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PubMed1999

"You worked on your own, making your own decisions and coping on your own": midwifery knowledge, practice and independence in the workplace in Britain, 1936 to the early 1950s.

Midwifery knowledge is a complex entity-comprising of training and experiential elements-not fixed but mutable, both informed and altered by practice. This study uses oral history accounts to explore how midwives viewed themselves and how they interacted with widwifery knowledge in an attempt to gain a greater understanding of their power and independence in the workplace and, as a result, of their professional status. Midwifery knowledge cannot simply be defined as the technical skills taught in training; it was also shaped by the environment in which practice took place and midwife's relationships with women and with doctors.

History, 20th Century↗
PubMed1998

Operative complications of hernia repair in childhood.

In a training center, 1,131 inguinal hernias were repaired in 1,000 consecutive patients in 6 years. The documents of these patients were reviewed retrospectively for surgical complications. A total of 38 complications were encountered in 35 patients, including wound infection (1.9%), recurrence (0.9%), tethered testis (0.3%), bladder injury (0.3%), was deferens injury (0.2%), iatrogenic orchiectomy (0.1%), and postoperative death. Most of them occurred in the early years of the clinic, and nearly one-half were technical in nature. Careful training, stressing the importance of gentle handling of the tissues, and meticulous dissection with emphasis on learning groin anatomy should reduce the incidence of such complications.

Adolescent↗
PubMed1994

Evaluation of task-oriented performance of several fully 3D PET reconstruction algorithms.

The relative performance of five fully 3D PET reconstruction algorithms is evaluated. The algorithms are a filtered backprojection (FBP) method and two variants each of the EM-ML and ART iterative methods. For each of the iterative methods, one variant makes use of voxels and the other makes use of 'blobs' (spherically symmetric functions smoothly decaying to zero at their boundaries) as basis functions in its discrete reconstruction model. The methods are evaluated from the point of view of the efficacy of the reconstructions produced by them for three typical medical tasks--estimation of the average activity inside specific regions of interest, detection of hot spots, and detection of cold spots. A free parameter is allowed in the description of each of the five algorithms; the parameters are determined by a training process during which a value of the free parameter is selected which (nearly) maximizes a technical figure of merit. Such training and the actual comparative evaluation is done by making use of randomly generated phantoms and their projection data. The methodology allows assignation of levels of statistical significance to claims of the relative superiority of one algorithm over another for a particular task. We find that using blobs as basis functions in the iterative algorithms is definitely advantageous over using voxels. This result has high statistical significance. (We also include a visual illustration of it.) Comparing FBP, EM-ML using blobs, and ART using blobs, we do not find a clear difference in the overall performance of the investigated variants of the methods. If anything, our results suggest that ART using blobs may be the most efficacious of the three.

Algorithms↗
PubMedDate not supplied

[Training experience in climacteric and menopause among physicians of the IMSS].

OBJECTIVE: To analyze the level of knowledge concerning climateric and menopause among family physicians and gynecologists and obstetricians of the Instituto Mexicano del Seguro Social (IMSS), after a training process in institutional technical guidelines and in educational content for population. We also analyze possible changes in frequency of medical attention for climateric and menopause in the first level of medical care. MATERIAL AND METHODS: Prospective and descriptive study on 1) results of the knowledge evaluation by means of 23 questions with multiple answers, and 2) analysis of rates of medical care for menopausal and perimenopausal disturbances (N95 code, X Revision, IDC) from 1995 to 2000. RESULTS: The percentage of correct answers prior to training was 62.2 for family physicians and 65.9 for gynecologists and obstetricians; after training, 79.3 and 81.4, respectively. Both groups had on increase in knowledge levels (p < 0.001) but there were no differences among them. An increase was registered in medical care rates for menopausal and perimenopausal disturbances in the group from 45 to 64 years of age in the period from 1995 to 2000. CONCLUSIONS: All physicians had on increase in knowledge on climateric and menopause issues but without differences among them, probably because the care of this health problem is referred to specialized services and as well as to more attention on other more frequent problems in women's health. In addition, we did not find changes yet in the rates of medical attentions attributable to training and information to population.

Climacteric↗
PubMed2000

Laparoscopic training on bench models: better and more cost effective than operating room experience?

