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PubMed1993

Co-operation in veterinary education between sub-Saharan Africa and the developed countries: experience of the University of Zambia.

As is the case with many other veterinary schools in sub-Saharan Africa, the development of the University of Zambia (UNZA) Veterinary School has been supported largely by aid from the developed countries in the form of general expenditure grants, staff training scholarships and technical assistance. The three major pillars of the policies which have governed interactions between UNZA and donors have been bilateralism, "projectisation" (the supplying of aid within the framework of specific projects) and donor management of aid. These have been blended according to the resources endowed by the donors and the negotiating position of UNZA. The authors discuss the effect of the consequent diverse policies on the development of the UNZA school. It is recognised that high dependence on donors by veterinary schools in sub-Saharan Africa will continue in the future. However, the emerging political and economic integration in the sub-region and in the developed countries, as well as the trend towards early specialisation in the veterinary profession in the developed countries at a time when countries in sub-Saharan Africa still require generalists, will mean that co-operation within a bilateral framework will become less desirable. It is therefore recommended that veterinary schools in sub-Saharan Africa evolve mechanisms for collective aid negotiations and utilisation of aid. Conversely, co-operation between donors in multi-donor supported schools will be essential to minimise rigidity in projects, which tends to undermine the cohesion of multi-donor funded schools.

Belgium↗

PubMed2005

English language proficiency and smoking prevalence among California's Asian Americans.

The authors documented California's tobacco control initiatives for Asian Americans and the current tobacco use status among Asian subgroups and provide a discussion of the challenges ahead. The California Tobacco Control Program has employed a comprehensive approach to decrease tobacco use in Asian Americans, including ethnic-specific media campaigns, culturally competent interventions, and technical assistance and training networks. Surveillance of tobacco use among Asian Americans and the interpretation of the results have always been a challenge. Data from the 2001 The California Health Interview Survey (CHIS) were analyzed to provide smoking prevalence estimates for all Asian Americans and Asian-American subgroups, including Korean, Filipino, Japanese, South Asian, Chinese, and Vietnamese. Current smoking prevalence was analyzed by gender and by English proficiency level. Cigarette smoking prevalence among Asian males in general was almost three times of that among Asian females. Korean and Vietnamese males had higher cigarette smoking prevalence rates than males in other subgroups. Although Asian females in general had low smoking prevalence rates, significant differences were found among Asian subgroups, from 1.1% (Vietnamese) to 12.7% (Japanese). Asian men who had high English proficiency were less likely to be smokers than men with lower English proficiency. Asian women with high English proficiency were more likely to be smokers than women with lower English proficiency. Smoking prevalence rates among Asian Americans in California differed significantly on the basis of ethnicity, gender, and English proficiency. English proficiency seemed to have the effect of reducing smoking prevalence rates among Asian males but had just the opposite effect among Asian females.

Acculturation↗

PubMed2005

The New York City Beacons: rebuilding communities of support in urban neighborhoods.

Established in 1991 in New York City and now operating in at least seven other cities, Beacons are designed to rebuild communities of support for children and youth in urban neighborhoods. The Beacon framework is based on research findings and practitioner experience indicating that programs taking a youth development approach are more effective than those focused on "fixing" specific youth problems. Successful Beacon programs provide positive ways to meet young people's need for safety, a sense of belonging, and mastery; they also provide opportunities for decision making and contributing to others. There are currently eighty Beacons in New York City, serving about 140,000 youth and adults annually. Beacons have been replicated in several parts of the country, including Denver, Minneapolis, Oakland, Palm Beach County, Philadelphia, San Francisco, and Savannah. The Youth Development Institute of the Fund for the City of New York provides technical assistance and training to Beacons in New York City and in all seven replication sites.

Adolescent↗

PubMed1995

A new role for community organizations in the prevention and control of tuberculosis.

The resurgence of tuberculosis in the United States has forced public health officials to reconsider the most appropriate strategies for its prevention and control. Many recent reports have suggested that the priority of public health programs should be to identify those with active tuberculosis and ensure that these individuals complete medical treatment. While this goal is necessary, it is not sufficient. First, it does not acknowledge the difficulty that health care agencies have in contacting and engaging those at highest risk of active tuberculosis. Second, it fails to address the broader social factors that have contributed to the reemergence of epidemic tuberculosis. This report describes an alternative strategy in which community organizations play a significant role in TB prevention and control. An examination of two previous efforts, the community TB programs of the first part of this century and the community AIDS prevention programs of the last decade, provides suggestions for specific activities that community organizations can carry out in order to control TB. To fulfill this expanded role, community organizations will need new resources, technical assistance, and training.

