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PubMed1997

Training initiative list scheme (TILS) for minimal access therapy: the MATTUS experience.

The objective of the MATTUS intercollegiate exercise was to set up and audit a training initiative list scheme (TILS) by which funds are awarded to Trust hospitals for operative sessions used specifically for the training of staff in minimal access therapy (MAT). A prospective centralized audit of TILS involving nine Trust hospitals in Scotland over a 12-month period (1 March 1995-end of February 1996) was carried out. These hospitals had contracted for 510 4-h training sessions (389 for minimal access surgery, 121 for allied interventional techniques) by MATTUS accredited consultant tutors. The scheme covered training in technical competence for Minimal Access Surgery (MAS), interventional flexible endoscopy and interventional radiology within Scottish Hospitals. The main outcome measures used in the audit were trainee completion rates, conversion rates, morbidity and mortality, assessment of training received by trainees and assessment of aptitude by the trainers. The results were as follows. Of 510 sessions, 482 (95%) were completed within the deadline. Of these, 463 sessions were audited (367 for MAS, 69 for flexible endoscopy and 27 for interventional radiology). During these sessions, 817 operations/procedures were performed (781 training and 36 developmental). A total of 544 operations were performed during 339 MAS training sessions and 237 radiological/flexible endoscopy procedures in 96 MAT training sessions. The trainee was the principal operator in 643 (82%) procedures and completed the task in 581 (74%) cases. Four per cent of the MAS operations (22/544) required conversion. Post-operative complications occurred in 42 out of 817 patients (5%). Four patients, all with advanced malignancy, died within 30 days of the procedure. Trainees graded 355 sessions as excellent, 109 good, two as average and one as unsatisfactory. The tutors graded their trainees' aptitude to perform the operation as excellent in 34%, good in 53%, average in 11% and poor in < 1%. The training initiative list scheme which allows unhurried training in MAT by consultant tutors using operating sessions that are extra to the service lists is operationally and educationally viable. Furthermore, it can be implemented within a pre-determined budget. The audit of TILS has also demonstrated that the immediate clinical outcome of patients is not compromised by this type of training.

Education, Medical, Graduate↗
PubMedDate not supplied

The importance of a successful Quality Assurance (QA) program from a research manager's perspective.

One responsibility of an EPA research manager is to ensure that data from research projects are acquired, processed, and reported in accordance with Quality Assurance (QA) requirements established by the Agency. To meet this responsibility, the research manager should understand Agency QA requirements, require an appropriate, effective Quality Assurance program to ensure that data are of known and acceptable quality for the intended use of the data, and provide support, guidance, and oversight to principal investigators in meeting QA requirements. In addition, the effectiveness of the QA effort can be enhanced if the research manager 1) ensures that principal investigators and other managers are aware that QA is viewed as an essential, integrated component of the research programs; 2) provides adequate resources (people and money) to support an effective Quality Assurance program; 3) encourages cooperative, productive interactions between researchers and Quality Assurance professionals; and 4) maintains oversight so that issues that have the potential for adversely affecting research and Quality Assurance objectives can be negotiated and corrected quickly. This presentation will discuss the Air Pollution Prevention and Control Division's Quality Assurance program and the approaches used to meet Quality Assurance requirements in the Division. The presentation will be a technical manager's perspective of the Division's requirements for and approach to Quality Assurance in its research programs. The presentation will include the design of the QA Team, the roles of members of the QA Team, training and technical aids provided by the QA Team to promote understanding of and adherence to Agency QA requirements, the interactions of the QA Team members with principal investigators, and examples of effective conflict resolution.

Air Pollution↗
PubMed1999

A comparative study of the attitudes of users and non-users towards computerized care planning.

The aim of this study was to compare the attitudes of nurses who had little or no experience of computerized care planning (non-users) with those who had at least two years' experience (users). The study also assessed levels of computer literacy among both cohorts and the training methods that were considered most appropriate to meet their needs. The approach was quantitative, using a questionnaire to collect data from 15 non-users and 14 users. The overall results suggest that both non-users and users had favourable attitudes towards the use of computerized care plans. However, non-users with previous computer experience had more favourable attitudes towards the introduction of computerized care planning than those with no previous experience. The preferred teaching method identified by both groups was training by technical staff in the clinical area.

