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At least 541 records · Page 30Linked to original sources
PubMed2004

Developing an OSTE to address lapses in learners' professional behavior and an instrument to code educators' responses.

PURPOSE: To develop an instrument for measuring medical educators' responses to learners' lapses in professional behavior. METHOD: In 1999, at the Indiana University School of Medicine, a 22-item checklist of behaviors was developed to describe common responses used by educators responding to learners' lapses in professional behavior. Four medical students were trained to portray lapses in professional behaviors. These students and seven clinical observers trained to categorize behaviors as present or absent. Interrater reliability was assessed during 18 objective structured teaching evaluations (OSTEs). Videotaped OSTEs were coded twice at a one-month interval for test-retest reliability. Items were classified as low, moderate, or high inference behaviors. Script realism and educator effectiveness were assessed. RESULTS: Educators rated OSTE scripts as realistic. Raters observed an average of 6 +/- 2 educator behaviors in reaction to learners' lapses in professional behavior. Educators' responses were rated as moderately effective. More experienced educators attempted more interventions and were more effective. Agreement was high among raters (86% +/- 7%), while intraclass correlation coefficients decreased with increasing inference level. From videotaped OSTEs, raters scored each behavior identically 86% of the time. CONCLUSIONS: Accurate feedback on educators' interactions in addressing learners' professionalism is essential for faculty development. Traditionally, educators have felt that faculty's responses to learners' lapses in professional behavior were difficult to observe and categorize. These data suggest that educators' responses to learners' lapses in professional behavior can be defined and reliably coded. This work will help provide objective feedback to faculty when engaging learners about lapses in professional behavior.

Education, Medical↗
PubMedDate not supplied

Adjuvant topiramate administration: a pharmacologic strategy for addressing NMDA receptor hypofunction in schizophrenia.

N-methyl-d-aspartate receptor hypofunction (NRH) and its downstream consequences, especially excitotoxicity, may explain the progressive psychosocial deterioration and ventriculomegaly observed in at least some patients with schizophrenia. Topiramate has several properties that address downstream consequences of NRH. In this open-label investigation, the authors examined the salutary therapeutic effects of adjuvant topiramate in 12 patients with schizophrenia and schizoaffective disorder. Patients were selected on the basis of the presence of negative symptoms. An optimal dose of topiramate was determined for each patient during a slow 4-week titration process. Patients were maintained on topiramate and their stable antipsychotic medications for 8 weeks, after which topiramate was tapered and discontinued. Patients were followed for an additional 4 weeks on their stable antipsychotic medications. Clinical measures of efficacy (eg, Positive and Negative Syndrome Scale), cognitive measures (eg, verbal fluency, memory), and safety measures (eg, postural sway) were assessed throughout this study. Topiramate administration (average dose, 110.42 mg/day) decreased total scores on the Positive and Negative Syndrome Scale. Topiramate was also associated with a selective and reversible worsening of verbal fluency performance. These results encourage further testing of topiramate and kainate/alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid receptor antagonists in schizophrenia patients and support the heuristic model of NRH.

Adult↗
PubMedDate not supplied

Interventions that address cancer health disparities in women.

Health disparities exist in cancer incidence and mortality rates among certain populations. Women of low socioeconomic status and minority women are at particular risk for not adhering to recommended cancer screening guidelines. Such behaviors may contribute to disparities when cancers are discovered at later stages, contributing to higher mortality rates in these women. Barriers to screening tests exist and are factors in preventing women from accessing available screening tests for breast and cervical cancer. Once barriers are identified, interventions can be developed to reduce certain health disparities. This article is a review of the literature that focuses on interventions that have been successful in addressing barriers that interfere with cancer screening in women.

Breast Neoplasms↗
PubMed1989

Human subject age and activity level: factors addressed in a biomathematical deposition program for extrapolation modeling.

A deterministic aerosol deposition model, previously validated by data from adult inhalation exposure experiments, is used to study particle deposition within the developing human lung. Here, two age-dependent lung morphologies are presented, in which the number of tracheobronchial (TB) generations is complete at birth but airway dimensions vary with age; the number of pulmonary (P) generations, however, changes with age, as do the alveolated airway dimensions. Deposition patterns within the two morphologies are compared. For the light and heavy respiratory-activity levels considered, regional TB and P, and total (TB + P) lung deposition fractions are calculated. For all particle sizes (0.2-9.0 microns diameters) tested, total deposition in both morphologies was minimal for the 30-y-old adult and maximal for either of the youngest subjects (7 and 22 mo old). A breakdown of total deposition into lung compartments was specifically addressed for one morphological model. Age-dependent deposition models are intended to aid in future extrapolation efforts to assess the threat to human health from airborne contaminants.

