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PubMed2004

Clinical prevention and population health: curriculum framework for health professions.

The Clinical Prevention and Population Health Curriculum Framework is the initial product of the Healthy People Curriculum Task Force convened by the Association of Teachers of Preventive Medicine and the Association of Academic Health Centers. The Task Force includes representatives of allopathic and osteopathic medicine, nursing and nurse practitioners, dentistry, pharmacy, and physician assistants. The Task Force aims to accomplish the Healthy People 2010 goal of increasing the prevention content of clinical health professional education. The Curriculum Framework provides a structure for organizing curriculum, monitoring curriculum, and communicating within and among professions. The Framework contains four components: evidence base for practice, clinical preventive services-health promotion, health systems and health policy, and community aspects of practice. The full Framework includes 19 domains. The title "Clinical Prevention and Population Health" has been carefully chosen to include both individual- and population-oriented prevention efforts. It is recommended that all participating clinical health professions use this title when referring to this area of curriculum. The Task Force recommends that each profession systematically determine whether appropriate items in the Curriculum Framework are included in its standardized examinations for licensure and certification and for program accreditation.

Advisory Committees↗

PubMed2005

The synergy model: the ultimate mentoring model.

Clarian Health Partners is a system that includes Methodist Hospital of Indiana, Indiana University Hospital, and Riley Hospital for Children. The nurses of Clarian Health Partners are the recipients of many national awards for their leadership and innovations in critical care. Nurse leaders at Clarian have developed and implemented a unique framework for professional development based on the synergy model. In this article, the Chief Nurse Executive for the System, Dr. Karlene Kerfoot, and Marilyn Cox, the Senior Vice President for Nursing and Patient Care at Riley Hospital for Children, describe their vision of and strategies for a new approach to mentoring professional nursing staff.

Attitude of Health Personnel↗

PubMed1996

Behavioral responses of healthy Chinese siblings to the stress of childhood cancer in the family: a longitudinal study.

Advances in the treatment of childhood malignancies have dramatically altered survival rates of children with cancer, changing the nature and scope of stressors that their families encounter. Very little is known about how childhood cancer affects healthy Chinese siblings and what can be done to help children adjust to this stressful life event. The cognitive theory of psychological stress was the framework for this study. The purpose of this research was to explore behavioral responses of healthy Chinese siblings in Taiwan to childhood cancer in the family and to examine the factors that may contribute to the presence or absence of behavioral problems in these siblings, using a 12-month longitudinal data set. Forty-five Chinese families were selected through referrals and a cancer foundation name roster. Content analysis of qualitative and quantitative sibling data revealed major stressor themes of inadequate knowledge, reduced family communication, and insufficient support. Healthy Chinese siblings showed significantly more behavior problems and fewer social competence behaviors than a standardized normal western population.

Adaptation, Psychological↗

PubMed2006

Examining the communication skills of a young cochlear implant pioneer.

The purpose of this longitudinal case study was to closely examine one deaf child's experience with a cochlear implant and his speech, language, and communication skills from kindergarten through middle and high school using both developmental and sociocultural frameworks. The target child was one of the first children to receive a cochlear implant in the United States in 1988, when he was 5 years of age. The developmental analysis revealed that prior to receiving a cochlear implant the child demonstrated profound delays in speech and language skill development. His speech and language skills grew slowly during the first 3-4 years following implantation, very rapidly from about 5 through 7 years postimplantation, then slowed to rates that were highly similar to same-age peers with normal hearing. The sociocultural analysis revealed that the child's communicative competence improved; that he used sign language but use of sign language decreased as his oral communication skills improved; that as his oral communication skills improved, the adults talked and directed the topic of conversation less frequently; and that topics became less concrete and more personal over time. The results of this study indicate that we may learn more about how to support children who use cochlear implants by examining what they are saying as well as how they are saying it.

Adolescent↗

PubMed1999

Repressor binding to a dorsal regulatory site traps human eIF4E in a high cap-affinity state.

Eukaryotic translation initiation involves recognition of the 5' end of cellular mRNA by the cap-binding complex known as eukaryotic initiation factor 4F (eIF4F). Initiation is a key point of regulation in gene expression in response to mechanisms mediated by signal transduction pathways. We have investigated the molecular interactions underlying inhibition of human eIF4E function by regulatable repressors called 4E-binding proteins (4E-BPs). Two essential components of eIF4F are the cap-binding protein eIF4E, and eIF4G, a multi-functional protein that binds both eIF4E and other essential eIFs. We show that the 4E-BPs 1 and 2 block the interaction between eIF4G and eIF4E by competing for binding to a dorsal site on eIF4E. Remarkably, binding of the 4E-BPs at this dorsal site enhances cap-binding via the ventral cap-binding slot, thus trapping eIF4E in inactive complexes with high affinity for capped mRNA. The binding contacts and affinities for the interactions between 4E-BP1/2 and eIF4E are distinct (estimated K(d) values of 10(-8) and 3x10(-9) for 4E-BP1 and 2, respectively), and the differences in these properties are determined by three amino acids within an otherwise conserved motif. These data provide a quantitative framework for a new molecular model of translational regulation.

