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PubMed1983

Emergency medical personnel training: I. An historical perspective.

The status of Emergency Medical Technicians has evolved from an undefined role with few rules, regulations, or standards to an established health care profession and a nationally administered program. The evolution of this profession received major impetus from the 1966 report by the National Academy of Science/National Research Council that provided recommended training standards. Development of a training course curriculum for basic life support (BLS) followed. The need for coordinated training of Emergency Medical Technical Technicians was recognized, and funds became available to aid in the national standardization of education, examination, certification, and recertification procedures for EMTs. Concomitant with the attempt to standardize BLS training, advanced life support (ALS) programs grew in number. By 1977 the National Standard Training Curriculum became available and was soon followed by a national certification exam. As states have the option to accept or reject the federal standards embodied in the national training course, there remains variation among programs offered by each state. Because of the difference in need for specific emergency services among the states at a time of increased professional mobility, arguments still exist regarding the desirability of federally mandated training and certification programs.

Allied Health Personnel↗
PubMed2004

Microbiological risk assessment in developing countries.

Microbiological risk assessment (MRA) has been evolving at the national and international levels as a systematic and objective approach for evaluating information pertaining to microbiological hazards in foods and the risks they pose. This process has been catalyzed by international food trade requirements to base sanitary measures on sound scientific evidence and appropriate risk assessments. All countries, including developing countries, need to understand and use MRA. MRA is resource intensive, as has been demonstrated by some of the the assessments undertaken in industrialized countries. However, when used in the appropriate circumstances MRA offers many benefits. The process of undertaking MRA improves the understanding of key issues, enables an objective evaluation of risk management options, and provides a scientific justification for actions. Although the gap between developing countries and some industrialized countries is quite extensive with regard to MRA, many developing countries recognize the need to at least understand and move toward using MRA. This process requires development of infrastructure and enhancement of scientific and technical expertise while making optimal use of limited resources. International organizations, such as the Food and Agriculture Organization of the United Nations, are in a position to provide countries with guidance, training, information resources, and technical assistance to develop and/or strengthen food safety infrastructure. Enhanced cooperation and collaboration at all levels are needed for such efforts to be successful and to ensure that MRA, as a food safety tool, is available to all countries.

Consumer Product Safety↗
PubMed2003

Treadmill training with partial body weight support after stroke.

Treadmill therapy with partial BWS is a promising new approach to improve gait ability after stroke. This task-specific approach enables nonambulatory patients the repetitive practice of complex gait cycles instead of single-limb gait-preparatory maneuvers. Patients walk more symmetrically with less spasticity and better cardiovascular efficiency on the treadmill than with floor walking. Several controlled, clinical studies have shown the potential of treadmill training as a therapeutic intervention for nonambulatory patients with chronic stroke-related hemiplegia. Furthermore, controlled trials in acute stroke survivors have shown that treadmill training is as effective as other physiotherapy approaches that stress the repetitive practice of gait. Controlled multicenter trials comparing locomotor training with conventional therapy will be forthcoming. An electromechanical gait trainer that relieves the strenuous effort of the therapists and provides control of the trunk in a phase-dependent manner is a new technical alternative for gait training in severely impaired stroke patients.

Acute Disease↗
PubMed1999

Transbronchial needle aspiration. An underused diagnostic technique.

