling↗
PubMed2001

Improved interactive medical and public health education in Japan and Korea.

We have carried out case based comparative studies in Japan, US and Korea with special reference to the medical education programme using standardized patients (SPs). The schools in US we have visited are still in the process further reforming interactive medical education. In Daegu, Korea, five medical schools have jointly started a working group for the betterment of medical education on a regular basis from the year 1999. The emphasis is on cooperative research on standardized patient training and its application. In Japan, the substantial activities for training and implementing SPs were later followed by several citizens who are active in training and providing SPs to medical schools and hospitals in need. In comparison to the established research oriented framework and flexible application of SPs in US and new & dynamic developmental discussions of SPs in Korea, the Japanese reality is a bit behind with less opportunity for research oriented trials.

Competency-Based Education↗
PubMed2006

Interdomain communication in DNA topoisomerase II. DNA binding and enzyme activation.

Topoisomerase II catalyzes the ATP-dependent transport of a DNA segment (T-DNA) through a transient double strand break in another DNA segment (G-DNA). A fundamental mechanistic question is how the individual steps in this process are coordinated. We probed communication between the DNA binding sites and the individual enzymatic activities, ATP hydrolysis, and DNA cleavage. We employed short DNA duplexes to control occupancy at the two binding sites of wild-type enzyme and a variant with a G-DNA site mutation. The DNA concentration dependence of ATP hydrolysis and a fluorescence anisotropy assay provided thermodynamic information about DNA binding. The results suggest that G-DNA binds with higher affinity than T-DNA. Enzyme with only G-DNA bound is competent to cleave DNA, indicating that T-DNA is dispensable for DNA cleavage. The ATPase activity of enzyme bound solely to G-DNA is partially stimulated. Full stimulation requires binding of T-DNA. Both DNA binding sites therefore signal to the ATPase domains. The results support and extend current mechanistic models for topoisomerase II-catalyzed DNA transport and provide a framework for future mechanistic dissection.

Adenosine Triphosphatases↗
PubMed2001

Technology as the representative anecdote in popular discourses of health and medicine.

Using a Burkean framework (1969), this article approaches medical dramas as cultural texts to be read for dominant meanings of health and health care. Burke's representative anecdote illuminates the melding of science, technology, and healing in popular discourses of health, establishing technological intervention as the norm and marginalizing nontechnological (i.e., alternative) forms of health care. Popular entertainment reinforces this anecdote in narratives of healing as technological competence triumphing over nature.

Anecdotes as Topic↗
PubMed2006

Mathematical models and the experimental analysis of behavior.

The use of mathematical models in the experimental analysis of behavior has increased over the years, and they offer several advantages. Mathematical models require theorists to be precise and unambiguous, often allowing comparisons of competing theories that sound similar when stated in words. Sometimes different mathematical models may make equally accurate predictions for a large body of data. In such cases, it is important to find and investigate situations for which the competing models make different predictions because, unless two models are actually mathematically equivalent, they are based on different assumptions about the psychological processes that underlie an observed behavior. Mathematical models developed in basic behavioral research have been used to predict and control behavior in applied settings, and they have guided research in other areas of psychology. A good mathematical model can provide a common framework for understanding what might otherwise appear to be diverse and unrelated behavioral phenomena. Because psychologists vary in their quantitative skills and in their tolerance for mathematical equations, it is important for those who develop mathematical models of behavior to find ways (such as verbal analogies, pictorial representations, or concrete examples) to communicate the key premises of their models to nonspecialists.

Humans↗
PubMed1985

[Criterion-oriented measurement in clinical psychology: development of a test on stress management].

Criterion-oriented tests evaluate the performance of the individual in relation to a given criterion which describes abilities and skills (intended competencies). The measuring process decides statistically if the person is "mastering" the criterion or not. The intended competencies should be represented by test items of high content-validity. The structure and application of this method especially to diagnostical issues of clinical psychology and therapeutic control are discussed. Steps are described construing a criterion-oriented test of stress and coping processes related to depressive and fearful behavior. The test is based on a situation-action-model in the theoretical framework of "stress and coping", "self-efficacy", "control" and "learned helplessness". Method and construction of items are shown in order to find some dimensions of coping-behavior-in-situations (appraisals, person-directed and environment-directed actions) and its sequential organisation in stressful episodes.

