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PubMed1993

Ethics and law in the medical curriculum--a university of the West Indies perspective.

The Faculty of Medical Sciences (FMS), University of the West Indies, recognizes that ethics and law are not currently given adequate importance in the training of health professionals. FMS also recognizes the rapid advancement of technology, such as transplants, artificial organs, in vitro fertilization, life-sustaining equipment and euthanasia, as well as the ever-increasing prevalence of malpractice. Thus, two conferences were held to consider the implementation of ethics and law in the medical curriculum. The conferences recommended an increased input into the curriculum of ethics and law, and that this programme be taught and examined in all the medical years. The article discusses implementation strategies.

Bioethical Issues↗

PubMed1994

Medical device regulation in Canada: direction for change.

The medical device regulatory programme in Canada was first instituted in 1975. Recently this programme underwent a review. This paper first describes the system of regulations as it has been administered by the Health Protection Branch of the government of Canada. The rationale for the establishment of the Medical Devices Review Committee, its deliberations and report are then discussed. Finally, the paper examines measures currently being taken to implement recommendations that will take the regulatory programme for medical devices in Canada into the twenty-first century.

Canada↗

PubMed2003

Total testing process: appropriateness in laboratory medicine.

BACKGROUND: The need to reduce costs in Laboratory Medicine is often related to the possibility of reducing test requests without taking into account patients' outcomes. Therefore, the term "appropriateness" in Laboratory Medicine as referred to the specific steps (pre-analytical, analytical, post-analytical) and related to the clinical process could allow the improvement of clinical effectiveness and economic efficiency. METHODS: Our experience has shown an improvement in analytical appropriateness (reorganization and re-engineering by Laboratory automation) and pre-analytical appropriateness (critical revision of the panel for cardiac markers) by evaluating the workload and errors rate in the pre-analytical phase. RESULTS: We obtained an economic saving (119,580 euro/year) in cardiac markers request (analytical appropriateness: 60%, pre-analytical appropriateness: 40%) and also an improvement in clinical appropriateness (diagnosis and therapy). CONCLUSIONS: Our data confirm the need to improve communications between physicians and Laboratory Medicine as regards the pre-analytical step and to implement educational programs for defining criteria and procedures. Appropriateness in analytical and post-analytical steps contribute to achieve economic saving (Core lab, POCT) and improvement of the turn-around time (TAT).

Humans↗

PubMed2003

A formative evaluation in maternal and child health practice: the Partners for Life Nutrition Education Program for pregnant women.

OBJECTIVES: This paper describes the formative evaluation of the Partners For Life Program that was developed to change dietary behavior of low income pregnant women in the Mississippi Delta region. METHODS: A diverse group of nutrition/health professionals, adapted the Expanded Food and Nutrition Education Program's (EFNEP) methodology for pregnant patients in the local Women, Infants, and Children program who were receiving maternity care at the county health department. Formative evaluation activities included gathering data to determine 1) whether a new nutrition curriculum, modeled after EFNEP could be created, 2) whether peer educators could be recruited and trained to deliver the intervention, 3) whether pregnant women could be recruited to participate in the new program, 4) whether a pilot test of the new intervention would produce short-term impact in nutrition knowledge and dietary behavior, and 5) reactions of pregnant women on the usability of the new program. Data were gathered through use of the Program Implementation Index, focus groups, and a retrospective record review. Pilot test assessments included tests of nutrition knowledge and self-reported changes in dietary behavior. RESULTS: The formative evaluation demonstrated both positive and negative outcomes. Positive data included 1) successful recruitment and training of the peer educators to deliver the intervention; 2) successful recruitment of the targeted population for the pilot study; 3) complete information on project questionnaires and measuring forms; and 4) among those who completed the program, a statistically significant improvement in nutrition knowledge and dietary behavior. Two negative aspects in this formative study were 1) the Program Implementation Index quantitatively showed that the program experienced problems retaining participants it recruited and 2) deviation of the timeframe for intervention delivery. Program length was identified as the primary reason for participant attrition. CONCLUSIONS: It is important for program developers to use results from formative evaluations to make changes in problem areas prior to implementation of a full-scale impact evaluation.

