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At least 1,765 records · Page 98Linked to original sources

PubMed2004

Stakeholders' views about cardiac report cards: a qualitative study.

CONTEXT: Health care report cards provide stakeholders with information on health care outcomes and other measures of care. Report cards are most well developed in cardiac care. A necessary first step to ground the development of cardiac report cards in actual experience is to understand the views of those most closely involved. To date, there has been no systematic description of stakeholders' views. OBJECTIVE: To describe stakeholders' views about cardiac report cards. DESIGN: The present study involved qualitative person-to-person interviews with 58 stakeholders from seven Canadian cities with major cardiac programs: Vancouver, Calgary, London, Toronto, Ottawa, Montreal and Halifax. PARTICIPANTS: A total of 58 participants from six stakeholder groups in cardiac care consisting of 15 administrators, 13 nurses, 12 cardiologists, seven outcomes researchers, six cardiac surgeons and five members of the media who report on health care. OUTCOME MEASURES: Participants' views and expectations of cardiac report cards were analyzed and organized into themes. RESULTS: The views of stakeholders on cardiac report cards were organized according to four themes: PURPOSE: Participants identified two purposes--accountability for quality care as well as public education and informed decision-making; DEVELOPMENT: Participants thought that the development of report cards should involve multistakeholder collaboration; CONTENT: Participants discussed three concepts--context, level of reporting and data; and Dissemination: Mechanisms discussed include the Internet, media and directly to health care providers. CONCLUSIONS: The views of stakeholders regarding cardiac report cards can be the basis of an evidence-based conceptual framework that can guide in the development, implementation and delivery of cardiac report cards. In the present study, the views of cardiologists, cardiac surgeons, cardiac nurses, administrators, outcomes researchers and members of media are described. A next step is to explore the views of cardiac patients.

Attitude of Health Personnel↗

PubMed2006

Informatics for patient safety: a nursing research perspective.

In Crossing the Quality Chasm, the Institute of Medicine (IOM) Committee on Quality of Health Care in America identified the critical role of information technology in designing a health system that produces care that is "safe, effective, patient-centered, timely, efficient, and equitable" (Committee on Quality of Health Care in America, 2001, p. 164). A subsequent IOM report contends that improved information systems are essential to a new health care delivery system that "both prevents errors and learns from them when they occur" (Committee on Data Standards for Patient Safety, 2004, p. 1). This review specifically highlights the role of informatics processes and information technology in promoting patient safety and summarizes relevant nursing research. First, the components of an informatics infrastructure for patient safety are described within the context of the national framework for delivering consumer-centric and information-rich health care and using the National Health Information Infrastructure (NHII) (Thompson & Brailer, 2004). Second, relevant nursing research is summarized; this includes research studies that contributed to the development of selected infrastructure components as well as studies specifically focused on patient safety. Third, knowledge gaps and opportunities for nursing research are identified for each main topic. The health information technologies deployed as part of the national framework must support nursing practice in a manner that enables prevention of medical errors and promotion of patient safety and contributes to the development of practice-based nursing knowledge as well as best practices for patient safety. The seminal work that has been completed to date is necessary, but not sufficient, to achieve this objective.

Accidental Falls↗

PubMedDate not supplied

Collaboration puts the ENB Higher Award into practice.

The ENB Framework for continuing professional education and Higher Award for nurses, midwives and health visitors was introduced in April 1992. The framework outlines 10 key characteristics to guide practitioners in the integration of theory and practice. This paper describes how a group of teachers and practitioners have applied the framework. They explain how it helps pull theoretical learning and practice together for practitioners. For educators, involvement with practitioners has helped them be more involved in practice. Three-way, or tripartite, tutorial work between the practitioner, the teacher and the facilitator in the clinical area is central to the success of this initiative.

Certification↗

PubMed2026

Robust prioritization of genomic features with stability selection.