Adaptation, Psychological↗
PubMedDate not supplied

Evaluating cognitive learning for radiography education.

This discussion has been written to assist radiologic technology educators build better teacher-made tests. The systematic framework for test development has included defining cognitive learning objectives, constructing a test blueprint, writing clear test directions, and writing objective test items. This process enables the faculty to effectively monitor student progress, assess their own teaching effectiveness, and diagnose learning difficulties. It is hoped that this systematic approach to the assessment of cognitive learning will contribute to the education and development of a competent entry level radiologic technologist.

Educational Measurement↗
PubMed2002

Face-, expert, and referent validity of the Xitact LS500 laparoscopy simulator.

BACKGROUND: This study was undertaken to establish face-, expert, and referent validity of the Xitact LS500; a virtual reality laparoscopic cholecystectomy simulator. METHODS: A four-page, 20-item structured questionnaire was presented to 120 surgeons attending a surgical convention. Participants received an instructed hands-on "tour" on the Xitact simulator. Data were analyzed according to the level of experience of the surgeon, resulting in an "expert group opinion" of 87 surgeons and a "referent group opinion" of 33 surgeons. RESULTS: The majority of respondents believe Xitact has the potential to become a useful tool in teaching (93.1%) and measuring performance assessment (79.3%) in laparoscopic cholecystectomy. Expert- and referent-group opinion does not differ significantly on any of the presented statements. The opinion regarding the realism of the virtual laparoscopic cholecystectomy environment is favorable among both groups, although it is considered not yet perfect. The "haptic feedback" sensation of the Xitact is a parameter that needs further development. CONCLUSIONS: Both expert- and referent surgeons value Xitact to be an important and useful tool in the laparoscopic teaching setting. Further studies need to be performed to establish the construct validity of the simulator (e.g., to what extent is the simulator logically encompassed into a theoretical framework of acquiring skills, needed for the laparoscopic cholecystectomy) to measure shortening of learning curves on the laparoscopic cholecystectomy procedure, and ultimately to justify its use in the surgical curriculum.

Adult↗
PubMed1999

Capacity to make health care decisions: its importance in clinical practice.

BACKGROUND: Assessment of capacity plays a pivotal role in determining when decisions need to be made on behalf of an individual. It therefore has major clinical management implications for health care professionals and civil liberties implications for the person concerned. In many countries, there is a presumption that adults have the capacity to make health care decisions. However, in persons with a mental disability, capacity may be temporarily or permanently impaired. METHODS: A selective review is presented which considers: (i) the broad approaches taken to determining capacity; (ii) the abilities commonly assessed in determining capacity; and (iii) the principles underlying health care decision-making for adults who are without capacity. RESULTS: Capacity is a functional concept, determined by the person's ability to understand, retain, and weigh up information relevant to the decision in order to arrive at a choice, and then to communicate that choice. We have reviewed the studies that examined decision-making abilities in people with dementia, chronic mental illness or intellectual disabilities. Approaches to decision-making in adults who lack capacity include: anticipatory decisions made through advance health care statements or decisions by proxy based on 'best interests' or 'substituted judgement'. CONCLUSIONS: The understanding of clinical and legal aspects of capacity is still developing. This paper examines current concepts of capacity and decision-making on behalf of those without capacity. We propose a framework, in line with current ethical and legal guidelines, as an aid to clinicians when they are seeking consent for a health care intervention.

Adult↗
PubMed2004

Operationalizing the concept of the optimal healing environment in clinical settings: the importance of "readiness".

Creation of an optimal healing environment (OHE) in a clinical setting is a multifaceted undertaking and subject to a wide variety of developmental influences. While comprehensive definitions for OHE might provide sufficient guidance for communicating philosophy and values and developing patient-practitioner processes, direction for creating a supportive administrative structure or establishing an evaluation/research strategy is less defined. Operationalizing the concept of OHE by breaking it down into components such as values, structure, process, and measurement of outcomes, proved to be a useful framework for analyzing the evolution of our integrated care program. Future OHE initiatives may benefit from using this type of framework to assess readiness among cocreators prior to development and implementation, as a guide for ongoing evaluation of an OHE postimplementation and as a basis for comparing OHEs across a variety of clinical settings.

Attitude of Health Personnel↗