Advisory Committees↗

PubMed1996

Nursing and technology: a dialectic.

Caring and expertise are fundamental to nursing. Technology, although often viewed as inimical to these human qualities in the provision of care, has the potential to support caring and enhance expertise. Nurses whose expertise embraces both technology and nursing can design and implement technologies that will help them fulfill their commitments to patients. Appropriate, well-designed, flexible technologies can improve the care of individuals and enlarge the store of nursing knowledge and expertise.

Clinical Competence↗

PubMed2002

Reported eating behavior and attitudes improvement after a nutrition intervention program in a group of young female dancers.

The aim of the study was to evaluate the effectiveness of an intervention program that combined nutrition education and prevention of disordered eating in a group of female professional dance students. Thirty-two dancers, aged 19-25 years, took part in the program. Evaluation was done by a series of questionnaires that participants were asked to complete on 3 occasions. Assessments of body composition and dietary intake were also performed. Significant improvements in nutrition knowledge as well as a decrease in abnormal eating behavior and dietary restraint were observed at post intervention. At 6-month follow-up, the positive effects were maintained and further benefits were recorded; only nutrition knowledge showed a minor decline. Participants who were at higher risk for adopting abnormal eating behavior benefited the most from the program. These findings encourage the implementation of intervention programs in groups of young women that experience particular pressures for controlling body weight.

Adult↗

PubMed2003

Species-specific assessment of pain in laboratory animals.

Pain has been defined by the International Association for the Study of Pain as "an unpleasant sensory and emotional experience associated with actual or potential damage or described in terms of such damage". However, the ability to describe the concept of pain is difficult largely because pain is an individualized and subjective experience. What one person finds painful, another may not; what relieves pain for one may not do so for another. Awareness of pain management has become an important health issue for humans and animals. To effectively manage pain, it is crucial to be able to identify it, and identification of pain in animals can be especially problematic. Recognition and alleviation of pain in animals used in biomedical research and teaching is an important goal, both from a humane and regulatory perspective. This paper will: 1) review current literature regarding pain assessment using pain scales and 2) describe how an institutional care and use committee (IACUC) has implemented an effective pain scoring system to allow for an objective, accurate, and humane assessment of pain experienced by animals used in biomedical research.

Animal Welfare↗

PubMed1992

New technology in U.S. Army health care: the role of laparoscopic cholecystectomy.

In the near future, laparoscopic cholecystectomy could become one of the most frequently performed surgical procedures in U.S. military hospitals. To determine the best way to implement this new technology in the U.S. Army Health Services Command (HSC), we have assessed the safety, efficacy, and health consequences of laparoscopic cholecystectomy. Approximately 2,800 open cholecystectomies are performed annually in HSC hospitals, 11% of them on active duty personnel. If cholecystectomies were performed using laparoscopic surgical techniques on active duty patients who meet currently accepted indications, 3,360 personnel duty days lost to convalescence and 7,048 days of limited duty (time on physical profiles) would be recouped. Applying the procedure to other beneficiaries (dependents and retired service members) would result in a potential annual savings of 11,000 hospital bed days. If implemented using stringent criteria for training and certification, these savings could be achieved with no increase in patient morbidity or mortality and with significant improvement in patient outcome.

California↗

PubMed2025

The impact of genetic counselor involvement in genetic and genomic test order review: A scoping review.