Adult↗
PubMed1995

Addressing the service versus education conflicts created by residency training in ambulatory care settings.

Much of the tension and conflict that result from the competing demands of work and learning during residency training--the service versus education conflict--can be addressed by mutual adherence to fundamental guidelines of fairness and personal responsibility by residents and their employers, mentors, and teachers. Residents should be recognized by their employers as professionals and by their teachers as colleagues. Because residency is postgraduate professional education for medical school graduates, the content of resident education must be primarily determined by the educational needs of maturing physicians. The greatest value of residents' services for their employing institutions remains in the inpatient setting where they work as inexpensive professional labor, working long and unattractive patient care shifts providing acute care. In the ambulatory setting, they are less efficient, work ordinary hours, and require real-time on-site supervision. Nevertheless, it is clear that the opportunities for medical education are rapidly shifting from the inpatient setting to ambulatory settings--locations in which there is less experience in proven techniques in medical education.

Ambulatory Care Facilities↗
PubMed2001

Addressing challenges, creating opportunities: fostering consumer participation in Medicaid and Children's Health Insurance managed care Programs.

With more than half of the Medicaid population enrolled in managed care and with enrollment in Medicaid managed care and Children's Health Insurance Programs continuing to accelerate, policy makers and program administrators must quickly come to consensus on the role of the consumer in the planning, implementation, and oversight of Medicaid and S-CHIP managed care. This article explores the barriers to consumer participation and makes concrete policy and programmatic recommendations to increase consumer participation in public managed care programs. To fully comply with existing federal and state requirements for consumer participation and for this participation to have an impact on the quality of managed care programs, states need to provide more education and support to consumers on: how to choose a health plan; how to access the health plan services and out-of-network benefits; and how to use grievance procedures. In addition, more work needs to be done to make the growing availability of health plan and provider performance data meaningful and available to Medicaid and S-CHIP consumers. Finally, states must address the lack of resources, lack of information, and lack of training that prevent many consumers from being able to sustain their involvement in system-level advisory and oversight bodies.

Child↗
PubMedDate not supplied

A multipronged approach to addressing the organ shortage.

Organ donation rates continue to lag behind the number of patients waiting for an organ transplant. The Alabama Organ Center, the organ procurement organization for the state of Alabama, is using a multipronged approach to address the organ shortage. The plan includes clinical options, public education, and professional education. Donation after cardiac death is proving to be an excellent option to increase the number of donors. Public and professional education must be conducted through a variety of avenues, and the Alabama Organ Center has implemented a successful Department of Motor Vehicles educational effort, in conjunction with other programs. The current issue impacting professional education is participation in the Health and Human Services Organ Donation Breakthrough Collaborative. The common link to all of these programs is effective relationship building.

Alabama↗
PubMed1998

Work complexity assessment. Decision support data to address cost and culture issues.

Nurse administrators, in response to budget imperatives, have made decisions that, rather than solve their difficulties, magnify them. Finding solutions that address cost as well as culture changes in nursing is crucial if we are to remain financially and professionally viable. In this article, the authors describe a tool for reconstructing reality for both cost reduction and relationship development.

Costs and Cost Analysis↗
PubMed1993

The ligand-receptor interactions of the endothelin systems are mediated by distinct "message" and "address" domains.

Pharmacologic responses to endothelins (ETs) are mediated by two subtypes of G-protein-coupled receptors, termed ETA and ETB. A chimeric receptor that has the transmembrane domains (TMDs) IV-VI with the adjacent loop regions from ETB embedded in the remaining regions from ETA exhibits specific binding to the N-terminally truncated ETB agonists 125I-BQ3020 and 125I-IRL1620, to the same level as that of wild-type ETB receptor. Furthermore, the ETA-selective antagonist BQ123 competed for the binding of these ETB-selective radioligands to this chimeric receptor, with Ki values similar to those determined by using wild-type ETA receptor and 125I-ET-1. These findings indicated that the endothelin systems consist of two distinct parts, both on the ligand and receptor sides. The N-terminal loop structure of the agonists and the TMDs IV-VI with adjoining loops of the receptors determine the isopeptide/subtype selectivity. On the other hand, the C-terminal linear portion of the isopeptides and the TMDs I-III and VII plus adjacent loops of the receptors are probably involved in ligand-receptor binding itself. This scheme can be explained by the classic "message-address" concept proposed for a number of peptidergic ligand families.