Despite its proven usefulness, TBNA is not widely used. An American College of Chest Physicians (ACCP) survey showed that only 11.8% of pulmonologists use TBNA. Most pulmonologists in the 1980s were not formally trained in TBNA. This lack of training has unfortunately translated to minimal emphasis on TBNA in current training programs in a large number of institutions. Technical problems with the procedure (faulty site selection, incomplete needle penetration, catheter kinking that prevents adequate suction, etc.), the confusing array of needles, low diagnostic yields, unproven concerns regarding the safety of the procedure, inadequate cytopathology support, and bronchoscopic damage have all perpetuated the image of limited usefulness for this procedure. Limitations to the practice of TBNA are: Lack of training during fellowship Technical inadequacies Lack of cytopathologists trained in TBNA interpretation Fear of bronchoscope damage Safety issues Failure to reproduce published successes Reservations regarding usefulness of TBNA results Hands-on experience with TBNA, developing familiarity and expertise with only a few needles, and paying careful attention to anatomy, procedure techniques, and specimen acquisition may all help to increase yield. The following lists how better results can be obtained with TBNA: Preprocedure Review TBNA instruction tapes Attend hands-on courses Practice with lung models Review patient's CAT scans Familiarize with one-two cytology and histology needle Obtain a trained assistant Procedural Identify target site Needle to airway angle at least greater than 45 degrees Insert entire length of the needle Use scope channel to support the catheter Release suction before withdrawing needle (for staging) Specimen acquisition Avoid delay in preparing slides Adequate sampling (at least two) Use smear method for cytology specimen Analyze all samples flush solutions cell block Postprocedure Find an experienced cytopathologist Review your procedure (by watching video) Review pathology slides Acquisition of skills with cytology needles should precede the use of the histology needle. Increasing education and experience can also increase diagnostic yields. Transbronchial needle aspiration has been proven to be accurate in staging lung cancers, identifying inoperable carcinomas, and diagnosing a variety of lung diseases. Few complications have been encountered and the technique is less invasive and less costly than surgical procedures. Drawing on evidence from published literature, we suggest the following guidelines for TBNA: All patients presenting with mediastinal or hilar adenopathy or both, should have 22-ga and/or 19-ga TBNA as the initial procedure. These procedures would help diagnose malignant and nonmalignant diseases, and stage lung cancers. All patients with evidence of submucosal and peribronchial disease should have 22-ga needle cytology sampling. In patients with visible endobronchial disease, 22-ga TBNA should be optional. In the presence of a necrotic or a hemorrhagic tumor, or in a patient with a bleeding diathesis, TBNA would be helpful. In all patients with Type III and IV peripheral nodules, TBNA should be the initial diagnostic procedure. There remains no doubt about the diagnostic usefulness of TBNA. Guidelines must be developed to ensure that pulmonary fellows are adequately trained in this procedure. Regional workshops with hands-on experience targeted to practicing pulmonologists organized by the ACCP would help popularize the procedure. Initial low yields should not discourage pulmonologists from using the procedure. Collaboration between thoracic surgeons, oncologists, and pulmonary physicians is essential to set up TBNA programs within institutions. With time, as more and more pulmonologists attain expertise in TBNA, the full potential of this nonsurgical, cost-effective, and safe procedure will be realized.

Biopsy, Needle↗
PubMedDate not supplied

Public perception of the terms "cosmetic," "plastic," and "reconstructive" surgery.

OBJECTIVE: To investigate potential differences in perception of the terms "cosmetic," "plastic," and "reconstructive" as descriptors for surgery. METHODS: An anonymous questionnaire was offered to subjects over 18 years of age throughout the Unites States via the Internet and in person. The multiple-choice survey measured variables including permanence, risk, expense, recovery, reversibility, pain, technical difficulty, and surgeon training. The questionnaire also included several open-ended questions to capture qualitative perceptions. Semantic differential data were analyzed to measure statistical significance. RESULTS: For most variables--permanence, risk, recovery, reversibility, pain, and surgeon training--the 216 subjects had significantly lower mean responses for cosmetic surgery than those for plastic or reconstructive surgery (P < .002). CONCLUSIONS: Overall, the results of this study support the authors' hypothesis that there is a significant difference in perception of cosmetic surgery and plastic or reconstructive surgery. Cosmetic surgery is perceived to be more temporary and less technically difficult than plastic or reconstructive surgery. In addition, cosmetic surgery is believed to be associated with less risk, shorter recovery time, and less pain. Subjects also thought that cosmetic surgeons required significantly less training than plastic or reconstructive surgeons.

Adolescent↗
PubMed1979

[Manpower training at the Institute of Nutrition and Food Technology].

The Institute of Nutrition and Food Technology (INTA) of the University of Chile was established in 1976. Its functions are, among others, to study the country's nutritional problems, conduct research into measures for improving the nutritional status of the community, and train researchers and professionals, technical, and auxiliary staff in the nutrition field. Since 1977 the Institute has operated as an associated center of the United Nations University (UNU) in the area of human needs and, as such, carries out research in food and nutrition problems, provides training and education to UNU fellows, collaborates in the establishment of a worldwide network of institutions interested in the problem of world hunger, and advises UNU on the conduct of occupational training and research programs. This article refers more specifically to the teaching functions of INTA and describes its undergraduate and graduate activities and pedagogical training for nutrition instructors.

Academies and Institutes↗
PubMed2005

Improving the 'how' and 'what' decisions of elite table tennis players.