PURPOSE: The increasing complexity of genetic technologies paired with more genetic tests being ordered by nongenetic health care providers, has resulted in an increase in the number of inappropriately ordered tests. Genetic counselors (GCs) are ideally suited to assess the appropriateness of a genetic test. METHODS: We performed a scoping review of GC involvement in utilization management initiatives in order to describe the impact of having GCs involved in this process. Five databases (MEDLINE, EMBASE, CINHAL, EBM reviews, and Web of Science Core Collection) and gray literature were searched. We considered literature published in English since 2010. RESULTS: A total of 51 studies were included. The most commonly evaluated outcomes included cancellation rate, economic efficiencies, impact on medical management, diagnostic rate, and time or triage efficiencies. Several studies also described GC impact on nongenetic health care providers. CONCLUSION: Employment of GCs in the laboratory has been implemented widely as a solution to test misordering. These studies describe ways in which GCs can be integrated into testing workflows to reduce the number of inappropriate tests and have wider impacts on nongenetic health care providers' ordering practices and the patient experience.

Humans↗

PubMed1998

Molecular epidemiology: assumptions and limitations of commonly applied methods.

An understanding of the epidemiology of a disease (i.e. its aetiology, transmission patterns) is crucial for the development and implementation of effective management practices. This requires sound epidemiological data. It is therefore important that scientists understand the assumptions and limitations of the methods used to gather such data. The aim of this paper is to discuss some of the assumptions and limitations of PCR-based methods used in studies of epidemiology. Since its development, PCR has had a major impact in the biological sciences. The ability to selectively amplify a specific region of the genome from a small amount of DNA makes this technique particularly useful as a diagnostic tool. A variety of PCR-based methods are available which can be used to identify strains and species of parasites. Some of these methods, such as random amplification of polymorphic DNA, have intrinsic properties which can limit their application. Other methods, such as PCR-restriction fragment length polymorphism, require the availability of a sound taxonomic or genetic framework for the development of any diagnostic system for a particular organism. The problems encountered developing diagnostic probes in the absence of such a framework will be discussed using Giardia intestinalis as an example.

Animals↗

PubMed2002

Revisiting field experimentation: field notes for the future.

Field experiments in the social sciences were increasingly used in the 20th century. This article briefly reviews some important lessons in design, analysis, and theory of field experiments emerging from that experience. Topics include the importance of ensuring that selection into experiments and assignment to conditions occurs properly, how to prevent and analyze attrition, the need to attend to power and effect size, how to measure and take partial treatment implementation into account in analyses, modern analyses of quasi-experimental and multilevel data, Rubin's model, and the role of internal and external validity. The article ends with observations on the computer revolution in methodology and statistics, convergences in theory and methods across disciplines, the need for an empirical program of methodological research, the key problem of selection bias, and the inevitability of increased specialization in field experimentation in the years to come.

Forecasting↗

PubMed1993

Recent issues related to nutrition during pregnancy.

In July 1990, new guidelines for nutrition during pregnancy were published by the National Academy of Sciences. The Subcommittee on Weight Gain During Pregnancy revised the weight gain recommended for pregnancy. During the process of developing new recommendations, the subcommittee considered several factors that might help to determine the appropriate weight gain for an individual pregnant woman. Some of these factors include demographic and biological changes that might influence the effect of weight gain. Clinical issues that must be considered in implementing the weight gain recommendations include the importance of accurate weight and height measurement, categorizing the woman's weight for height, determining rate of gain at different times during pregnancy, and evaluating the significance of deviations from the expected weight gain pattern. A review of prior studies reveals that body composition changes, which might be important to consider in conjunction with weight changes, have not been well studied. Data are presented from a current study that indicates the problems encountered if traditional methods of body composition measurement are used during pregnancy.

Body Composition↗

PubMed2006

Nursing in tele-mental health.

This article discusses a cooperative project involving an academic health sciences center, a state university, a women's shelter, and a community mental health center in East Texas, a medically underserved, rural region of Texas. The U.S. Department of Commerce provided grant funding to develop a telehealth network to provide an evaluation, referral, and treatment program for victims of domestic violence. Nurses were involved in all phases of the project, from initial conception through development, implementation, and evaluation. The authors concluded that all of the women involved in the study had significant mental health issues and other health concerns that were not being addressed by the existing health care delivery system. Without the use of telehealth, these women would have had limited access to primary health care and virtually no access to mental health services. The East Texas Tele-Mental Health Network demonstrates the value of the clinical and organizational skills that nurses bring to innovative models of mental health service delivery.

