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PubMed2004

A statistical method for the quantification of the learning index by means of multiple answer tests-Graduated Response Test.

In the fields of didactics and continuous professional development (CPD) plans, the increasing use of multiple answer tests for the evaluation of the level of knowledge in various kinds of subjects makes it increasingly important to have reliable and effective tools for data processing and for the evaluation of the results. The aim of the present work is to explore a new methodological approach based on a widely tested statistical analysis able to yield more information content when compared with the traditional methods. With this purpose we suggest a Graduated Response Test and the relative operating characteristic curve (ROC) for the evaluation of the results. A short description of a computerized procedure, written in Visual Basic Pro (v.6.0), which automatically performs the statistical analysis, the ROC curves plot and the calculation of a learning index is given as well.

Computer-Assisted Instruction↗
PubMed2005

New diagnostics in parasitology.

The long-overdue introduction of new technology into parasite diagnostics has produced important tests that are now finding a place in clinical laboratories. It is too early to consider abandoning microscopy; the novel technology will run alongside the more traditional techniques for some years to come. Well-trained microscopists, supported by regular continuing professional development and external quality assessment schemes, are still central to the provision of a reliable diagnostic parasitology service.

Feces↗
PubMed2004

Health informatics education for clinicians and managers--what's holding up progress?

This paper reports outcomes of a national survey of health informatics (HI) education and training carried out in the UK. A questionnaire to elicit details of HI and IT skills teaching was derived from a national consensus document (Learning to Manage Health Information, LtMHI). Forms were sent to all pre-qualification medical and nursing schools and to a stratified sample of postgraduate and post-registration programmes. Three case studies were carried out in acute hospital trusts to gain insight into opportunities for continuing professional development in health informatics and IT. Our evidence suggests that in the UK, health informatics is not yet integrated into the clinical curriculum. Nearly all the pre-qualification courses made some provision for teaching IT skills. Nonetheless, many respondents felt that students did not receive sufficient training. There was considerable variation in the amount of HI teaching provided in the different educational sectors. The case studies suggested very little HI training was provided for clinical staff and take-up of provision was not monitored. A number of factors are holding up progress, the most important being a lack of staff with the knowledge and skills to provide academic leadership. The paper outlines some steps that need to be taken to ensure health informatics is embedded in all clinical curricula.

Computer Literacy↗
PubMed2005

The decision-making processes of nurses when extubating patients following cardiac surgery: an ethnographic study.

BACKGROUND: The movement towards research and evidence-based practice in health care demands that the best available evidence is applied to practice. At the same time, changes to role boundaries mean that nurses are assuming increased responsibility, especially in relation to decision making. While increasing, there has been limited consideration about the application of best evidence and decision making by nurses in the context of their clinical work. OBJECTIVES: This study sought to explore the realities of research and evidence-based practice through an examination of the decision making of nurses when extubating patients following cardiac surgery. DESIGN: The tradition of qualitative research and, more specifically, ethnography were used for the study. SETTING: Data were gathered over an 18-month period during 1998 and 1999 within a Cardiothoracic Intensive Care Unit (CICU). PARTICIPANTS: The sample comprised 43 nursing, 16 medical and two managerial staff. A purposive sample of five nurses, a cardiac surgeon, intensivist, CICU manager and Deputy Divisional Manager were included in interviews. METHODS: All staff were included in participant observation. Semi-structured interviews were conducted with a purposive sample of nurses during the 6th and 14th months and with a purposive sample of other staff during the 16th month. Data were analysed using progressive focusing, data source triangulation and sensitising concepts to identify themes and categories. RESULTS: The findings indicated that, despite the use of an unwritten physiologically based protocol for weaning and extubation, factors other than best evidence were significant in nurses' decision making. A range of personal, cultural and contextual factors including relationships, hierarchy, power, leadership, education, experience and responsibility influenced their decision making. CONCLUSION: This study revealed, often disregarded, cultural, contextual and personal characteristics which combined to form a complex process of decision making. Providing new insight into research and evidence-based practice, the findings have implications for policy makers, educators, managers and clinicians and for the continued professional development of nursing.

Anthropology, Cultural↗
PubMed2004

Portfolio assessment: practice teachers' early experience.