Adaptor Proteins, Signal Transducing↗

PubMedDate not supplied

Selecting and using research instruments.

Many factors must be considered in planning and implementing research. Scientific reasons for decisions are important, but so are practical considerations. The suggestions made throughout this column are based on experience and may seem to some to be simply "common sense." However, the importance of these practical, common sense considerations cannot be minimized. These practical suggestions are intended to bring into focus the fact that the research process is not that different from other decision-making processes: In research as in life, there are multiple ways to get from point A to point B, and none of them is inherently right or wrong. The choices the researcher makes in designing and implementing a study must be clearly described and must be based on the research goals, the theoretical framework used, and the resources available. Potential nurse researchers should not be intimidated by the task at hand. Rather, they should be comforted by the fact that the same processes they use in making decisions about clinical practice can be employed in designing and implementing research studies.

Data Collection↗

PubMedDate not supplied

Implementing evidence-based practice in clinical situations.

Many nurses in a variety of clinical settings are facing the challenges posed by incorporating evidence-based practice in health care. Some of the steps involved in implementing evidence-based care in clinical practice are discussed and a two-step framework to assist practitioners in implementing evidence-based practice is outlined. Factors such as the relevance of specific guidelines or research, generalisability of research findings, the strength of the evidence relative to the risks and benefits of treatment, and patient preferences are discussed in terms of evidence-based decision making.

Benchmarking↗

PubMedDate not supplied

Measuring service line competitive position. A systematic methodology for hospitals.

To mount a broad effort aimed at improving their competitive position for some service or group of services, hospitals have begun to pursue product line management techniques. A few hospitals have even reorganized completely under the product line framework. The benefits include focusing accountability for operations and results, facilitating coordination between departments and functions, stimulating market segmentation, and promoting rigorous examination of new and existing programs. As part of its strategic planning process, a suburban Baltimore hospital developed a product line management methodology with six basic steps: (1) define the service lines (which they did by grouping all existing diagnosis-related groups into 35 service lines), (2) determine the contribution of each service line to total inpatient volume, (3) determine trends in service line volumes (by comparing data over time), (4) derive a useful comparison group (competing hospitals or groups of hospitals with comparable size, scope of services, payer mix, and financial status), (5) review multiple time frames, and (6) summarize the long- and short-term performance of the hospital's service lines to focus further analysis. This type of systematic and disciplined analysis can become part of a permanent strategic intelligence program. When hospitals have such a program in place, their market research, planning, budgeting, and operations will be tied together in a true management decision support system.

Catholicism↗

PubMed1994

The making of Spanish public health administration during the first third of the twentieth century.

An overview of the forming of the modern Health Administration in Spain is intended, trying to relate proposals with day to day realities. Starting with the dissection of elements that suggested the sanitary backwardness of Spain to contemporary observers, this paper traces the actual program to modernization in public health services through the analysis of the political action led by an élite of doctors and public health administrators, who happened to be at the same time relevant political figures of the dynastic parties, the legal framework of reform (the General Decree of Health, 1904) and the institutional changes in the provisions for public health surveillance; these are labelled "from the Health Boards to the Institutes of Hygiene", symbolizing the moving away from a traditional, pluri-composed and political instance, the Health Board, where experts performed just as advisers, to a new, scientific based and professionally managed institution which, under the Second Republic, extended its benefits to the rural population. The lack of practical effects of these public health reforms led us to conclude that they were suggested more to extend professional areas of competence as well as part of conciliatory policies regarding the "social question".

History, 20th Century↗

PubMed2000

[Perceptions, adaptation and health care strategies of the elderly family caregivers from the standpoint of the shift to ambulatory care].

This article presents the results of an exploratory study funded by the Social Sciences and Humanities Research Council of Canada. The objectives of this research were to explore (a) the perception by elderly women caregivers of the shift to ambulatory care; (b) their use of coping behaviours in the face of this major change within the health care system; and (c) their perceptions of health care services. In a theoretical framework of stress and coping, and using standardized questionnaires and open-ended questions, 40 home interviews were initially conducted with elderly women, each of whom was caring for her spouse after his discharge from hospital. Additional data were collected through focus groups. Quantitative and qualitative analyses revealed that elderly women caregivers perceive ambulatory care in a positive manner and as a change involving challenges only when they feel in control of the health care situation and when the care does not necessitate specialized abilities. When the care to be provided is complex and requires continued involvement and specific competence on the caregiver's part, the situation results in insecurity for elderly women. Caregivers use cognitive coping strategies to deal with their problems and are not inclined to use formal services in their social support network. Participants in this study wished to be better informed about the health care system in general ("how the system works") so that they could acquire a sense of predictability. Other expectations of elderly women caregivers concerned the importance of continuity in health services delivery, better preparation for the transition from hospital to home and availability of psychological support for themselves. These results suggest a critical analysis of the present paradigm guiding health care services, in which family caregivers are considered as resources or coworkers instead of coclients.

