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Health care should be entrusted to professionals who have received well-rounded training in the humanitarian as well as the technical aspects of such care. Training of this sort is essential for effective resolution of ethical conflicts that arise in professional practice. Starting from that premise, this article examines a number of ethical problems commonly encountered by nurses in the course of their daily work.
Most mental health programs need technical assistance to develop effective psychiatric rehabilitation programs. This article discusses how psychiatric rehabilitation was introduced into three community mental health programs and describes the elements of a psychiatric rehabilitation program and the phases of a technical assistance process. A case study illustrates how technical assistance consultants can be trained to develop psychiatric rehabilitation programs. Barriers and facilitators to the technical assistance are discussed in the context of several other technical assistance studies.
OBJECTIVE: The purpose of this study was to develop an effective curriculum to teach hysteroscopy, as well as to develop an objective assessment instrument (OSATS). STUDY DESIGN: All 24 residents in our training program attended a 3-hour hysteroscopy curriculum in each of 3 years. Each year after the curriculum, an OSATS was administered consisting of an assembly and operative task. Each task was evaluated with a task-specific checklist and a previously validated global assessment form. Twenty-four residents from an outside institution served as controls. All residents were examined by blinded and unblinded examiners. RESULTS: The reliability coefficient was .7857 for the checklist and .9763 for the global scale. Interrater reliability for the checklist was .7478 and ranged from .4222 to .9329 for the global instruments. Evaluation of construct validity revealed that the junior residents at both locations did significantly worse on the checklist and global scale than the senior residents for all 3 years of the study (P < .001). Those residents provided the curriculum did significantly better on both the checklist and the global scale than the resident controls with a mean of 45% versus 63% for the checklist and 18.3 versus 24.9 for the global score. (P = .001 checklist, P = .007 global scale). CONCLUSION: This curriculum is an effective way to impart knowledge and skill in the assembly and use of the operative hysteroscope. The checklist developed for this OSATS has excellent reliability and construct validity.
UNLABELLED: A complex interplay of cognitive, socio-economic and technical factors may determine hand-washing practice among hospital-based health workers, particularly doctors, regardless of the location of the country or hospital they work in. OBJECTIVES: To assess quality of care with respect to handwashing practice as a routine measure of infection prevention in Keren hospital, a provincial referral hospital, second largest in Eritrea; with a view to putting in place quality standards and effective means of monitoring and evaluation. DESIGN: Qualitative study with a participatory and iterative/dynamic design. METHODS: Semi-structured interviews and focus group discussions were held with 34 members of the hospital staff; and a total of 30 patients in the medical, surgical and obstetric wards were interviewed. Direct observation of handwashing practice and facilities were also employed. RESULTS: Although only 30% of health workers routinely washed their hands between patient contact, the study revealed genuine interest in training and the need to reward good practice in order to motivate health workers. Educational intervention and technical training resulted in significant improvements in health workers' compliance with hospital infection prevention standards. Patient satisfaction with health workers' hygiene practices also improved significantly. CONCLUSION: Hospital-based health workers' handwashing practice needs to improve globally. There is no room for complacency, however, in Eritrea (as indeed in other African countries) where public health services need to keep patients' welfare at heart; particularly with respect to women in childbirth, as mothers continue to bear the lion's share of post-war rebuilding of lives, livelihoods, and the country as a whole.
Sixteen therapists participated in a year-long manualized training program as part of the Vanderbilt II study of time-limited dynamic psychotherapy. Changes in therapist behavior were measured with the Vanderbilt Therapeutic Strategies Scale (an adherence measure), the Vanderbilt Psychotherapy Process Scale (VPPS), and interpersonal process codings using the Structural Analysis of Social Behavior (SASB). The training program successfully changed therapists' technical interventions in line with the manualized protocol. After training, there was increased emphasis on the expression of in-session affect, exploration of the therapeutic relationship, an improved participant-observer stance, and greater use of open-ended questions. There was also an indication of unexpected deterioration in certain interpersonal and interactional aspects of therapy as measured by the VPPS and SASB ratings. These results question the assumption that greater control of the therapy variable is straightforwardly achieved with manuals and adherence scales. Changing or dictating specific therapist behaviors to achieve technical adherence may alter other therapeutic variables in unexpected and even counterproductive ways.