Experience was recognised to be a vital source of learning as long ago as 1762 [Emile, Everyman, London, 1993] and reflection on practice experience may be one way forward in addressing nursing's anxieties concerning the practice theory gap. However, despite the acceptance that subjectivity in the process seems inevitable and potentially important, little is understood of the practitioner's experience of practice assessment. Two questionnaires sought the views of specialist community nursing practitioner (SCNP) programme (United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) 2001) practice teachers (PTs) on the introduction of the portfolio approach to practice assessment. These were distributed to 62 and 76 PTs and the response rates were 32% and 50%, respectively. Responses of those PTs from the three specialisms participating in the piloting of the portfolio approach were compared with those using an existing approach. An action research method was adopted which attempted to use established theory to explain the challenges presented by the introduction of this approach and ultimately to raise the PT group's awareness of assessment issues. Both qualitative and quantitative data were collected and the findings support the use of the portfolio approach to practice assessment. The PT experience of portfolio use was found to be a largely positive one. PTs reported the utility of the portfolio in prompting student self-evaluation of learning. Concerns were expressed by PTs around the quality of portfolio evidence although many felt that it had promoted students' reflection on practice. Inter-PT reliability in practice assessment was identified as a topic for PT continuing professional development. Many sources of evidence, including patient feedback, were used by PTs in their assessment of students although PTs using the portfolio approach used less first-hand experience of students' practice in their assessments of competence, relying more on written evidence, than those PTs using a traditional approach to practice assessment.

Community Health Nursing↗
PubMed2026

Genomic science and the nurse educator's role: Promoting integration from curriculum to clinical practice.

BACKGROUND: Registered nurses and nurse educators play a critical role in preparing future clinicians to translate genomic discoveries into practice. However, emerging evidence suggests that both groups may lack sufficient knowledge and confidence in genomics, potentially limiting their ability to teach, mentor, and apply genomics in real-world settings. This gap is especially concerning in Aotearoa New Zealand, where the genomic literacy of nurse educators and clinicians remains underexplored. OBJECTIVE: This study aims to: (1) assess nurse educators' genomic literacy and confidence in teaching genomics; and (2) evaluate registered nurses' knowledge and confidence in applying and teaching genomics in clinical practice. DESIGN: Exploratory descriptive qualitative. SETTING: This study was conducted in the greater Auckland area. PARTICIPANTS: A total of 17 participants were recruited using purposive sampling to ensure a diverse range of perspectives across varying levels of teaching experience, disciplinary backgrounds, and exposure to genomic content. METHODS: Data were collected using semi-structured focus group interviews, a method well-suited for generating in-depth discussion and facilitating interaction among participants with shared professional interests. The collected data were analysed using thematic analysis methods. RESULTS: The findings offer insight into the preparedness of New Zealand's nursing workforce to engage with genomic-informed healthcare and inform strategies for integrating genomics into nursing curricula and continuing professional development. Given the interdisciplinary nature of genomic healthcare, these insights may also be relevant to other health professionals-including midwives, pharmacists, and allied health practitioners-who increasingly encounter genomic information in clinical practice and require foundational competencies to support patient care. CONCLUSION: Addressing this educational gap is critical to ensuring that nurses-key facilitators of patient care and public health-are equipped to deliver safe, equitable, and evidence-based genomic healthcare.

Humans↗
PubMed2006

What sort of networks are public health networks?

BACKGROUND: Re-organization of the English National Health Service (NHS) has fragmented the public health workforce, relocating teams from about 100 health authorities into over 300 primary care trusts (PCTs). The UK Government announced the setting up of public health networks (PHNs) as a solution to the problems created by fragmentation. METHODS: Fifty-seven semi-structured telephone interviews were held with key players in PHNs in all strategic health authority areas in England in early 2003. RESULTS: PHNs appeared to be primarily networks of public health professionals rather than of organizations. Informants were unsure about PCTs' commitment to public health. Predominantly, members were those NHS personnel with a clear and explicit public health role. Most PHNs intended to include others later (e.g. health visitors, environmental health officers), although a few thought that inclusivity was essential from the start. Continuing professional development for public health personnel dominated the work being undertaken, with some collaborative work across PCTs. PHNs were seen as a compulsory reconfiguration of existing networks, and informants doubted that they were appropriate for the many levels of networking that public health work requires. CONCLUSION: The formation of PHNs does not appear to have been either necessary or sufficient. However, the public health community has a well-established tradition of networking, and therefore has the skills to use PHNs advantageously.