MOTIVATION: The heterogeneity of complex diseases including cancer leads to heavy-tailed distributions in the disease traits. In such settings, non-robust variable selection methods are inherently susceptible to data contamination and can yield unstable or misleading results. This vulnerability becomes more severe for recently proposed approaches that introduce pseudo-features as negative controls, as these methods further amplify the curse of dimensionality by expanding the genotype matrix in the presence of outliers and high-dimensional genomic features. RESULTS: We develop a robust variable selection framework with stability selection to prioritize genomic features in the presence of contamination. In contrast to existing approaches that rely on pseudo-features for error control, the proposed method achieves double robustness. First, it adopts least absolute deviation (LAD) LASSO to ensure robustness against outliers and heavy-tailed errors in disease traits. Second, it avoids augmenting the genotype matrix with pseudo-features, thereby mitigating the curse of dimensionality that is particularly problematic in high-dimensional genomic data. The proposed method has been extensively evaluated in simulation studies to demonstrate its effectiveness over multiple competing methods for variable selection. In addition, we have applied the proposed method and competing approaches to two real-data case studies: the The Cancer Genome Atlas (TCGA) Skin Cutaneous Melanoma (SKCM) dataset and an eQTL dataset. The results demonstrate that the proposed method achieves superior performance by identifying genomic features with higher reproducibility. AVAILABILITY AND IMPLEMENTATION: The source code for implementing the proposed methods is publicly available at https://github.com/cenwu/RSS with an archival DOI https://doi.org/10.6084/m9.figshare.32306883.

Genomics↗

PubMed2004

To Stretch the Boundary of Secondary Metabolite Production in Plant Cell-Based Bioprocessing: Anthocyanin as a Case Study.

Plant cells and tissue cultures hold great promise for controlled production of a myriad of useful secondary metabolites on demand. The current yield and productivity cannot fulfill the commercial goal of a plant cell-based bioprocess for the production of most secondary metabolites. In order to stretch the boundary, recent advances, new directions and opportunities in plant cell-based bioprocessing, have been critically examined for the 10 years from 1992 to 2002. A review of the literature indicated that most of the R&D work was devoted predominantly to studies at an empirical level. A rational approach to molecular plant cell bioprocessing based on the fundamental understanding of metabolic pathways and their regulations is urgently required to stimulate further advances; however, the strategies and technical framework are still being developed. It is the aim of this review to take a step forward in framing workable strategies and technologies for molecular plant cell-based bioprocessing. Using anthocyanin biosynthesis as a case study, an integrated postgenomic approach has been proposed. This combines the functional analysis of metabolic pathways for biosynthesis of a particular metabolite from profiling of gene expression and protein expression to metabolic profiling. A global correlation not only can thus be established at the three molecular levels, but also places emphasis on the interactions between primary metabolism and secondary metabolism; between competing and/or complimentary pathways; and between biosynthetic and post-biosynthetic events.

Journal Article↗

PubMed2006

[Study of the introduction of the European Credit Transfer System (ECTS) in pediatrics and modification of the teaching methodology].

INTRODUCTION: Spanish medical faculties have initiated the new curriculum reform process within the framework of the European Higher Education Area and are required to incorporate the European Credit Transfer System (ECTS) to new syllabi before 2010. OBJECTIVES: To test the introduction of the ECTS in pediatrics and modify the teaching methodology. STUDY DESIGN: The theoretical and practical programs were adapted; academic objectives and a student evaluation system were established. Students were surveyed on starting the second term of the 2004-05 academic year before the theory examination and again on terminating the academic year: a 5-point Likert-type scale was used for responses. Priorities for generic and specific competencies selected by students were compared with those selected by the National Deans Conference (NDC). The results were analyzed using non-parametric tests. RESULTS: Fifteen credits became 11 ECTS, with 297 student working hours. The theory program was reduced from 80 to 52 lessons. The students prepared 14 tutor-supervised case presentations. The teaching staff considered that learning of theory was similar to previous years (66 %) and that practical learning improved (73.3 %). The students thought the program should continue (73.2 %) but 98.8 % considered the workload excessive. The students believed that their practical training and their ability to prepare and make case presentations significantly improved during the semester. Academic performance was significantly higher than that in students of the previous year. Students agreed with NDC priorities for 9/9 general and 4/17 specific competencies. Estimation of workload by students was significantly higher than that by staff, and 73.3 % of the students believed that workload should be reduced and the examination system improved. CONCLUSIONS: Introducing the ECTS improved academic performance, practical training, and self-directed learning. The project was satisfactory for staff and students. Student workload was underestimated.

Achievement↗

PubMedDate not supplied

Perceived patient deviance and avoidance by nurses.