Training methods in sport usually focus on improving either technical or tactical aspects of performance, ignoring the fact that successful performance requires the athlete to simultaneously decide what movement to perform and how it should be executed. Young elite table tennis players were trained, in a first phase, to improve their forehand and backhand movements and, in a second phase, to make a tactical switch between forehand and backhand movements. Half of the players took part in behavioral training focusing on how to perform the required movements, whereas half received additional video feedback about their technical and tactical performance (decision training). The results indicate that improvements of how decisions (techniques) and what decisions (tactics) can occur as a consequence of combining technical and tactical training. These results were stable in delayed Post-test analyses of competitive matches. It was concluded that a combination of both technical and tactical training is beneficial to elite table tennis performers, particularly during early seasonal training programs.

Child↗
PubMed2003

Pharmaceutical care in Denmark: perceived importance of medicine-related problems and participation in postgraduate training.

OBJECTIVE: To investigate the readiness of Danish community pharmacists to provide pharmaceutical care. Special focus was on information provided to patients on medicine-related problems and participation in postgraduate training. METHOD: National cross-sectional survey distributed to all Danish community pharmacies (N = 288). Response rate 75.7%; non-responders were interviewed by telephone to establish their reasons for not participating. MAIN OUTCOME MEASURES: Prioritization of information to patients regarding medicine-related problems. Postgraduate courses selected by pharmacists during the past three years. RESULTS: In accordance with the profile of Danish community pharmacists, respondents were primarily female and half were below 45 years of age. The main reason given for not responding was lack of time. The prioritization of information to patients regarding medicine-related problems resulted in three clusters of answers. The overall topics of the clusters were: information related to the technical-practical use of medicines; information related to pharmacotherapeutic aspects of medicine use; and information related to the function of the medicine. The clusters accounted for 61.9% of the total variance. The most frequently attended postgraduate courses were on quality assurance and specific diseases. CONCLUSION: The patient information prioritized by Danish community pharmacists is primarily of a technical-practical nature. The postgraduate training pursued is primarily technical without much focus on the philosophy of pharmaceutical care. These factors contribute to the lack of proper readiness of pharmacists to practice pharmaceutical care.

Adult↗
PubMed1994

[Surgical hysteroscopy: complications, safety aspects, education and training].

Hysteroscopy has become an integral part of the overall gynaecological surgical concept. On the one hand the experience of our study group as well as a literature survey have demonstrated that results of hysteroscopic metroplasty, resection of submucous myoma and synechiolysis are at least comparable to those of conventional procedures, the advantages of minimal invasive surgery being evident. However, increasing complications, even with a lethal outcome, due to deficient technical equipment or insufficient training of the surgeon are reported. Yet, a survey of complications in literature and in our own series of hysteroscopies (n = 200), shows a median complication rate below 1%. Knowledge of possible complications, symptoms and management alternatives is, however, a first requirement for application of these minimal access procedures. The second major precondition being a well structured training program for surgeon and assisting team. With the recently developed in-vitro-simulation trainer, the HysteroTrainer, training of the entire spectrum of hysteroscopic procedures, including laser and high frequency electrosurgical applications, is now feasible. The simulator may also be employed for security checking of the complex hysteroscopic equipment.

Equipment Safety↗
PubMed1998

A UK training programme for nurse practitioner flexible sigmoidoscopy and a prospective evaluation of the practice of the first UK trained nurse flexible sigmoidoscopist.

BACKGROUND: Flexible sigmoidoscopy is a technical skill that has been successfully performed by suitably trained colorectal nurse practitioners in the USA. However, no recognised training course exists for nurse practitioners in the UK. AIMS: To design and evaluate a training programme for nurse endoscopists. METHODS: A multidisciplinary committee of nurses and clinicians developed a structured programme of study and practice. This involved a staged process of observations, withdrawals, and ultimately, full procedures. Once training had been completed the nurse practitioner was permitted to practice independently. Patients with colorectal symptoms referred for flexible sigmoidoscopy were examined for the final stages of training and independent practice. A prospective evaluation of the training and practice of the first trained nurse flexible sigmoidoscopist was performed. Barium enema, video, clinical follow up, and histology were used to validate the results of the flexible sigmoidoscopies. RESULTS: The training programme required that 35 observations, 35 withdrawals, and 35 supervised full procedures were performed prior to the development of independent practice. Subsequent to the completion of this programme 215 patients have been examined independently by the nurse practitioner. Ninety three per cent of the examinations were judged successful and pathology was identified in 51%. The nurse endoscopist successfully identified all "significant" pathology whereas barium enema failed to identify pathology in 12.5%. There were no complications. CONCLUSION: With suitable training nurse endoscopists are able to perform flexible sigmoidoscopy safely and effectively.