Acquired Immunodeficiency Syndrome↗

PubMed1994

The alumni survey as an instrument for program evaluation in internal medicine.

The objective of this analysis was to assess the practical value of the training experience for graduates of U.S. internal medicine residencies. Six alumni surveys were selected for analysis, wherein training items were grouped into comparable categories. Results of the studies were compared, using simultaneous preparation/importance ratings as the basis for assessment of items in each category. Six recent alumni surveys depict internal medicine residency training as a technical experience, wherein basic skills and practice-related issues may be underemphasized. Such surveys are useful for periodic re-evaluation of program goals and outcomes.

Data Collection↗

PubMed2006

Pediatric clinical visual electrophysiology: a survey of actual practice.

PURPOSE: Survey the actual clinical practice of pediatric visual electrophysiology. The electrophysiologists surveyed were members of the International Society for Clinical Electrophysiology of Vision (ISCEV). METHODS: A self-administered questionnaire with 55 items about visual evoked potential (VEP) and electroretinogram (ERG) testing of pediatric patients was sent to ISCEV members. The survey queried personnel, facilities, referral patterns and conduct of tests. RESULTS: Nearly all respondents (94%) had advanced scientific or clinical degrees or both, and most (96%) worked in academic or medical facilities. Of the 71 respondents, 68 tested patients 12 years or younger, and nearly all of those performed both VEPs and ERGs. However, fewer than a third did high volume (>10/month) testing of infants and young children (< or =6 years). Eye care professionals and neurologists made the majority (57%) of the referrals, with the most common reason for referral being suspected visual impairment. Conduct of a pediatric test session often required more than one practitioner. For both VEP and ERG, more than 70% of respondents required at least 30 min for each test. The majority indicated that they followed the ISCEV standards for stimuli and data acquisition. Almost all (94%) reported using the ISCEV recommended VEP electrode configuration. For ERG, most (88%) used ocular contact electrodes (including contact lens, thread, foil and HK loop), but 12% used skin electrodes exclusively and some (17%) used skin electrodes at times. CONCLUSIONS: Pediatric ERG and VEP testing is a labor intensive endeavor of highly trained professionals. ISCEV technical standards are typically met or exceeded, indicating that high quality testing of infants and children is feasible. Revision of the ISCEV ERG standard is necessary to bring actual practice into accord with evidence-based recommendations for infant testing.

Child↗

PubMed1978

Aortoesophageal fistula.

With the advent of cardiovascular and bypass procedures, aortoesophageal fistula has progressed from the stage of a pathologic curiosity to a treatable lesion. Although the causes of aortoesophageal fistula are varied, a remarkably consistent clinical picture emerges from study of this condition. Chiari's triad of midthoracic pain, sentinel hemorrhage, and a symptom-free interval followed by fatal exsanguination remains the most important clinical finding today. Although contrast esophagography, esophagoscopy, and aortography are important diagnositc aids, immediate left thoracotomy may be the only means of making the diagnosis and saving the patient when hemorrhage is profuse. In most cases (80 per cent of the present series) there is a symptom-free period varying from hours to days from the original sentinel hemorrhage to the final exsanguination. This permits the informed surgeon trained in cardiovascular technics an opportunity to salvage some of these patients. The various methods of aortic and esophageal repair are discussed.

Aorta↗

PubMed1977

The use of performance profiles in the design of a systematic medical suturing training programme.

Systematic training methods are generated by contrasting task knowledge and skill performance profiles of highly experienced workers against those of inexperienced, through task and skills analysis. Training methods are then developed based on performance profile differences rather than similarities. The studies reported in this paper are concerned with the methodology and findings of task and skills analysis used in the development of a systematic training programme for medical suturing. The general conclusions suggest the following: (1) the experienced and inexperienced groups differ in task knowledge on the task components - (a) proper instrument handling, (b) hierarchy of elements that must be followed in attaining symmetric and atraumatic would closures and (c) proper suture tension during instrument knot-tying; (2) inexperienced workers exhibited significantly higher number of anatomical position changes during task performance than the experienced surgeons; (3) due to task knowledge profiles and unique usage of hand, finger and thumb of the favoured and non-favoured hand, the surgeons were approximately three times faster than the students on critical task elements; and (4) the contrasting of performance profiles developed through task and skills analysis is a valuable tool in the development of an analytical training strategies for technical psychomotor surgical skills.

Journal Article↗

PubMed1990

Supporting cancer care in the developing countries: role of IAEA/WHO.