BACKGROUND: Developing technical skill is essential to surgical training, but using the operating room for basic skill acquisition may be inefficient and expensive, especially for laparoscopic operations. This study determines if laparoscopic skills training using simulated tasks on a video-trainer improves the operative performance of surgery residents. STUDY DESIGN: Second- and third-year residents (n= 27) were prospectively randomized to receive formal laparoscopic skills training or to a control group. At baseline, residents had a validated global assessment of their ability to perform a laparoscopic cholecystectomy based on direct observation by three evaluators who were blinded to the residents' randomization status. Residents were also tested on five standardized video-trainer tasks. The training group practiced the video-trainer tasks as a group for 30 minutes daily for 10 days. The control group received no formal training. All residents repeated the video-trainer test and underwent a second global assessment by the same three blinded evaluators at the end of the 1-month rotation. Within-person improvement was determined; improvement was adjusted for differences in baseline performance. RESULTS: Five residents were unable to participate because of scheduling problems; 9 residents in the training group and 13 residents in the control group completed the study. Baseline laparoscopic experience, video-trainer scores, and global assessments were not significantly different between the two groups. The training group on average practiced the video-trainer tasks 138 times (range 94 to 171 times); the control group did not practice any task. The trained group achieved significantly greater adjusted improvement in video-trainer scores (five of five tasks) and global assessments (four of eight criteria) over the course of the four-week curriculum, compared with controls. CONCLUSIONS: Intense training improves video-eye-hand skills and translates into improved operative performance for junior surgery residents. Surgical curricula should contain laparoscopic skills training.

Clinical Competence↗
PubMed1988

Railway signals passed at danger. Situational and personal factors underlying stop signal abuse.

Based upon a systematic registration of cases of unauthorised passing through signals at danger (SPD cases) during the period 1 January 1983 to 1 January 1985, the contribution of situational and personal factors to the occurrence of this kind of safety error was studied. Exposural deviances were taken into account by presenting the relevant exposural details as well as the SPD frequencies. To study the effect of personal factors, the group of drivers involved was compared with an individually matched control group. Data analysis indicated that SPD cases tended to be fairly evenly dispersed over the months of the year. The distribution of incidents throughout the days of the week corresponded rather closely to the numbers of train driver shifts. Neither technical nor mechanical faults nor weather nor visibility conditions seemed to be significant contributory factors. SPD cases were relatively many during the morning hours (midnight till 6 am and 8 am till noon) and at the start of duty periods. At a number of (black) spots two or more cases were recorded accounting for a relatively high percentage of all cases. The most frequently mentioned hazard was that of the signal being situated behind a bend. About 90% of the cases took place at or near stations and most were with arriving trains. The direct cause of an SPD case often seemed to be that a signal was overlooked or not anticipated. Personal factors (age, time on duty, length of service or track and rolling-stock experience) did not seem to be important variables. However, it was proven that previous incidents, worse performance with multiple choice reaction tests, and less job satisfaction are predictive of a future SPD case. In this study the consequences of SPD cases were not as serious as they could be. Most damage was to points (forced open). Other consequences include level crossings not closed and a very small number of crashes. There were no fatalities and only one person was injured as a result of stop signal abusage.

Journal Article↗
PubMed2004

The educational impact of bench model fidelity on the acquisition of technical skill: the use of clinically relevant outcome measures.

OBJECTIVE: To evaluate the impact of bench model fidelity on the acquisition of technical skill using clinically relevant outcome measures. METHODS: Fifty junior surgery residents participated in a 1-day microsurgical training course. Participants were randomized to 1 of 3 groups: 1) high-fidelity model training (live rat vas deferens; n = 21); 2) low-fidelity model training (silicone tubing; n = 19); or 3) didactic training alone (n = 10). Following training, all participants were assessed on the high- and low-fidelity bench models. Immediate outcome measures included procedure times, blinded, expert assessment of videotaped performance using checklists and global rating scales, anastomotic patency, suture placement precision, and final product ratings. Delayed outcome measures (obtained from the live rat vas deferens 30 days following training) included anastomotic patency, presence of a sperm granuloma, and the presence of sperm on microscopy. RESULTS: Following training, checklist (P < 0.001) and global rating scores (P < 0.001) on the bench model simulators were higher among subjects who received hands-on training, irrespective of model fidelity. Immediate anastomotic patency rates of the rat vas deferens were higher with increasing model fidelity training (P = 0.048). Delayed anastomotic patency rates were higher among subjects who received bench model training, irrespective of model fidelity (P = 0.02). Rates of sperm presence on microscopy were higher among subjects who received high-fidelity model training compared with subjects who received didactic training (P = 0.039) but did not differ among subjects in the high- and low-fidelity groups. CONCLUSIONS: Surgical skills training on low-fidelity bench models appears to be as effective as high-fidelity model training for the acquisition of technical skill among novice surgeons.