Binding, Competitive↗
PubMedDate not supplied

Addressing the National League for Nursing critical-thinking outcome.

The National League for Nursing outcome-oriented accreditation process challenges nursing faculty to think about teaching and evaluating critical thinking. In a survey of schools of nursing, the authors found that programs are using standardized measures and individualized assessments to address the criterion. Their greatest difficulty involves decisions about measuring critical thinking. School administrators identified a variety of approaches effective for helping faculty. The authors provide insight and ideas for nursing faculty involved with critical thinking in the curricula.

Accreditation↗
PubMedDate not supplied

Addressing the underperformance of faculty and staff.

Many new nursing leaders assuming work as deans, assistant deans, or interim deans have limited education, experience, or background to prepare them for the job. To assist new deans and those aspiring to be deans, the authors of this department, both deans, offer survival tips based on their personal experiences and insights. They address common issues, challenges, and opportunities that face academic executive teams, such as negotiating an executive contract, obtaining faculty lines, building effective work teams, managing difficult employees, and creating nimble organizational structure to respond to changing consumer, healthcare delivery, and community needs. The authors welcome counterpoint discussions with readers.

Adaptation, Psychological↗
PubMed2001

Is sacral instrumentation mandatory to address pelvic obliquity in neuromuscular thoracolumbar scoliosis due to myelomeningocele?

STUDY DESIGN: Prospective study. OBJECTIVE: To evaluate the functional outcome of two-stage anterior and posterior instrumented fusion without fixation to the sacrum on 11 patients with neuromuscular scoliosis from thoracolumbar myelomeningocele. SUMMARY OF BACKGROUND DATA: To our knowledge, there are no published results of combined anterior and posterior correction and fusion without inclusion of the sacrum in neuromuscular scoliosis from thoracolumbar myelomeningocele. In this article we present our experience and critically evaluate the functional outcome on 11 patients with neuromuscular scoliosis. PATIENTS AND METHODS: From July 1, 1992 through June 30, 1995, 11 consecutive patients with severe thoracolumbar scoliosis were admitted at our hospital. The mean age at operation was 12 years 9 months (range 9 years 9 months to 14 years 6 months). All patients underwent a two-stage anterior and posterior spinal reconstruction. The patients were evaluated before surgery and after surgery. RESULTS: All patients were observed for a mean of 4 years 11 months (range 42-88 months) from the time of second stage procedure. Before treatment the mean scoliosis was 81 degrees (range 55-110 degrees ); this was reduced to a mean of 31 degrees (range 8-70 degrees ), and at the final follow-up the correction had deteriorated slightly to a mean of 35 degrees (range 12-80 degrees ). No patient had increased neurologic deficit or showed other major complication. CONCLUSIONS: Pelvic obliquity in thoracolumbar neuromuscular scoliosis from lumbosacral myelomeningocele spontaneously corrected when the scoliotic deformity is adequately addressed with instrumented fusion without inclusion of the sacrum. The correction obtained remained stable at follow-up. In the absence of a control group we believe that sparing lumbar segments from primary fusion offers these patients a better freedom of mobility.

Adolescent↗
PubMed1997

Addressing epistemologic and practical issues in multimethod research: a procedure for conceptual triangulation.

Although a combination of quantitative and qualitative methods are being used increasingly in nursing research, little practical advice exists about the conduct of such studies. Conceptual triangulation offers one approach to multimethod research, addressing epistemologic and practical issues that have long plagued investigators. Conducting quantitative and qualitative research as parallel studies and using method-specific criteria for rigor provide an alternative to blending methodologic assumptions. Systematic examination of the support for findings guides judgments about model development, and the provision for multiple conceptual models resolves issues about the interpretation of findings.

Humans↗
PubMed2005

Barrett's surveillance is worthwhile and detects curable cancers. A prospective cohort study addressing cancer incidence, treatment outcome and survival.