Cancer management can be expensive and constitutes a major problem in many developing countries where management standards are poor due to many factors, including non-availability of sufficient funds, equipment, and trained personnel. The incidence of cancer is rising worldwide. This is more so in the developing countries, many of whom are less equipped to deal with the problems. Radiation therapy is one of the major treatment modalities for cancer, and it is estimated that about 60% of all cancer patients require this treatment at one time or another during the course of their disease. Unfortunately, radiotherapy facilities are lacking or grossly inadequate in many developing countries. Over the past 8 years the IAEA and WHO have shown more interest in the problem and treatment of cancer in the developing countries. This paper reviews the role of these international organizations, with emphasis on research activities, education (seminars, workshops, training courses), and technical assistance programs. These include establishment or upgrading of radiotherapy facilities, provision of experts, etc. Scientific papers are published with a view to disseminating current information and research findings in the developing countries. The achievements up to date are assessed and discussed.

Africa↗

PubMed2004

The effect of mismatched recording conditions on human and automatic speaker recognition in forensic applications.

In this paper, we analyse mismatched technical conditions in training and testing phases of speaker recognition and their effect on forensic human and automatic speaker recognition. We use perceptual tests performed by non-experts and compare their performance with that of a baseline automatic speaker recognition system. The degradation of the accuracy of human recognition in mismatched recording conditions is contrasted with that of the automatic system under similar recording conditions. The conditions considered are of public switched telephone network (PSTN) and global system for mobile communications (GSM) transmission and background noise. The perceptual cues that the human subjects use to perceive differences in voices are studied along with their importance in different conditions. We discuss the possibility of increasing the accuracy of automatic systems using the perceptual cues that remain robust to mismatched conditions. We estimate the strength of evidence for both humans and automatic systems, calculating likelihood ratios using the perceptual scores for humans and the log-likelihood scores for automatic systems.

Bayes Theorem↗

PubMed2006

Mobile computing acceptance factors in the healthcare industry: a structural equation model.

OBJECTIVE: This paper presents a revised technology acceptance model to examine what determines mobile healthcare systems (MHS) acceptance by healthcare professionals. METHOD: Conformation factor analysis was performed to test the reliability and validity of the measurement model. The structural equation modeling technique was used to evaluate the causal model. RESULTS: The results indicated that compatibility, perceived usefulness and perceived ease of use significantly affected healthcare professional behavioral intent. MHS self-efficacy had strong indirect impact on healthcare professional behavioral intent through the mediators of perceived usefulness and perceived ease of use. Yet, the hypotheses for technical support and training effects on the perceived usefulness and perceived ease of use were not supported. CONCLUSION: This paper provides initial insights into factors that are likely to be significant antecedents of planning and implementing mobile healthcare to enhance professionals' MHS acceptance. The proposed model variables explained 70% of the variance in behavioral intention to use MHS; further study is needed to explore extra significant antecedents of new IT/IS acceptance for mobile healthcare. Such as privacy and security issue, system and information quality, limitations of mobile devices; the above may be other interesting factors for implementing mobile healthcare and could be conducted by qualitative research.

Attitude of Health Personnel↗

PubMedDate not supplied

An assessment tool for brachial plexus regional anesthesia performance: establishing construct validity and reliability.

BACKGROUND AND OBJECTIVES: Technical proficiency in regional anesthesia is often determined subjectively through in-training evaluations. Objective assessment tools improve these evaluations by providing criteria for measurement. However, any evaluation instrument needs to be valid and reliable before it is adopted into a curriculum. The purpose of this study is to determine the validity and reliability of a devised assessment of residents performing an interscalene brachial plexus block (ISB). METHODS: In this prospective study, 10 junior trainees and 10 senior trainees were videotaped performing an ISB. Junior trainees were defined as in their first year of anesthetic training and had performed less than 10 ISBs independently. Senior trainees had completed at least 1 year of anesthesia training and had performed greater than 10 ISBs independently. Two blinded expert raters independently evaluated the performance of the ISB using a checklist and global rating scale. Construct validity was established if the assessments were able to reliably discriminate between different levels of training. RESULTS: Senior trainees performed an ISB significantly better than junior trainees when assessed using the global rating scale (P < .05) and checklist (P < .001). The overall interrater reliability for the global rating scores was excellent (r = 0.85, P < .05) and was good for the checklist scores (r = 0.74, P < .05). CONCLUSIONS: Both assessment modalities were valid, in that they reliably discriminated between different levels of training. Objective measures of technical skills are feasible, timely, and improve the validity and reliability of competency assessments.