Community Networks↗
PubMed1997

Pharmacological choices after one antidepressant fails: a survey of UK psychiatrists.

BACKGROUND: At least 30% of depressed patients fail to respond to adequate first-line anti-depressant medication. Several pharmacological strategies have been suggested to treat such refractory depression. There has been no survey of United Kingdom psychiatrists' treatment preferences for refractory depression. This study was carried out to determine both experience and preference of various strategies for management of refractory depression. METHOD: A total of 300 fellows, members and inceptors of the Royal College of Psychiatrists were randomly selected and approached by postal questionnaire. They were asked to comment on management of a detailed clinical vignette of a case of depression with initial treatment failure. RESULTS: The response rate was 63% (n = 175). The most popular treatment choices were increasing dosage of tricyclic medication and change of medication of SSRI. The most rarely selected were augmentation with triiodothyronine (T3) and augmentation with tryptophan or MAOIs. Treatment choice was significantly influenced by previous experience. A large number (39%) of psychiatrists were not confident in treating refractory depression. CONCLUSION: Surprisingly few psychiatrists chose to use the best proven pharmacological treatments such as augmentation with lithium or T3. In view of this and the considerable proportion of psychiatrists lacking confidence in the management of refractory depression, this topic deserves priority as a topic for continuing professional development (CPD) courses.

Antidepressive Agents↗
PubMed2004

Mastery of fundamental movement skills among children in New South Wales: prevalence and sociodemographic distribution.

Fundamental movement skills form the foundation for many of the specific motor skills employed in popular sports and leisure activities. Little data exist on the prevalence and socioeconomic distribution of fundamental movement skill mastery among young children in Australia. This study process-assessed performance on six fundamental movement skills in a randomly selected sample of students from Years 1 through 3 in the Sydney metropolitan area of New South Wales. The prevalence and sociodemographic distribution of mastery and near mastery for each skill and each skill component is reported for boys and girls in each school year. The findings revealed that the prevalence of mastery and near mastery of each of fundamental movement skill was generally low. Boys performed significantly better than girls in the run and in the four object-control skills (throw, catch, kick, and strike) whilst girls performed better than boys in the skip. There was no consistent association between prevalence of skill mastery and socio-economic status (SES), with only the kick and vertical jump for boys and catch, dodge, and vertical jump for girls differing across SES tertiles. Based on these results, we recommend that adequate curriculum time, resources, and professional development continue to be devoted to fundamental movement skills in NSW primary schools.

Australia↗
PubMed2002

Improving cardiac rehabilitation: a view from the United Kingdom.

Cardiac rehabilitation has assumed more prominence over the past decade, due largely to an increase in user demand, an improvement in the evidence base and an enhancement of its status. This paper presents a view from the United Kingdom and suggests some ways in which cardiac rehabilitation can be improved by focusing on a number of key issues: service organisation and delivery, process and outcome measurement, performance management, and education, training and continuing professional development. The paper concludes that there is a need to make cardiac rehabilitation more widely available using creative and flexible approaches to enhance access, participation and adherence.

Benchmarking↗
PubMed2000

Do we really want a quick fix?

Dental practitioners have been encouraged recently to take a more structured long term view of their continuing professional development, in particular being wary of any 'weekend' courses apparently offering 'quick fix' solutions to their clinical problems.

Adolescent↗
PubMed1996

The continuum of dental education--one year on.

Continuing professional development should embrace all aspects of our professional life. Changes in the pattern of oral disease, developing concepts of specialisation and delivery of dental care require a flexible approach to the interface between the end of the undergraduate dental course and the early years of general professional training. This report lists a number of proposals agreed by an ad hoc working group, meeting under the auspices of the General Dental Council.

Clinical Competence↗
PubMed2004

The current working patterns and future career aspirations of specialist trainees in dentistry.