OBJECTIVES: To establish whether Barrett's surveillance is worthwhile in terms of incident cancers and whether outcomes are favourable. METHODS: A prospective non-randomized single centre Barrett's surveillance programme commencing 1 January 1992 through 1 April 2001 (112 months). Oesophagectomy recommended for high-grade dysplasia or carcinoma. RESULTS: Of 23 725 patients, 506 were diagnosed as Barrett's oesophagus and 24 (5%) had carcinoma at diagnosis (prevalence cancers). One hundred and twenty-six patients had at least one surveillance endoscopy; 248 surveillance endoscopies were performed spanning 338 patient years. Thirteen surveillance (incidence) cancers were detected. In the prevalence cancer group 12 of the 24 patients underwent oesophagectomy. Lymph nodes showed evidence of metastases in 10 of the 12 resections. In the surveillance group 10 patients underwent oesophagectomy. Lymph nodes showed evidence of metastases in one of the 10 resections. One patient in the prevalence cancer group (4% of group; 8% of those operated) and seven patients in the surveillance cancer group (54% of group; 70% of those operated) remain disease-free more than 2 years post-oesophagectomy. The cost per cancer cured is 7546 pounds. One curable cancer was detected per 48 patient years of surveillance. CONCLUSIONS: Few Barrett's surveillance studies have addressed treatment outcomes and survival. In our study 5% of Barrett's patients undergoing endoscopy have prevalent cancers. If surveillance is performed, 4% per year develop cancer and 2% per year are cured of their cancers. Most surveillance cancers are operable and of those undergoing surgery 70% are cured. Barrett's surveillance is cost-effective compared with other cancer screening or surveillance initiatives.

Adenocarcinoma↗
PubMed2000

A framework for addressing health issues in or near a manufacturing facility.

Clustering of health events in or around industrial facilities sometimes leads to worker and community concerns that plant management or local health professionals must address. We provide an eight-step process to deal with these concerns systematically. We emphasize the use of good scientific practices with managerial oversight for effective worker and community communication. This process is directed to plant management and the local health professional and emphasizes the practical aspects of the investigation.

Contract Services↗
PubMedDate not supplied

Addressing barriers to cultural competence.

Although the need for cultural competence in healthcare is well established, the integration of cultural competence approaches in most healthcare settings is not yet a reality. A review of the literature reveals several factors in clinical settings that pose barriers for health providers. The purpose of this article is to explore the barriers to cultural competence faced by nurses and to examine the role of staff development in addressing these barriers.

Attitude of Health Personnel↗
PubMed2002

Recommendations for addressing quality and health assessment initiatives in Minnesota.

A recent priority of the Assessment Initiative in Minnesota has been to develop recommendations for addressing quality and health assessment activities in the state. These recommendations consist of a comprehensive array of issues, most of which where there was fairly strong consensus and a few of which where there were differing perspectives among key stakeholders. There are some significant opportunities for advancing quality and health assessment activities in Minnesota in the context of state and national programs in health care and public health.

Health Planning Guidelines↗
PubMed2002

Addressing the challenges of adherence.

Adherence to antiretroviral therapy is a crucial determinant of treatment success. Studies have unequivocally demonstrated the close association between adherence and plasma HIV RNA levels, CD4 cell counts, and mortality in patients with HIV infection and disease. Adherence levels of > or =95% are required to maintain virologic suppression. However, actual adherence rates are often far lower; most studies show that 40% to 60% of patients are <90% adherent. Adherence also tends to decrease over time. Patients offer a range of reasons for nonadherence, but the most frequently cited one is simply that they forget; other reasons include being away from home, being busy, or experiencing a change in daily routine. Additional barriers to adherence include psychiatric disorders, such as depression or substance use, uncertainty about the effectiveness of treatment and the consequences of poor adherence, regimen complexity, and treatment side effects. Several strategies can be employed in the effort to support patients' adherence, and all members of the multidisciplinary team should ideally employ these strategies in combination. Efforts should be made to educate and motivate patients, simplify treatment regimens and tailor them to individual lifestyles, prepare for and manage side effects, and address the concrete issues that may be a barrier to adherence. Recruiting an adherence monitor, providing memory aids to medication taking, and anticipating course corrections can also help patients achieve the adherence rates needed for successful treatment of HIV infection and disease.

Acquired Immunodeficiency Syndrome↗