Adult↗
PubMed2001

Development of a model for training and evaluation in subfascial endoscopic perforator surgery (SEPS).

We describe a training method with objective evaluation that enhances video-assisted surgical skills. Training is via a simulator for subfascial endoscopic perforator surgery (SEPS) and can assess whether specific training exercises are helpful in the acquisition of skills for video-assisted surgical techniques. Twenty-five surgeons, with or without experience in video-assisted surgical techniques, were asked to perform standardised drills connected with the SEPS technique. The SEPS simulator consisted of an artificially constructed subfascial space in a leg, in which false perforator veins had to be localised, clipped and cut. The participants performed two sequences of actions three times, in order to improve their dexterity. The time required to perform each sequence was recorded. All trainees showed a steady improvement in skill-acquisition of the SEPS technique; the difference was statistically significant (p < 0.004). Despite its obvious importance in teaching programmes, the assessment and training of technical ability has not been fully developed. If virtual reality simulators are to become more important in the future, simulation models will have to approximate more closely the real operating theatre, and thus will become more valid in the training and evaluation of surgical technique.

Journal Article↗
PubMedDate not supplied

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Acquired Immunodeficiency Syndrome↗
PubMed2002

The Chilean legacies in health care quality.

OBJECTIVE: The Chilean quality assurance (QA) program evaluation took place in July 1999, at the request of the Chilean Ministry of Health. The main objectives of the evaluation were to identify key aspects of the 8-year-old Chilean QA program that could be considered by other countries and to make strategic recommendations. SETTING: In 1991, the Ministry of Health of Chile launched a national QA program. A national-level team initiated countrywide training of health care providers in QA skills, the development of quality committees at facility levels to direct local quality improvement activities, and training of quality monitors to provide technical support for training and quality improvement activities. DESIGN: The evaluation team, consisting of two international consultants and a regional consultant from the Costa Rican Ministry of Health, visited six regions and seven health 'servicios' (geographically defined administrative units within a region). The regions and servicios were purposefully chosen to represent different geographic areas, types of facilities, and levels of performance of QA activities. The evaluation was based on a framework developed and applied by the Quality Assurance Project (Center for Human Services, USA). Group and individual interviews with staff complemented document and record reviews. RESULTS: The evaluation team found that Chile's QA program had been successful in achieving sustainability and institutionalization. Factors contributing to this success included the enabling environment, management and leadership, technical functions, and support functions. CONCLUSION: The Chilean QA program constitutes an interesting experience for consideration by other countries. Key features include its sustainability, nationwide coverage, decentralization, and alliance of quality improvement and regulation. Training results are impressive: almost 20% of Ministry of Health personnel received training, and 19 training modules are in use. Coaches are active and technically sustaining quality assurance activities nationwide.

Chile↗
PubMed1996

Remote trauma management--setting up a system.

A telemedicine link to enable nurse practitioners at a remote minor injuries unit to obtain advice from an emergency physician at a main accident and emergency department is feasible and worthwhile. However, it is fraught with difficulties. These include technical difficulties, training problems, familiarization with the technology and provision of enough emergency physician time for the much longer duration of a full consultation. When choosing the equipment, attention has to be paid to the cameras, lighting, echo cancellation, layout of rooms, privacy and ambience. It is useful to obtain the system from suppliers who know what they are doing and have adequate backup of appropriate technical expertise, because each installation is different and difficult. Our experience suggests that anyone wishing to use similar technology should be prepared to be doggedly determined to learn the system, iron out kinks and motivate all concerned. The project will need to be driven. The technology is still at a stage where frustration and delay are significant. However, it is rewarding and very useful if the staff overcome its shortcomings and in due course all are pleased that they participated.

Emergency Medical Services↗
PubMedDate not supplied

Virtual reality training for the operating room and cardiac catheterisation laboratory.