Aged↗

PubMedDate not supplied

The Iowa model: a proposed model for nursing administration.

The purpose of the Iowa Model is to serve both as a heuristic device and as a framework for articulating knowledge for nursing administration research, practice, and education. The model delineates two domains of knowledge (systems and outcomes), each with three levels (patient aggregates, the organization, and the health care system). Concepts useful for knowledge development are identified for each level. Practice, research, and curricular applications of the model are made.

Clinical Competence↗

PubMed2006

Osteoarthritis: an example of phenoptosis through autonomic dysfunction?

Phenoptosis, the programmed death of organisms akin to cellular apoptosis, constitutes a type of Darwinian selection that enhances inclusive fitness. It provides a means by which senescent and pre-senescent members can self-terminate if they have incurred sufficient cumulative stress such that their continued survival detracts from inclusive fitness. Sepsis, vascular disease, menopause, cancer, and aging all represent examples of phenoptosis at work. We previously proposed that feed-forward autonomic dysfunction fundamentally drives phenoptosis in all its guises. Accordingly, we now postulate that osteoarthritis defines a type of biomechanical phenoptosis, mediated by feed-forward autonomic dysfunction, and manifested through joint destruction associated with fitness disadvantages. Biomechanical capability plays a significant role in evolutionary fitness, and sustained joint insults such as immobility or undue biomechanical stress may serve as proxies for inferior fitness. By both hindering an individual's ability to compete for energy and increasing that individual's vulnerability to predation, feed-forward joint destruction may facilitate adaptive phenoptosis among impaired or senile members. Empirical data suggests that contrary to common belief, heavy joint use does not necessarily cause osteoarthritis, whereas immobility and neuropathy can predispose to the condition. From a Darwinian perspective, another process mediated by sympathetic activity, the alarm cry of attacked prey, simultaneously promotes the escape of kin while attracting predators and scavengers. By effectively enabling the martyrdom of biomechanically-challenged individuals, osteoarthritis may serve to optimize system energy efficiency in a similar fashion. This framework may generalize to other situations where regenerative capacity dissipates in conjunction with maturation, typically leading to fibrosis. By allowing environmental pressure to sort the phenotypes, imperfect repair mechanisms may accelerate adaptation and optimize long-term inclusive fitness for all individuals. As the basis of competition shifts from biomechanical to cognitive skills, and as novel triggers for physical stress emerge, osteoarthritis may now represent a modern maladaptation.

Apoptosis↗

PubMed2005

Orphan comparisons and indirect meta-analysis: a case study on antidepressant efficacy in dysthymia comparing tricyclic antidepressants, selective serotonin reuptake inhibitors, and monoamine oxidase inhibitors by using general linear models.

Direct comparisons of the efficacy of competing interventions are not always available in the literature. This situation leads to the presence of clinically relevant "orphan comparisons" of therapeutic interventions which have never been compared head-to-head. To overcome this limitation, simple methods for indirect meta-analysis have been suggested. Nevertheless, their results are prone to bias when more than 1 indirect comparison is tested because of the likely duplication of data for some comparisons. In contrast, general linear models can be used to extend simple indirect meta-analysis beyond 1 indirect comparison by fitting to incomplete data using maximum likelihood within the framework of multitreatment comparisons. This study presents a tutorial application of general linear models to the comparative efficacy of several antidepressants in dysthymia (tricyclic antidepressants, selective serotonin reuptake inhibitors, and monoamine oxidase inhibitors. Working with previously published data comparing the efficacy of antidepressants with placebo, it is shown that tricyclic antidepressants and selective serotonin reuptake inhibitors present similar efficacy (odds ratio = 1.19, P = 0.37; relative risk = 1.10, P = 0.24; risk difference = 0.03, P = 0.53), whereas monoamine oxidase inhibitors outperform both tricyclic antidepressants and selective serotonin reuptake inhibitors, at least for some effect scales (odds ratio = 1.57, P = 0.05; relative risk = 1.25, P = 0.05; risk difference = 0.09, P = 0.08). This finding, which is an instance of a relevant orphan comparison and could not be obtained otherwise, could motivate the conduct of clinical trials or focused systematic reviews to support or refute its importance through appropriate head-to-head comparisons.

Antidepressive Agents, Tricyclic↗

PubMed2002

Sociocultural Learning Theory in Practice: Implications for Athletic Training Educators.