Perceived patient deviance and its relationship to avoidance behaviors of nurses was examined using a social deviance/labeling framework. Avoidance included a reduction in the number and duration of nursing contacts with patients, a reduction in the number of nurse-initiated contacts, the use of physical restraints, and failure to meet the individualized needs of patients. Fifty-two registered nurses on adult health units classified known patients into three study groups: ideal patient, neutral patient, and difficult (deviant) patient. Analysis of variance showed no significant differences for mean number, duration, and initiator of nurse-patient contacts. Significant differences were found in the Psychosocial Individual, Physical, and General subscales of the Slater Nursing Competencies Rating Scale and in the use of physical restraints for the three study groups. Agreement of nurses in their classification of patients occurred in 74.63% of cases. The results suggest that the label of difficult (deviant) patient is well communicated among nurses and that it has a negative influence on the quality of care.

Adolescent↗

PubMed1996

Strategies for managing uncertainty and complexity.

OBJECTIVES: To identify strategies involved in the diagnosis and treatment plans of primary care problems that are uncertain and complex. METHODS: In this exploratory study we observed primary care physicians encountering standardized patients who portrayed typical primary care problems involving uncertainty and complexity. First, we analyzed 10 tapes of nine physicians with a range of clinical experience (first-year residents through faculty physicians) interacting with four standardized patient cases (headache, back pain, hypertension, and abdominal pain). We analyzed the 10 tapes to determine the regular occurrence of physician behavior patterns that we later described as strategies. Then, using a written questionnaire, 19 general internal medicine faculty physicians from our hospital and from an affiliated hospital rated the perceived importance of these strategies for clinical practice in general. Finally, we checked the incidence of the strategies: (1) across a range of six cases (headache, back pain, hypertension, abdominal pain, fatigue, and well-adult care) using six first-year residents (a total of 19 encounters), and (2) across different levels of clinical experience using the standardized patient case of headache involving eight physicians (first-year residents through faculty physicians). RESULTS: Nine strategies were identified, and each was rated as important to primary care clinical practice. The strategies were: (1) defines the context of the diagnosis and explains the signs and symptoms as part of the expected spectrum of the disease; (2) eliminates alternative diagnoses by dealing with patient fears, giving reasons in the context of the patient's belief system; (3) describes the prognosis in terms of the likely course of the disease and expectations of treatment; (4) negotiates key problems or issues that are important to both patient and physician; (5) negotiates the plan and ensures patient understands, and is willing and able to comply, given his/her particular context; (6) keeps diagnostic options open by making provisional diagnoses while keeping alternatives in mind; (7) is circumspect and takes action to minimize the possibility of missing other critical diagnoses; (8) plays for time by allowing signs and symptoms to develop to help clarify the diagnosis; and (9) plans for contingencies by providing appropriate if/then statements concerning situations requiring further action. The strategies were used in each of the six cases, and by physicians with all levels of clinical experience. CONCLUSIONS: The nine strategies led to the generation of a construct we termed "strategic medical management," which refers to the management (diagnosis and proposed treatment) of uncertain and complex medical problems in primary care. The construct provides a more elaborated framework in which to view clinical decision making and integrates recent ideas concerning doctor-patient communication into this process. Strategic medical management appears to be based on tacit knowledge that is seldom explicity articulated or taught. It has potential implications for enhancing instruction and assessment in medical education.

Clinical Competence↗

PubMed2003

Developing postgraduate awards for critical care.

This report outlines a qualitative study that explored the academics' perceptions of postgraduate education for critical care. A framework was generated using models of curriculum design. Focus groups and interviews were undertaken to explore four areas within this framework - taught theory/professional practice, advanced practice skills, assessment and delivery. The findings revealed that ethical and legal aspects of role, research, physiology decision-making and practice skills such as defibrillation, first line treatment and patient assessment were considered extremely relevant to such a programme. Practice assessment was considered essential to ensure clinical credibility of the programme and the practitioner. Frameworks were generated to define the nature of advanced critical care practice. As such, work-based learning and interprofessional supervision were seen as key elements of the programme. Finally areas for further research were identified.

Awards and Prizes↗

PubMed2004

Thinking aloud on paper: an experience in journal writing.