OBJECTIVES: To determine current demographic details of dental specialist registrars in the UK, to examine their current working patterns and ascertain their future career aspirations. METHODS: A cross-sectional survey, using a self-administered postal questionnaire of all 418 dental specialist registrars (SpRs) in the UK. RESULTS: The response rate was 78%. Of the SpRs who responded 59% were male, the majority were aged under 36, 54% were married and over one third had dependants. Orthodontics had the greatest number of SpRs with 141, followed by maxillofacial surgery (70) and restorative dentistry (52). On completion of training, 80% of SpRs intended to work full time. Significantly more women intended to work part-time. Only a fifth of SpRs said they would consider an academic appointment compared with 54% for specialist practice. Three quarters intended to work partly in the public sector and partly in a private capacity. London was the most popular choice of location for a post in the future. Access to a wide range of clinical work, continuing professional development, autonomy and sociability were the most important factors when considering their future choice of career. CONCLUSION: Changes in the demographic profile of dental specialists and increasing opportunities for providing care within primary care may lead to difficulties in recruitment to academic and hospital posts. Increasing provision of specialist services in the 'high street' might improve access but could lead to inequalities unless these services are commissioned according to the needs of the population.

Adult↗
PubMed2004

Mercury vapour levels in dental practices and body mercury levels of dentists and controls.

AIM: A study of 180 dentists in the West of Scotland was conducted to determine their exposure to mercury during the course of their work and the effects on their health and cognitive function. DESIGN: Data were obtained from questionnaires distributed to dentists and by visiting their surgeries to take measurements of environmental mercury. METHODS: Dentists were asked to complete a questionnaire including items on handling of amalgam, symptoms experienced, diet and possible influences on psychomotor function such as levels of stress and alcohol intake. They also completed the 12-item General Health Questionnaire. Dentists were asked to complete a dental chart of their own mouths and to give samples of urine, hair and nails for mercury analysis. The dentists were visited at their surgeries where environmental measurements were made in eight areas of the surgery and they undertook a computerised package of psychomotor tests. One hundred and eighty control subjects underwent a similar procedure, completing a questionnaire, having their amalgam surfaces counted, giving urine, hair and nail samples and undergoing the psychomotor test procedure. RESULTS: Dentists were found to have, on average, urinary mercury levels over 4 times that of control subjects although all but one dentist had urinary mercury below the Health and Safety Executive health guidance value of 20 mumol mmol(-1) creatinine. Urine was found to be a better biological marker for mercury exposure than hair or nails.Dentists were significantly more likely than control subjects to have suffered from disorders of the kidney but these symptoms were not significantly associated with their level of mercury exposure as measured in urine. One hundred and twenty two (67.8%) of the 180 surgeries visited had environmental mercury measurements in one or more areas above the Occupational Exposure Standard (OES) set by the Health and Safety Executive. In the majority of these surgeries the high levels of mercury were found at the skirting and around the base of the dental chair. In 45 surgeries (25%) the personal dosimetry measurement (ie in the breathing zone of dental staff) was above the OES. CONCLUSION: On the basis of these findings, it is recommended that greater emphasis should be made relating to safe handling of amalgam in the training and continuing professional development of dentists, that further studies are carried out on levels of mercury exposure of dental team members during the course of their working day, and that periodic health surveillance, including urinary mercury monitoring, of dental personnel should be conducted to identify possible effects of practising dentistry.

Air Pollutants, Occupational↗
PubMed1993

A trainer's perspective of an innovative programme teaching health visitors about the detection, treatment and prevention of postnatal depression.

Health visitors in North Staffordshire, Edinburgh and Lewisham were given the opportunity to participate in a training programme in the detection, treatment and prevention of postnatal depression, based on previously reported successful intervention strategies. They were trained in the use of the Edinburgh Postnatal Depression Scale (EPDS), and given information about the value and practice of non-directive counselling and about preventative strategies. Knowledge acquisition was evaluation by self-report questionnaires given before and after training. The health visitors were encouraged to screen postnatal women at three specified times using the EPDS and to offer non-directive counselling to women who obtained high scores. A baseline measure of the incidence of postnatal depression was obtained by asking health visitors to give an EPDS form to all women in their caseload with a 6-month-old baby before training commenced. A comparison of the number of women with high EPDS scores at 6 months postnatally, before and after training, showed that participation in the programme enabled health visitors to positively influence the emotional well-being of postnatal women. These results have implications for the role of health visitors which is currently being challenged, as well as for components of their training and continuing professional development.