Anesthesia, Conduction↗

PubMed2006

Non-technical skills for surgeons in the operating room: a review of the literature.

BACKGROUND: This review examines the surgical and psychological literature on surgeons' intraoperative non-technical skills. These are the critical cognitive and interpersonal skills that complement surgeons' technical abilities. The objectives of this paper are (1) to identify the non-technical skills required by surgeons in the operating room and (2) assess the behavioral marker systems that have been developed for rating surgeons' non-technical skills. METHODS: A literature search was conducted against a set of inclusion criteria. Databases searched included BioMed Central, Medline, EDINA BIOSIS, Web-of-Knowledge, PsychLit, and ScienceDirect. RESULTS: A number of "core" categories of non-technical skills were identified from 4 sources of data: questionnaire and interview studies, observational studies, adverse event analyses, and the surgical education/competence assessment literature. The main skill categories were communication, teamwork, leadership, and decision making. The existing frameworks used to measure surgeons' non-technical skills were found to be deficient in terms of either their psychometric properties or suitability for rating the full range of skills in individual surgeons. CONCLUSIONS: Further work is required to develop a valid taxonomy of individual surgeons' non-technical skills for training and feedback.

Cognition↗

PubMed1998

Identification of communication apprehension in medical students starting a surgery rotation.

BACKGROUND: Most methods used to critically evaluate young surgeons for advancement or certification in surgery require oral communication skills, eg, case and research presentations, rounds, morbidity and mortality conferences, interviews, journal clubs and oral examinations. The irony, though, is that much of surgery training focuses on technical skill lists, and the rhetorical aspects are often neglected until the surgeon encounters failure in an oral examination or is sued for not "talking" appropriately. Early identification of those at risk for difficulty with oral skills would provide programs with time needed to arrange for the appropriate types of interventions. Therefore, the purpose of this study was to identify those medical students with high communication apprehension scores in dyadic, group, or public speaking situations before they encountered failure and caused problems, not only for themselves, but also for their programs and practices. METHODS: Two scales, Willingness to Communicate (WTC) and the Personal Report of Communication Apprehension (PRCA-24), were administered to medical students at two large university medical centers during new student orientation to the surgery rotation. The WTC is a 20-item probability-estimate scale designed to measure one's predisposition toward approaching or avoiding the initiation of communication. The PRCA-24 is a scale designed to measure one's fear associated with either real or anticipated communication in four different contexts. In addition to the 44 items, a lengthy list of demographic items was added for possible correlations. These items were based on the student's perception of the communication or language environment in which he was raised. Therefore, a student ranked past and future socioeconomic status (eg, blue collar or white collar) according to his or her own criteria. The chairman was provided with a list of individual scores. Those students who were below the group means on skills required during a surgery rotation were identified for immediate intervention. RESULTS: The published data show a norm mean of 65.6 for PRCA-24 and 65.2 for WTC for college students. The current study found medical students to be more willing to communicate (WTC) and less anxious about communication (PRCA-24) than college students (mean 70.7 versus 65.2, P = 0.003, and 61.6 versus 65.6, P = 0.01, respectively). This difference was accentuated for blue-collar medical students compared with college students and persisted when blue-collar medical students were compared with white-collar medical students (73.9 blue-collar versus 70.9 college students, P = 0.15 for WTC, and 58.5 blue-collar versus 63.6 white-collar, P = 0.002 for PRCA-24). Male medical students were found to be less anxious about communication than female medical students. CONCLUSIONS: These instruments are easily administered at orientation and produce simple class lists with individual scores. They can be used to identify students who are below the mean for specific forms of communication before they encounter failure.

Clinical Clerkship↗

PubMed1999

Endoscopic coronary artery bypass grafting with the aid of robotic assisted instruments.

OBJECTIVE: The development of endoscopic coronary artery bypass grafting has been limited because of poor visualization and increased technical difficulties in carrying out operations through ports. We investigated whether the use of robotic assisted instruments could minimize these difficulties. METHODS: After a period of technical development and training on cadavers (n = 8) with the Intuitive Surgical system (Intuitive Surgical, Inc, Mountain View, Calif), the first clinical application in coronary artery surgery was performed in 4 male patients (mean age 59 +/- 6 years) with the indication of grafting the left internal thoracic artery to the left anterior descending coronary artery. Robotic assisted 3-dimensional endoscopes and instruments were introduced into the left side of the chest through 3 intercostal ports. The Heartport system (Heartport, Inc, Redwood City, Calif) was used for arresting the heart during the anastomosis. RESULTS: In 2 patients, the harvesting of the left internal thoracic artery was completed endoscopically with robotic assisted instruments and the anastomosis to the left anterior descending artery was performed through a minithoracotomy with conventional instruments. In 2 other patients, the entire operation was completed endoscopically with robotic assisted instruments. Early postoperative coronary angiography demonstrated the patency of the grafts in all cases. At 6-month follow-up, all patients were free of symptoms. CONCLUSIONS: Robotic assisted instruments make endoscopic coronary bypass possible and open a new era in minimally invasive surgery.