OBJECTIVE: To discuss cognitive and sociocultural learning theory literature related to athletic training instructional and evaluation strategies while providing support for the application of these practices in the didactic and clinical components of athletic training education programs. DATA SOURCES: We searched Educational Resources Information Center (ERIC) and Education Abstracts from 1975-2001 using the key words social cognitive, sociocultural learning theory, constructivism, and athletic training education. Current literature in the fields of educational psychology and athletic training education provides the foundation for applying theory to practice with specific emphasis on the theoretic framework and application of sociocultural learning theory strategies in athletic training education. DATA SYNTHESIS: Athletic training educators must have a strong fundamental knowledge of learning theory and a commitment to incorporate theory into educational practice. We integrate literature from both fields to generate practical strategies for using sociocultural learning theory in athletic training education. CONCLUSIONS/RECOMMENDATIONS: Social cognitive and sociocultural learning theory advocates a constructive, self-regulated, and goal-oriented environment with the student at the center of the educational process. Although a shift exists in athletic training education toward more active instructional strategies with the implementation of competency-based education, many educational environments are still dominated by traditional didactic instructional methods promoting student passivity. As athletic training education programs strive to increase accountability, educators in the field must critically analyze teaching and evaluation methods and integrate new material to ensure that learning is maximized.

Journal Article↗

PubMed2004

Professional codes in a changing nursing context: literature review.

BACKGROUND: Professional codes played a definitive role during a specific period of time, when the professional context of nursing was characterized by an increasing professionalization. Today, however, this professional context has changed. AIM: This paper reports on a study which aimed to explore the meaning of professional codes in the current context of the nursing profession. METHOD: A literature review on professional codes and the nursing profession was carried out. The literature was systematically investigated using the electronic databases PubMed and The Philosopher's Index, and the keywords nursing codes, professional codes in nursing, ethics codes/ethical codes, professional ethics. CONCLUSION: Due to the nursing profession's growing multidisciplinary nature, the increasing dominance of economic discourse, and the intensified legal framework in which health care professionals need to operate, the context of nursing is changing. In this changed professional context, nursing professional codes have to accommodate to the increasing ethical demands placed upon the profession. Therefore, an ethicization of these codes is desirable, and their moral objectives need to be revalued.

Codes of Ethics↗

PubMedDate not supplied

The introduction of nurse-initiated thrombolysis in coronary care.

Nurse-initiated thrombolysis has emerged as an organizational strategy to improve the delivery of thrombolytic agents to patients suspected of having an acute myocardial infarction. This article will outline the evolution of nurse-initiated thrombolysis on the coronary care unit in the authors' trust and present data on the critical decision-making skills of those nurses who have expanded their practice. Patients who were assessed, and whose thrombolysis was initiated by a nurse designated to deliver this treatment, had "door-to-needle" times consistent with the current targets of the National Service Framework for Coronary Heart Disease (Department of Health (DoH), 2000). A cardiologist acting as a "gold standard" reviewed the assessments of the first 50 patients seen by nurses able to deliver thrombolysis, finding each treatment decision appropriate. This gives support to the notion that appropriately trained and experienced nurses can assess and make treatment decisions in this acute care situation.

Clinical Competence↗

PubMed1993

From the Canadian Dietetic Association. Concept of dietetic practice and framework for undergraduate education for the 21st century.

Rapid change and marked diversity are expected to characterize the 21st century. If dietitians are to serve as change facilitators in this environment they will have to demonstrate greater flexibility and creativity, practise critical analysis and problem solving and employ creative thinking. Although provision of quality nutrition care will remain the unique contribution of dietitians, practitioners in the future will require a greater understanding of the impact of social, economic and political systems on food availability and food consumption and, in turn, health and well-being. Critical to the future practice of dietetics will be a greater understanding of research methodology, computer technology, quality improvement processes and risk management, principles governing learning and behaviour, personnel management and organizational behaviour, family and group dynamics, interpersonal communication and their application to dietetic practice. The Canadian Dietetic Association recently adopted a framework for the development of baccalaureate programs in dietetics designed to enable the dietetic practitioner to continue to make a unique contribution in the 21st century. The framework allows individual institutions the freedom and flexibility to plan programs that are compatible with their philosophy and organizational structure. In addition, it is predicted on the principle that a career in dietetics entails a lifetime commitment to education, of which the baccalaureate program is only the beginning.

Canada↗

PubMed1993

Novice to expert: an application of the Dreyfus model to management development in health care.

It has been the intent of the authors to describe a management development method which has as its basis a way to differentiate methods for skill development based on levels of skill acquisition. The intent is to provide an efficient and effective framework within which management development can occur as well as to test the utility of the Drefus model in the critical arena of developing management talent in health care environments. Further work and experience with both the model and the skills identified will continue.

Hospital Administrators↗