Community Health Nursing↗
PubMed1999

The 'greying' of the United Kingdom nursing workforce: implications for employment policy and practice.

One in five nurses on the United Kingdom (UK) professional register is aged 50 years or older. Over the next few years, the profession will lose, through retirement, many of its most experienced practitioners. The significance for policy makers and for employers of this age-shift is two-fold. Firstly it is clear that greater numbers of nurses and midwives are reaching, or soon will reach, potential retirement age. Secondly many more nurses are now reaching their middle years and they are likely to have different requirements and attitudes to nursing work. This paper examines the employment policy and practice of the ageing of the UK nursing population. The paper examines data from official sources, and information from attitudinal surveys and case studies with employing organizations to assess the major effects of the ageing of the nursing workforce. Key findings are that the age profile of those nurses working in the National Health Service appears to be 'younger' than that of the total population, with the age profile of nurses working in nursing homes and as practice nurses being older than that of the NHS nursing workforce. However, the overall age profile of NHS nurses masks considerable variation between specialties and trusts, and the 'pool' of potential nurse returners from which the NHS and other employers attempts to recruit, is declining in numbers, as it too ages. Other major issues requiring policy attention are the provision of appropriate flexible hours to older nurses who have caring responsibilities, improving access to continuing professional development, and reducing pension provision inflexibility.

Adult↗
PubMed2003

Responding to the implications of the genetics revolution for the education and training of doctors: a medical humanities approach.

BACKGROUND: Rapid advances in the field of genetics continue to present medical educators with significant challenges. Whilst there is undoubtedly a pressing need to educate doctors about genetic disorders, research and therapies, there is a parallel need to provide a context for all of these. CONTENT: An interdisciplinary, arts and humanities based approach, responding to this need, is described. This teaching has been successfully delivered both as optional and core undergraduate teaching, and as part of continuing professional development. THE HUMAN PERSPECTIVE: STORIES NOT HISTORIES: Understanding of the patient's perspective can be significantly improved by drawing on both written and oral stories of illness. THE HISTORICAL PERSPECTIVE: LEARNING FROM THE PATIENT: Experiential learning provides insights into the social history of developments in genetics, thereby placing the current concern and debate about the new genetics in context. THE ROLE OF THE MEDIA: THE POWER TO PERSUADE: Critical reading skills can be developed and the power of the popular press to influence the reader acknowledged by analysing and employing the skills of the journalist when reporting developments in biotechnology. LEARNER ASSESSMENT AND EVALUATION: Assessment, both formative and summative, demonstrates sophisticated insights and perspectives into the lived experience of genetic illness. Learner evaluation of the teaching is high. CONCLUSION: Medical humanities offers a powerful way to convey an understanding of how genetic disorders impact on the lives of patients and families, and to set this against the background of a history rich in the uses, and abuses, of knowledge of heredity.

Clinical Competence↗
PubMed2002

Applying evidence and theory to guide clinical decision making--implications for asthma management.

Evidence-based medicine has been described as the "conscientious, explicit and judicious use of current best evidence in making decisions about the healthcare of individual patients". Many sources of information may be used by doctors when making decisions about initiating asthma therapy. These include: personal experience, postgraduate education, continuous professional development and publications in peer-reviewed journals. However, despite these sources of information, available data suggest that it is often difficult to practice evidence-based medicine, particularly in general practice. In the future, physicians will be provided with better evidence of the relative efficacy of treatment to aid changes in clinical practice. This will be provided, in part, by large well-conducted clinical trials, systematic reviews and meta-analyses. Linked with these, will be other methods of presenting data, for example, the number of patients needed to treat (NNT) to prevent one clinically significant event (for example, an asthma exacerbation). Despite these advances, incorporation of evidence-based practice into routine asthma care will be a slow and complex process. However, this process can be facilitated by physician education and participation in intervention programmes. In addition, it is important that clinicians are trained in how to convey the best possible evidence to their asthma patients.

Asthma↗