Journal writing is one of many strategies that can help promote learning in a process-oriented curriculum. This article explores the experience of implementing journal writing as an expectation of second-year baccalaureate nursing students in a clinical practicum. Faculty had a vital role in facilitating this experience. The journals provided a medium within which students explored in depth significant events that occurred in their practicum. Their analysis of these events included application of theoretical frameworks and concepts that supported and strengthened the arguments made in the journals. Students responded very favorably to their experiences in journal writing. In the evaluation of this experience, students reported increased abilities in critical thinking and self-directed learning. These two important concepts complement each other in the students' learning processes.

Adaptation, Psychological↗

PubMed2004

Robot-assisted minimally invasive surgery: the importance of human factors analysis and design.

Success in robotic minimally invasive surgery (MIS) has been limited despite the innovations in robotic technology for surgical applications. Human factors engineering approach to the design and implementation of this technology is major to improving system performance and patient safety. The engineering discipline of human factors involves the study of factors and development of tools that enable human interaction with systems in a safe and effective manner. Human factors contribution is important to the product design life cycle, as it supports the design of a product capable of supporting, extending, and transforming user work in a cost-effective and timely fashion. A framework for modelling the interaction between the surgeon and technology in MIS is presented. This approach allows for identification of requirements and constraints at the physical, functional, and cognitive levels, which in turn guides the design of the technology and its interface. The human factors approach is expected to increase the effectiveness of the technology when deployed.

Clinical Competence↗

PubMedDate not supplied

The Triangle Technique: a new evidence-based educational tool for pediatric medication calculations.

Many nursing student verbalize an aversion to mathematical concepts and experience math anxiety whenever a mathematical problem is confronted. Since nurses confront mathematical problems on a daily basis, they must learn to feel comfortable with their ability to perform these calculations correctly. The Triangle Technique, a new educational tool available to nurse educators, incorporates evidence-based concepts within a graphic model using visual, auditory, and kinesthetic learning styles to demonstrate pediatric medication calculations of normal therapeutic ranges. The theoretical framework for the technique is presented, as is a pilot study examining the efficacy of the educational tool. Statistically significant results obtained by Pearson's product-moment correlation indicate that students are better able to calculate accurate pediatric therapeutic dosage ranges after participation in the educational intervention of learning the Triangle Technique.

Adult↗

PubMed2004

A simple significance test for quantile regression.

Where OLS regression seeks to model the mean of a random variable as a function of observed variables, quantile regression seeks to model the quantiles of a random variable as functions of observed variables. Tests for the dependence of the quantiles of a random variable upon observed variables have only been developed through the use of computer resampling or based on asymptotic approximations resting on distributional assumptions. We propose an exceedingly simple but heretofore undocumented likelihood ratio test within a logistic regression framework to test the dependence of a quantile of a random variable upon observed variables. Simulated data sets are used to illustrate the rationale, ease, and utility of the hypothesis test. Simulations have been performed over a variety of situations to estimate the type I error rates and statistical power of the procedure. Results from this procedure are compared to (1) previously proposed asymptotic tests for quantile regression and (2) bootstrap techniques commonly used for quantile regression inference. Results show that this less computationally intense method has appropriate type I error control, which is not true for all competing procedures, comparable power to both previously proposed asymptotic tests and bootstrap techniques, and greater computational ease. We illustrate the approach using data from 779 adolescent boys age 12-18 from the Third National Health and Nutrition Examination Survey (NHANES III) to test hypotheses regarding age, ethnicity, and their interaction upon quantiles of waist circumference.

Adolescent↗

PubMed2003

Meningitis, pathogenicity near criticality: the epidemiology of meningococcal disease as a model for accidental pathogens.

We formulate and analyse a model for infectious diseases transmitted by asymptomatic carriers finding, that if harmless and pathogenic strains of the infected agent compete, frequent outbreaks of the pathogenic strains can occur. A counterintuitively high number of clustered outbreaks at low pathogenicity in our model compares well with observations in diseases with severe and often fatal results for the host, as for example in meningitis. These clustered outbreaks can be described by the typical scaling behaviour around criticality. The epidemic model is a susceptible-infected-recovered system (SIR) for the harmless infective agent, acting as a background to a mutant strain Y which occasionally creates severely affected hosts X. The full system of SIRYX is described in the master equation framework, confirming limiting assumptions about a reduced YX-system with the SIR-system in stationarity. In this limiting case we can analytically show convergence to power law scaling typical for critical states, as well as the divergence of the variance of outbreaks near criticality. These large fluctuations of outbreaks of accidental pathogens as mutants of otherwise harmless commensal organisms is the challenging new feature of our model for future epidemiology of diseases like meningococcal disease.