CONTEXT: High-profile cases of medical errors in the USA and UK, and major reports from organisations such as the US Institute of Medicine and UK Senate of Surgery, have sensitised the public and medical profession. Training is a key area that must be tackled to positively affect the problem of medical errors, especially in surgery and interventional cardiology. Despite the radically novel skills required for minimally invasive surgery or interventional cardiology, current training has gone largely unchanged. At the end of the 20th century, the public and the medical profession have concluded that training on patients is no longer acceptable. STARTING POINT: Recently, Teodor Grantcharov and colleagues (Br J Surg 2004; 91: 146-50) did a randomised double-blind trial which showed that training by virtual reality (VR) significantly reduces objectively assessed intraoperative errors in laparoscopic cholecystectomy. They used a low-fidelity VR simulator. Much more sophisticated VR simulators exist for endoscopy, gynaecology, laparoscopy, orthopaedics, otolaryngology, robotics, and urology. There are few studies on the efficacy of these simulators in improving the safety of procedures on patients. WHERE NEXT: There needs to be more large and multicentre studies. Technical skills training for procedural based medicine continues to be an ad-hoc mentor-based experience for the trainee, with experience gained by practising on patients. The skills required now are so difficult to learn that this type of training is no longer acceptable. VR-simulator-based training does work, but further empirical evidence is required to convince the more conservative members of the medical community.

Cardiac Catheterization↗
PubMed1997

[Quality control in ultrasonography].

Because of the lack of resources, which is getting more and more important, the control of quality is becoming an important consideration in the health system. The ultrasound as a cheap and easily available tool is no exception in this consideration. The control of the technical quality must follow certain considerations, which must be anchored in the daily usage. This is especially important if we want to evaluate the effect of the ultrasound diagnostic on the further development of the patient, the general health status, the quality of life of a certain population with large-scale epidemiologic studies. If the interpretation and indication of ultrasound should be part of medical knowledge and training, the technical quality control should also be part of the basic duties regularly done. The technical quality is the first part of the chain of the diagnostic by ultrasound. The slightest disturbance will certainly have consequences in the following steps of the treatment of the patient. The evaluation of the quality must contain a control of the security of the technical equipment available, of the spatial and contrast resolution of all the ultrasound transducers as well as a control of the monitor. Testing of the resolution can be done with a specially designed simulator/phantom, equipped with special marks permitting the measuring of the axial, lateral and transversal resolution, this simulator is also used in planimetry to evaluate the region of the optimal resolution and the geometrical reproduction. These controls must be done regularly, and the data received must be stored. Only with such a regular control we can guarantee the quality of the technical equipment and installations.

Humans↗
PubMed2006

Development and implementation of pharmaceutical care planning software for nursing homes based on the Fleetwood Model.

PURPOSE: The effectiveness of pharmaceutical care planning software for nursing homes and the extent to which the software assisted in the implementation of the Fleetwood Model are described. METHODS: During the study, one long-term-care pharmacy identified 13 nursing homes to participate in the intervention group of a study evaluating the effectiveness of the Fleetwood Model. To successfully implement the Fleetwood Model, which demands prospective drug regimen review and collaborative practices between dispensing and consultant pharmacists, a software system that exchanged information between these pharmacists was deemed necessary. Pharmacists' self-reported assessments of the use of the software and the technical difficulties reported with its use were collected. The number of interventions performed by pharmacist type, the proportion of residents receiving interventions by multiple pharmacists, and the extent to which the interventions were prospective and performed before the mandated 30-day review were estimated from data documented in the software. The consistency of software use by the pharmacists was also estimated. RESULTS: Seventy-one percent of dispensing pharmacists and 40% of consultant pharmacists reported using the software most or all of the time. Fourteen percent of dispensing pharmacists and 40% of consultant pharmacists reported technical difficulties with the software. Over half of newly admitted or readmitted residents received a Fleetwood intervention within 3 days of admittance into the nursing home-71.2% occurred in less than 30 days of admission. CONCLUSION: The use of information technology to increase communication among health care professionals and assist in providing prospective drug regimen review in long-term-care facilities is feasible. Collaboration and extensive field testing with end users, realistic expectations, appropriate training, and technical support are necessary when implementing new technology.