Adult↗
PubMed2004

Small-group videotape training for psychotherapy skills development.

OBJECTIVE: Psychotherapy instructors have used video technology to train residents for over 40 years. Though it has met with some controversy, many will argue that videotape review is essential for self-directed learning and accurate psychotherapy supervision. METHODS: The author describes a technique of small-group videotape training as provided in a psychiatry residency training program. RESULTS: He reviews the merits and limitations of this format and suggests simple and inexpensive technical approaches to augment this training. CONCLUSION: The author concludes that small-group videotape training is an efficient psychotherapy training format that encourages self-monitoring and the exchange of supportive peer feedback.

Clinical Competence↗
PubMed1994

Family physicians and first-trimester abortion: a survey of residency programs in southern California.

INTRODUCTION: Since abortion has become a focus of increased public attention, it is important to assess family physicians' attitudes and scope of training regarding this outpatient procedure. METHODS: Residents and faculty at eight southern California family practice residency programs were surveyed about their views on first-trimester abortion, and about their interest in training to perform the procedure. RESULTS: While 62.5% of respondents believed abortion to be an appropriate procedure for family physicians to perform, only 19.5% had performed an abortion during the past year. Attitudes about situations in which abortion should be available to women were not associated with age, gender, or ethnicity. Religion of the respondents, however, was significantly associated with attitudes toward abortion. Of respondents without personal objections to the procedure, those who perceived the performance of abortion as appropriate for family physicians were significantly more likely to be interested in further training (48.2%) than those who did not perceive it as appropriate (18.2%, P = .0147). This perception of appropriateness was affected by whether or not a respondent had been offered training; those who had been offered training in abortion were 8.5 times more likely to believe it to be an appropriate procedure for family physicians to perform (P = .0001). CONCLUSION: If the number of family physicians providing abortions is to be increased, residency programs must offer abortion training as a more fully recognized part of the family medicine curriculum.

Abortion, Induced↗
PubMed1995

[Computer-assisted evaluation of bicycle ergometry for determining level of endurance training in physical fitness].

Recent studies have provided evidence of the importance of aerobic endurance training as an independent factor with regard to reducing morbidity and mortality from cardiovascular diseases. Clinical routine shows that test methods and training recommendations are often not specific enough for efficient, yet safe exercise. Software is presented which allows cycle ergometry to be used according to standard criteria in clinical practice, with special attention to the requirements for training with health benefit. Technical requirements: 1. Cycle ergometer with the possibility of increasing exercise intensity by Watt (W) increments; 2. ECG or other device for accurate pulse monitoring; 3. IBM-compatible PC and printer. Based upon the input of data on birth date, sex, height, weight, and heart rate (HR) at rest the programme calculates body surface area, the reference value of physical work capacity of matching subjects and the expected maximal HR (HRmax,exp) and HRmax,exp x 0.95. After the test, input of HR at exhaustion (HRmax), maximum achieved W-increment and time cycled at this intensity in seconds provides various parameters of the individual work capacity. The maximal work performance W (Wmax) is calculated. This value is used to provide further calculations of Wmax.kg-1, VO2max.kg-1 and the maximal work performance as a percentage of the normal value (LF%). The software provides an individual training plan with incremental extension of training time and a prescription for heart rate controlled intensity of endurance training based upon medically accepted training principles. The software enables a standard test to be used and recommends medically efficient and secure quality and quantity guidelines for endurance training.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[The triage in disaster medicine: analysis of a practical exercise].