Clinical Competence↗
PubMedDate not supplied

Establishing learning curves for surgical residents using Cumulative Summation (CUSUM) Analysis.

BACKGROUND: The assessment of technical proficiency is of paramount importance in the training of surgical residents. The fact that technical proficiency is underrepresented in the context of the ACGME outcomes project is evidenced in that proficiency skills comprise less than 5% of all assessments that evaluate residents. In this study, we use Cumulative Summation Analysis (CUSUM) as a visual objective analytic tool to determine performance accuracy and establish learning curves for PGY-1s in surgery. METHODS: From April 2001 to May 2002, 11 surgical residents completed a 1-month anesthesia rotation. Each resident was asked to complete a preoperative airway assessment followed by endotracheal intubation with induction of anesthesia. Airway assessment was performed independently by a resident and a licensed anesthesiologist or certified anesthetist with the modified Mallampati Score. Data were sequentially collected and plotted for summated successes and failures. RESULTS: The average intern required approximately 19 intubation attempts to complete the learning curve experience. There was no learning curve for airway assessment. CONCLUSIONS: The CUSUM analysis is an effective objective tool to define learning curves for technical skills. Vital information is provided for surgical programs that place residents in positions to manage airways, and limitless potential for defining the learning curves for technical skills is provided.

Adult↗
PubMed1981

[Prostheses for armless children and young people--experiences and conclusions (author's transl)].

Despite the many--often allegedly sensational--advances in the field of arm prosthetics, we continue to be far removed from satisfactory solutions especially where the needs of armless and bilaterally phocomelic children and young people are concerned. Continuing intensive research and development are needed but will never be able to render superfluous the compensatory potentialities of the feet in substituting hand function. Work to date in development and testing of technical aids for disabled children, which has been grant-aided generously over the past by the Federal Ministry of Youth, Health, and Family, as well as the Federal Ministry of Labour and Social Order, have enabled us here in our Heidelberg clinic to elaborate the catalogue of indications and contraindications described for the prosthetic management of armless or phocomelic children and young people; to develop child- and age-adapted programmes for the training of compensatory functions; technical aids for coping with the activities of daily living, and to achieve the described further developments in the field of prosthetics. These novel types of prostheses have meanwhile been used successfully for patients with accident-related armlessness. These experiences are of use not only to the field of prosthetic management but beyond that to the entire rehabilitation programming for armless persons, on the medical side of which highest priority is given to the training of inherent compensatory functions (hand function substituted for by the feet in the case of normal hip and knee joints, otherwise by the mouth), aimed at achieving maximum independence in daily living activities and as a preparation for best-possible integration in the educational, vocational, and social fields.

Activities of Daily Living↗
PubMed2003

Provider perceptions of key barriers to providing state-of-the-art clinical care for HIV-infected African-American patients.

U.S. AIDS rates have declined among same population groups; however, African-Americans and other ethnic minorities have experienced the least amount of decline. As a result medical and public health authorities are tasked with developing strategies to help eliminate the disparity in HIV/AIDS incidence rate and clinical outcomes. Thus, in 1999, the National Minority AIDS Education and Training Center (NMAETC) was developed to facilitate training, clinical consultation and technical assistance to clinicians that provide care to HIV-infected minority patients. Its initial activities were designed solely to increase providers' clinical capacity to use state-of-art anti-retroviral therapies to treat and manage the disease. However, through focused discussions with target providers and a survey of medical care service sites, the NMAETC confirms that provider' training and assistance needs extend into non-medical domains.

Black or African American↗
PubMed1998

[Computer-assisted neuropsychological training in neurological rehabilitation].

Using computer-assisted cognitive training to treat patients with cognitive disorders has proved a useful tool in neurological rehabilitation. This has been shown by positive experience in many rehabilitation clinics but also in numerous control studies investigating the efficiency of such training. Patients with attention deficits show the most pronounced improvements as the computer with its technical possibilities is an ideal training instrument because of stimulus representation and reaction time measures. In other areas, computer training has become an essential therapeutic means complementing other therapies. In a clinical environment it seems that computer training is essential because it enables attaining the necessary therapeutic density. However, training must be integrated and become part of a global therapeutic framework.

Brain Damage, Chronic↗