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Recovery from hemiparesis after stroke largely depends on widespread functional and structural neuronal plasticity. Based on animal studies of rehabilitative and pharmacological interventions on recovery, recent neuroscientific findings suggest that new rehabilitative interventions may also have benefits by modulating neuroplastic mechanisms in stroke patients. Neurofunctional imaging methods such as Positron Emission Tomography (PET) and functional Magnetic Resonance Imaging (fMRI) as well as transcranial magnetic stimulation (TMS) now permit direct studies of training-induced plasticity in stroke patients. Prospectively conducted studies using these techniques have investigated how plasticity relates to recovery of motor function and how intensive training modulates cortical reorganization. Despite technical and methodological differences, consistent neuroanatomic findings on training-induced reorganization of the motor system have been reported. These discoveries have important implications for the future development of neurorehabilitative training methods. With continuously improving methods to study cortical reorganization and over 100 randomized clinical trials on stroke rehabilitation published during the past five years, this promises to be an exciting time in stroke rehabilitation research.
Developments in surgical technology and procedure have accelerated and altered the work carried out in the operating theatre/room, but team modelling and training have not co-evolved. Evidence suggests that team structure and role allocation are sometimes unclear and contentious, and coordination and communication are not fully effective. To improve teamwork, clinicians need models that specify team resources, structure, process and tasks. They also need measures to assess performance and methods to train teamwork strategically. An effective training strategy might be to incorporate teamwork with other technical skills training in simulation. However, the measures employed for enhancing teamwork in training and practice will need to vary in their object of analysis, level of technical specificity, and system scope.
Unlike in laparotomy, the art of pelviscopic surgery cannot be learned through assisting. For this reason, a training dummy, called a Pelvi-Trainer, has been developed. With this device, all surgical measures occurring in abdominal surgery can be simulated, such as adhesiolysis, internal ligature, internal sutures, resection, adnexectomy, enucleation of myomas, etc. The Pelvi-Trainer, designed for a three-stage plan, allows one to become gradually acquainted with the field of endoscopic surgery, and to make the transition from binocular vision to perfect three-dimensional control over intra-abdominal surgery under monocular endoscopic vision.
BACKGROUND: EUS-guided FNA is an effective and safe method for tissue diagnosis of pancreatic cancer. However, EUS-guided FNA is technically challenging and requires special training. The number of cases required to become proficient and the technical steps required to achieve proficiency are unknown. METHODS: The first 57 EUS-guided FNAs of pancreatic masses by a trained endosonographer were analyzed retrospectively. For 50 masses, the histopathologic diagnosis ultimately was cancer. The sensitivity for the EUS-guided FNA diagnosis of adenocarcinoma was compared in quintiles of 10 procedures. RESULTS: Sensitivity for the diagnosis of pancreatic cancer from first to last quintile were, respectively, 50%, 40%, 70%, 90%, and 80%. There was a significant increase in sensitivity for the first 30 cases after improvement in specific technical skills: shortening of echoendoscope position, scrupulous maintenance of the US view of the needle tip at all times, swift jabbing punctures, sampling multiple areas of the mass in each pass, and performing more than 10 "jiggles" per needle pass. Sensitivity for the diagnosis of pancreatic cancer was greater than 80% for the last 20 of the 57 cases, a level that was maintained for cases 51 through 80. CONCLUSIONS: The current American Society for Gastrointestinal Endoscopy guideline of 25 supervised EUS-FNA procedures for the diagnosis of pancreatic adenocarcinoma is reasonable.
Many physicians believe that the tasks of postgraduate medical education and faculty development are best carried out by senior physicians trained in the appropriate specialty. However, many also will admit that, as physicians, they have received too little training for such an educational role, and that the practical demands of medical practice, scientific research, and administration make it difficult if not impossible to allocate time to continuing medical education program development, curriculum design for residency training, teacher training, and other key aspects of postgraduate medical education. Many medical disciplines have attempted to alleviate this problem by using nonphysician health-care educational consultants in their training programs. However, little attention has been paid to the possibilities of using such consultants in anesthesiology residency education and faculty development. Such consultants in postgraduate medical education and training programs in anesthesiology could perform a wide variety of functions and roles because they possess skills and technical expertise in teaching, training, curriculum design, evaluation, program planning, and interpersonal communications that faculty members often lack. The successful use of a nonphysician consultant in the Department of Anesthesiology at Hahnemann University in Philadelphia, Pennsylvania, is described.