BACKGROUND: The triage is a procedure for casualties classification using some criteria (severity, survival, therapeutical delay, etc.) which is basic for the preparedness of health personnel in event of disaster. Even being a basic procedure, its teaching and training is not enough extended among health personnel. The goal of this study was assess the efficacy of teaching triage procedures in terms of its capability to carry out the examination and classification of massive casualties under different conditions of environmental difficulties. METHODS: 25 couples of health professionals (doctor and nurse) were trained during 90 minutes on triage procedures and them aleatory located at 3 groups with 12 simulated casualties at each group corresponding to 3 different levels of environmental difficulties. They were asked to perform the triage and complete the information contained at the triage card. This information was analyzed in order to see and compare the results of each group. RESULTS: All the health professionals showed high correlations between observed and expected responses for the evacuation priority variable. However, only the group of less environmental difficulty showed a significative statistical correlation (p = 0.03). No significative statistical differences were found on the diagnostic classification but the adjust level was poor for the high environmental difficulties group. CONCLUSIONS: Acceptable levels of efficacy on triage procedures can be obtained using a single teaching session of theoretical contents plus a practical exercise, specially for the casualties prioritization. On the other hand, environmental conditions looks as a variable influencing the efficacy of other acceptable results expected on this kind of technic perhaps requiring further training.

Disaster Planning↗
PubMed2004

[Changes in undergraduate education in the health professions from the perspective of comprehensive training].

This article discusses the issue of legal, technical, and political legitimacy for formulating a public policy aimed at organizing the training of health professionals in accordance with the population's health needs, while highlighting the competencies of the education and health sectors in this construction. Comprehensiveness is viewed as the main thrust for proposing and supporting the changes needed in the training of professionals in education and health, since it involves an expanded understanding of health, the linkage among multi-professional and interdisciplinary knowledge and practices, and dialogue/exchange with health system users, aimed at innovation of practices in all scenarios of health care and health sector management.

Brazil↗
PubMedDate not supplied

Building a laparoscopic surgical skills training laboratory: resources and support.

BACKGROUND: Technical skills have historically been developed and assessed in the operating room. Multiple pressures including resident work hour limitations, increasing costs of operating room time, and patient safety concerns have led to an increased interest in conducting these activities in a safe, reproducible environment. To address some of these issues, many residency programs have developed laparoscopic surgical skills training laboratories. We sought to determine the current status of laparoscopic skills laboratories across residency programs. METHODS: In December 2004, surveys were mailed to all 251 United States general surgery residency program directors. This brief 2-page survey consists of 9 questions regarding laparoscopic skills training laboratories. RESULTS: Of the 251 mailed surveys, 111 completed surveys were returned (44%). Of the respondents, 81 have laparoscopic skills training laboratories in place (80%). Skills laboratories that used a defined curriculum, and general surgery programs that shared their laboratories with other training programs were determined to have significantly more resources. A wide variety of funding sources have been used to develop and support these skills laboratories. CONCLUSIONS: Significant variability in training practices and equipment currently used exists between laboratories. A more efficient, standardized approach to skills training across residency programs is a desirable goal for the immediate future.

Data Collection↗
PubMed2003

Preventing falls in community-dwelling frail older people using a home intervention team (HIT): results from the randomized Falls-HIT trial.