Adult↗

PubMedDate not supplied

New vision for health promotion within sports medicine.

Providing medical care for the treatment and prevention of injuries and health problems for competitive or recreational athletes is the most widely recognized role of sports medicine. However, the field is much broader and includes clinical practice and research in many areas related to physical activity in the prevention and treatment of chronic disease. Sports medicine and exercise science involve not only physicians and other licensed health care practitioners but also physiologists, social scientists, epidemiologists, kinesiologists, and other public health and medical professionals. There is overwhelming scientific evidence that a physically active lifestyle is important for optimal health. A key role of sports medicine is to focus the attention of a wide variety of health professionals, educators, and policy makers on developing and implementing strategies to help more individuals enjoy the many health-promoting benefits of regular physical activity.

Athletic Injuries↗

PubMed1992

[Cancerology training in France].

During the last years, training in cancerology in France has been developed extensively. The importance of training as a major element in the fight against cancer is now widely recognized. Cancerology teaching has been improved in the curse of clinical science for medical students as well as the training of general practitioners. Special courses qualifying for the Diploma of Specialised Complementary Studies in Oncology are available to Cancerologists. While appreciating the positive aspects of cancerology training at these different levels, we must stress a certain number of weak points that need to be corrected. Several propositions tending to further improve cancerology training are proposed. The implementation of these recommendations should allow France to maintain its rightful place in cancerology within the European Community.

Education, Medical, Graduate↗

PubMedDate not supplied

Evidence-based quality improvement: the state of the science.

Routine practice fails to incorporate research evidence in a timely and reliable fashion. Many quality improvement (QI) efforts aim to close these gaps between clinical research and practice. However, in sharp contrast to the paradigm of evidence-based medicine, these efforts often proceed on the basis of intuition and anecdotal accounts of successful strategies for changing provider behavior or achieving organizational change. We review problems with current approaches to QI research and outline the steps required to make QI efforts based as much on evidence as the practices they seek to implement.

Case Management↗

PubMed2004

Contextualism and the development of effective prevention practices.

Widespread and effective implementation of research-based prevention practices will be facilitated by the explicit adoption of a functional contextualist framework for prevention research. Such a framework has as its central goal predicting and influencing behavior and cultural practices. Research within this framework is evaluated in terms of its ability to contribute to that goal. As a result, it contributes directly to the ultimate goals of prevention science-affecting the incidence and prevalence of problems in populations. The approach contrasts with the mechanist framework, which is implicit in much behavioral science research. The mechanist framework has as its truth criterion the predictive verification of models of the interrelationships among variables. Such models can-but need not-identify manipulable variables that can be exploited to affect problems of interest. Such models require the inclusion of multiple cases for testing and this requirement may impede the tendency of scientists to work with a single school or community. Functional contextualism is suited to the study of the individual case. It provides a framework within which researchers can more readily collaborate with practitioners in the development and further evaluation of practices within the settings where practitioners will ultimately use those practices.

Models, Organizational↗

PubMed2001

Works of art: a complement to theoretical knowledge when teaching nursing care.

Visual art dialogues were used in student nurses' education as a teaching and learning complement to theoretical knowledge of nursing care. An intervention group as well as a control group discussed what was characteristic of good nursing care. The control group was used to control for the effects of visual art dialogues in the intervention group. The study was undertaken at two university colleges of health sciences in Sweden. Data were collected from student nurses (n = 267) during their first year of study. The Wheel Questionnaire was used in the intervention group and control group. It measured three aspects of student nurses' perception of nursing situations: structure, the extent of emotional involvement, and motivation. The results showed statistical differences (one way ANOVA) between the intervention group in which visual art dialogues were implemented and the control group. Students in the intervention group, compared to the control group, were more structured, motivated and emotionally balanced when they expressed the elements most typical of good nursing care. They showed personal readiness in caring situations.

Analysis of Variance↗