Anastomosis, Surgical↗

PubMed1994

What is a clinical immunologist?

The author defines the clinical immunologist as one who applies the concepts and techniques of basic immunology to the investigation, diagnosis, and treatment of patients. The formal requirements for certification in this discipline in the United States are described, and the intellectual and technical content of training are outlined. Potential future roles of the clinical immunologist are reviewed.

Accreditation↗

PubMed2003

Robotic technology and the translation of open radical prostatectomy to laparoscopy: the early Frankfurt experience with robotic radical prostatectomy and one year follow-up.

OBJECTIVE: Laparoscopic radical prostatectomy is a complex procedure and has been standardized only during the last years. The remote controlled da Vinci Surgical System has opened up a new era in minimally invasive surgery. We here present our initial experience with the translation of open retropubic radical prostatectomy to laparoscopic technique using da Vinci and a one year follow-up. METHODS: After a period of technical development and training on cadavers, 40 consecutive patients eligible for radical prostatectomy were treated. After port placement, the urologist took control of the 3D 30 degrees laparoscope and the two instrument arms at the da Vinci remote console to perform bilateral pelvic lymph node dissection, radical prostatovesiculectomy and urethrovesical anastomosis. RESULTS: The procedure was completed laparoscopically in all but two patients. Mean procedure time was 8.3 hours and mean intra-operative blood loss 570 ml. Learning curves associated with the use of the da Vinci Surgical System show that there is a 22-minute decrease in time required to perform the radical prostatectomy and lymphadenectomy for each case (p<0.0001). Patients recovered rapidly after surgery with early oncological and functional results that were similar to those obtained with our standard radical prostatectomy technique. CONCLUSIONS: Remote controlled robotic surgical systems are useful to translate open retropubic radical prostatectomy to laparoscopy. This new technology has the potential to equip the urologist with the microsurgical precision needed to preserve the delicate structural integrity of the pelvic floor in order to improve functional results without compromising the oncological outcome.

Aged↗

PubMed2001

Minimally invasive or interventional repair of atrial septal defects in children: experience in 171 cases and comparison with conventional strategies.

OBJECTIVES: The goal of this study was to evaluate percutaneous interventional and minimally invasive surgical closure of secundum atrial septal defect (ASD) in children. BACKGROUND: Concern has surrounded abandoning conventional midline sternotomy in favor of the less invasive approaches pursuing a better cosmetic result and a more rational resource utilization. METHODS: A retrospective analysis was performed on the patients treated from June 1996 to December 1998. RESULTS: One hundred seventy-one children (median age 5.8 years, median weight 22.1 kg) underwent 52 device implants, 72 minimally invasive surgical operations and 50 conventional sternotomy operations. There were no deaths and no residual left to right shunt in any of the groups. The overall complication rate causing delayed discharge was 12.6% for minimally invasive surgery, 12.0% for midline sternotomy and 3.8% for transcatheter device closure (p < 0.01). The mean hospital stay was 2.8 +/- 1.0 days, 6.5 +/- 2.1 days and 2.1 +/- 0.5 days (p < 0.01); the skin-to-skin time was 196 +/- 43 min, 163 +/- 46 min and 118 +/- 58 min, respectively (p < 0.001). Extracorporeal circulation time was 49.9 +/- 10.1 min in the minithoracotomy group versus 37.2 +/- 13.8 min in the sternotomy group (p < 0.01) but without differences in aortic cross-clamping time. Sternotomy was the most expensive procedure (15,000 EUR +/- 1,050 EUR vs. 12,250 EUR +/- 472 EUR for minithoracotomy and 13,000 EUR +/- 300 EUR for percutaneous devices). CONCLUSIONS: While equally effective compared with sternotomy, the cosmetic and financial appeal of the percutaneous and minimally invasive approaches must be weighed against their greater exposure to technical pitfalls. Adequate training is needed if a strategy of surgical or percutaneous minimally invasive closure of ASD in children is planned in place of conventional surgery.

Analysis of Variance↗