Aged↗
PubMed1993

Training of the sprint start technique with biomechanical feedback.

The purpose of this study was to improve the individual starting technique of eight top junior sprinters using biomechanical feedback training. Three technical parameters (blocks spacing to the start line, knee angle of the front leg and proportion of body mass falling on the hands) were varied. The horizontal velocity at take-off and the time to 10 m were the criteria used to evaluate the effect of the technical changes. All of the parameters were measured simultaneously and the athletes were provided with feedback immediately after each attempt. Seven of eight sprinters showed a statistically significant improvement in starting performance after modifying the position of their blocks. The improvement in 10-m time and horizontal velocity at take-off did not correlate significantly. The power exerted during the starting action correlated significantly with the time to 10 m. Therefore, it was concluded that effective biomechanical feedback during the training of the sprint start should use power exerted as the principal criterion because horizontal velocity shows an intra-individual optimal trend in improvement.

Acceleration↗
PubMed1974

Contraceptive distribution in Brazil.

Brazil's 1st program for the community based distribution of contraceptives is successfully in 30 municipalities in Rio Grande do Norte, a state in Brazil's arid Northeast. Already, over 5000 women have been reached by the program, which is operated by the State Secretariat of Health with technical assistance provided by BEMFAM, and IPPF affiliate, under an agreement signed by the governor of Rio Grande do Norte and BEMFAM. In December, several newspapers reported that the program was in possible violation of a law prohibiting distribution of contraceptives without a prescription. After conferring with the secretary of health and local BEMFAM personnel in Rio Grande do Norte, Dr. Walter Rodrigues, executive director of BEMFAM, declared: "There has been no violation of the law for the simple reason that the program was carried out by the Public Health Secretariat's Department of Maternal and Child Care and under the responsibility of its own doctors." He added that BEMFAM had provided both training and technical assistance. According to Dr. Rodrigues, the matter arose when certain well known groups that oppose family planning took advantage of an opportunity to hinder the development of the program. He also pointed out that the nurses and midwives who dispense the pill obtain a prescription for their patients from a local doctor. Many mayors of the 150 municipalities in Rio Grande do Norte have requested the governor and secretary of health to start the program in their municipality. However, expansion of the new distribution program to additional areas will take place gradually as the number of trained personnel and resources increase. Brazil's President elect General Ernesto Geisel takes office in March. The new president, a Lutheran, will be the 1st Protestant to lead Brazil.

Americas↗
PubMed2003

Evaluation of the Florida coordinated school health program pilot schools project.

The Florida Department of Education, with CDC funding, designed the Florida Coordinated School Health Program Pilot Schools Project (PSP) to encourage innovative approaches to promote coordinated school health programs (CSHP) in Florida schools. Each of eight pilot schools received $15,000 in project funding, three years of technical assistance including on-site and off-site assistance, a project office resource center, mailings of resource materials, needs assessment and evaluation assistance, and three PSP Summer Institutes. Project evaluators created a context evaluation, approaching each school independently as a "case study" to measure the school's progress in meeting goals established at baseline. Data were collected using the How Healthy is Your School? needs assessment instrument, a School Health Portfolio constructed by each school team, a Pilot Schools Project Team Member Survey instrument, midcourse team interviews, final team interviews, and performance indicator data obtained from pilot and control schools. The PSP posed two fundamental questions: "Can financial resources, professional training, and technical assistance enable individual schools to create and sustain a coordinated school health program?" and "What outcomes reasonably can one expect from a coordinated school health program, assuming programs receive adequate support over time?" First, activities at the eight schools confirmed that a coordinated school health programs can be established and sustained. Program strength and sustainability depend on long-term resources, qualified personnel, and administrative support. Second, though coordinated school health programs may improve school performance indicators, the PSP yielded insufficient evidence to support that belief. Future projects should include robust measurement and evaluation designs, thereby producing conclusive evidence about the influence of a coordinated school health program on such outcomes.