OBJECTIVES: To evaluate the effect of an intervention by a multidisciplinary team to reduce falls in older people's homes. DESIGN: Randomized, controlled trial with follow-up of subjects for 1 year. SETTING: University-affiliated geriatric hospital and older patients' homes. PARTICIPANTS: Three hundred sixty subjects (mean age +/- standard deviation = 81.5 +/- 6.4) admitted from home to a geriatric hospital and showing functional decline, especially in mobility. INTERVENTION: The participants were randomly assigned to receive a comprehensive geriatric assessment followed by a diagnostic home visit and home intervention or a comprehensive geriatric assessment with recommendations and usual care at home. The home intervention included a diagnostic home visit, assessing the home for environmental hazards, advice about possible changes, offer of facilities for any necessary home modifications, and training in the use of technical and mobility aids. An additional home visit was made after 3 months to reinforce the recommendations. After 12 months of follow-up, a home visit was made to all study participants. MEASUREMENTS: Number of falls, type of recommended home modifications, and compliance with recommendations. RESULTS: After 1 year, there were 163 falls in the intervention group and 204 falls in the control group. The intervention group had 31% fewer falls than the control group (incidence rate ratio (IRR) = 0.69, 95% confidence interval (CI) = 0.51-0.97). The intervention was most effective in a subgroup of participants who reported having had two or more falls during the year before recruitment into the study. In this subgroup, the proportion of frequent fallers and the rate of falls was significantly reduced for the intervention group compared with the control group (21 vs 36 subjects with recurrent falls, P =.009; IRR = 0.63, 95% CI = 0.43-0.94). The compliance rate varied with the type of change recommended from 83% to 33% after 12 months of follow-up. CONCLUSION: Home intervention based on home visits to assess the home for environmental hazards, providing information about possible changes, facilitating any necessary modifications, and training in the use of technical and mobility aids was effective in a selected group of frail older subjects with a history of recurrent falling.

Accidental Falls↗
PubMedDate not supplied

[The quality of radiology services in five Latin American countries].

OBJECTIVE: To determine the correlation between certain quality indicators for imaging services and the accurate interpretation of radiological exams for four frequent complaints: breast lumps, gastrointestinal discomfort, back pain, and symptoms of tuberculosis. METHODS: Twenty-six radiology services in Argentina, Bolivia, Colombia, Cuba, and Mexico were assessed. The mammography and conventional radiographic/fluoroscopic equipment used in selected services were evaluated utilizing common protocols, data sheets, testing instruments, phantoms, and calibrated dosimetry systems. The studies were performed in medium-complexity facilities. Informed consent was obtained from all patients studied, and the confidentiality of results was guaranteed. The following parameters were documented: type of facility (public vs. private); population covered; patient workload; radiological and image-processing equipment and supplies; education and training of professional and technical staff; quality assurance and preventive maintenance programs, and adherence to radiation safety standards. The performance of x-ray units, image receptors and processors; darkroom and image viewing conditions; patient doses and image quality, were determined using standardized parameters in all cases. Independent panels of radiologists, recognized as experts by the local radiological society, assessed the quality of the clinical images obtained and performed a radiological interpretation for each patient using the same films and clinical history available to the institution's imaging physicians. The agreement between the panel of expert's reports and those of local radiologists was taken as an indicator of the radiological diagnostic accuracy. RESULTS: Analyses were carried out of 366 mammograms, 343 radiological procedures for gastrointestinal complaints, 319 X-rays of the spinal column, and 157 chest radiographs. The agreement between the radiological interpretation of the panel of experts and of the local physician ranged from 70% to 100%, except in the case of spinal column films in Cuba (57.8%) and of mammograms in Mexico (33.3%), which the panel of experts found to be among those having the poorest quality. There was a significant positive correlation between the accuracy of the radiological interpretation and the quality of the radiological images. Image quality showed a positive correlation with the technicians' level of education and training. Studies performed in services that had automatic film processors and that complied with the indicators established for screen-film contact yielded better images and a higher proportion of studies with concordant results. More than 50% of the viewboxes did not satisfy the quality criteria for luminance and homogeneity. CONCLUSIONS: A good quality image is critical to achieving an accurate diagnosis. Emphasis should be placed on the continuing education of radiology technicians and on the acquisition and maintenance of adequate equipment and accessories, especially viewboxes, intensifying screens, and automatic film processors, given the impact they have on image quality.

Humans↗
PubMed1998

Evaluation of a training program using visible speech in German schools for the deaf.

The present study provides insight into several technical and computer-aided procedures that can be used with deaf students to improve their speech. A visible speech device combined with a training program was developed and evaluated in six German schools for the deaf. The teachers were initially given special instructions about the work with their students in accordance with our technical and training concept. The students were able to build up a knowledge of visible patterns of spoken sounds, syllables, and words. They used this knowledge to recognize speech errors and to improve their pronunciation. Teachers' experiences were mostly positive. As they said, this device made their work much easier. The results show that visible speech can be used effectively; however, it has to be embedded in a training program that systematically builds up phonological knowledge and considers symbolic meanings from signed and written language.

Journal Article↗