Carrier State↗

PubMed1996

Context-sensitive underspecification and the acquisition of phonemic contrasts.

Several competing proposals for the (under)specification of phonological representations are evaluated against the facts of phonemic acquisition. Longitudinal evidence relating to the emergence of a voice contrast in the well-documented study of Amahl (from age 2;2 to 3;11) is reconsidered. Neither contrastive specification nor context-free radical underspecification is capable of accounting for the facts. The problem is in the characterization of the change in the status of a feature from being noncontrastive and conditioned by context at one stage to being contrastive with phonetic effects that diffuse gradually through the lexicon. Both frameworks must treat as accidental the persistence of the early substitution pattern and require the postulation of wholesale changes in underlying representations, where these changes do not accord well with the observed phonetic changes or with the facts available to the learner. Context-sensitive radical underspecification provides a plausible account of each stage and the transition between stages with minimal grammar change.

Child Language↗

PubMedDate not supplied

Critical elements in the process of decision making: a nursing perspective.

Decision making is a fundamental element of nursing work, one that is essential to understand as organizations explore cost effective ways to deliver quality health care. While the importance of decision making has been well articulated, previous descriptions of nursing work have had difficulty describing completely this cognitive component. This paper identifies critical elements within the process of nursing decision making that have not been addressed adequately within current decision making frameworks. In this exploratory research, nursing personnel described their work; qualitative content analysis was used to categorize components of nursing decision making within these descriptions. Revealed are complex nursing decisions that occur after the selection of nursing intervention, and prior to the implementation of that intervention. These decisions address the complex network of interactions involved with enactment of the nursing role, the repertoire of leadership skills such as collaboration, negotiation, and delegation required to elicit the involvement of other individuals; discretionary decisions made in the allocation of resources; priority setting; and strategizing. These findings have implications for nursing competency and quality of care, cost-effective delivery of health care, and nursing education.

Attitude of Health Personnel↗

PubMed1995

In pursuit of computer literacy in health management education.

Computer literacy skills are essential tools students must possess to do well in computer-related and quantitative courses, and to be effective health managers. Many health management education programs are faced with the challenge of finding an ideal framework for teaching computer literacy courses. Recently, Austin and Malec (1990) proposed an instructional method for teaching computer literacy. This method was used for three consecutive semesters to teach the computer literacy course offered at Sangamon State University. A case analysis technique was utilized to assess of the effectiveness of this method. A pre-test and post-test design was used in the study. Post-test scores were found to be significantly higher than pre-test scores. Improvements in students' attitudes toward computers were noticed in the areas pertaining to how they view their competency levels. Overall, the data for this study suggest that this instructional method is effective for teaching computer literacy to adult students who have had limited exposure to computers.

Attitude to Computers↗

PubMed2004

The two faces of enhancing utilization of health-care services: determinants of patient initiation and retention in rural Burkina Faso.

OBJECTIVE: To explore the factors that determine whether a patient will initiate treatment within a system of health-care services, and the factors that determine whether the patient will be retained in the chosen system, in Nouna, rural Burkina Faso. METHODS: The data used were pooled from four rounds of a household survey conducted in Nouna, rural Burkina Faso. The ongoing demographic surveillance system provided a sampling framework for this survey in which 800 households were sampled using a two-stage cluster sampling procedure. More than one treatment episode was observed for a single episode of illness per patient. The multinomial logit model was used to explore the determinants of patient initiation to systems of modern, traditional and home treatment, and a binary logit model was used to explore the determinants of patient retention within the chosen health-care provider system. FINDINGS: The results suggest that the determinants of patient initiation and their subsequent retention are different. Household income, education, urban residence and expected competency of the provider are positive predictors of initiation, but not of retention, for modern health-care services. Only perceived quality of care positively predicted retention in modern health-care services. CONCLUSION: Interventions focusing on patient initiation and patient retention are likely to be different. Policies directed at enhancing initiation for modern health-care services would primarily focus on reducing financial barriers, while those directed at increasing retention would primarily focus on attributes that improve the perceived quality of care.

Adult↗