Adolescent↗
PubMed2006

Randomised, controlled study investigating the optimal instructor: student ratios for teaching suturing skills.

INTRODUCTION: Recently, there has been a shift away from practising procedures on patients for the first time and towards bench model teaching of clinical skills to undergraduate medical students. However, guidelines for the most effective instructor : student ratio for technical skills training are unclear. This has important implications for staffing laboratory based teaching sessions. The purpose of this study was to assess the optimal ratio of teachers to learners during the teaching of a simulated wound closure. METHODS: A total of 108 undergraduate medical students participated in a 1-hour course on wound closure. They were randomised to 3 groups, each with a different instructor:student ratio (Group A: 6-12; Group B: 3-12; Group C: 1-12). Students were evaluated on a pre-test, an immediate post-test and a delayed retention test using an objective, computer-based technical skills assessment method. Collectively termed the "economy of movements", the total time taken to complete the task and the number of movements executed were the primary outcome measures. RESULTS: Improvements in the economy of movements were the same for Groups A and B and were better than in Group C (P < 0.005). DISCUSSION: The optimal instructor:student ratio was 1 instructor for 4 students. Higher ratios of instructors to students resulted in no improvements in learning, and lower ratios of instructors to students resulted in significantly less learning. These findings are in keeping with current motor learning theories.

Analysis of Variance↗
PubMed2004

Understanding a VA preventive care clinical reminder: lessons learned.

This article presents "lessons learned" about using a computerized clinical reminder (CCR) for influenza in spinal cord injury (SCI) centers in the Veterans Health Administration (VHA). Although research has shown that use of a CCR increases adherence to preventive care measures, technical and administrative issues affect its use by nurses. CCR is a term for a reminder in a patient's electronic medical record to initiate a preventive care activity. Qualitative data about using the CCR for influenza were collected from staff using semi-structured interviews, e-mail questionnaires, and telephone calls. Once issues were identified, follow-up activities included discussions with local and national experts and problem-solving activities. The investigators identified two national issues about the CCR for influenza: the taxonomy to identify patients with SCI, and the "due date" for influenza vaccine. Local issues included authorization for nurses to use the CCR, ease of use of the CCR for inpatients and outpatients, connectivity of the medication tracking program for inpatients with the electronic medical record, configuration of the CCR in the electronic medical record, training, and technical support.

Aftercare↗
PubMed2006

Lessons learned from pilot site implementation of an ambulatory electronic health record.

As ambulatory care practices face increasing pressure to implement electronic health records (EHRs), there is a growing need to determine the essential elements of a successful implementation strategy. HealthTexas Provider Network is in the process of implementing an EHR system comprising GE Centricity Physician Office-EMR 2005, Clinical Content Consultants (now part of GE), and Kryptiq Secure Messaging throughout all 88 practices in the Dallas-Fort Worth area and is hoping to extend the system to other practices affiliated with Baylor Health Care System as well. We describe the preimplementation clinical process redesign and quality improvement training that has been conducted networkwide in preparation for the introduction of the EHR, as well as the specific steps taken to prepare and train clinic staff for the integration of the EHR into daily workflows. The first pilot site, Family Medical Center at North Garland, implemented the system in May 2006. Based on both the positive aspects of this experience and the challenges we encountered, we identified 20 essential elements for successful implementation in the areas of site selection, implementation strategy, staff education and preparation, team project management, content, hardware and software, and workflow process. Broadly, we determined that 1) a pilot site's understanding of and willingness to work within the fluid nature of the implementation process during what is essentially a testing phase is a key ingredient in achieving success at the pilot site and in improving the process for later sites; 2) input from and representation of viewpoints of all types of EHR users during preimplementation decision making enables customization of the system and sufficient preplanning to ensure minimal workflow disruptions during and after implementation; and 3) a high level of technical and training support during the early days of implementation is invaluable.

Journal Article↗