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PubMed1995

Do current educational programs address critical thinking in nurse anesthesia?

Critical thinking skills are vital in any of the nursing and medical specialties. These skills can be taught using adult teaching methods and should be incorporated into all courses in the educational process. Unfortunately, some nurse anesthesia programs fail to adequately address critical thinking or the use of these skills. They often teach using rigidly structured models. This descriptive study surveyed nurse anesthesia students (n = 197) and faculty members (n = 128) from 32 schools of nurse anesthesia. It was undertaken to determine the effect of using adult education principles on student satisfaction. Participants completed a survey that was designed by the investigator to determine individual perceptions of the program's teaching style, personal teaching and learning style preference, and, in the case of the students, satisfaction. Results of this study suggest that anesthesia students are more satisfied if they are approached as adult learners. Critical thinking, a vital component of nurse anesthesia practice, is also reinforced by these same teaching methods.

Adult↗

PubMed1994

Experimental studies addressing rigid fixation in craniofacial surgery.

This article has reviewed several experimental studies that address certain aspects of the use of rigid fixation in clinical craniofacial surgery. The effect of rigid fixation on growth was studied in an infant Rhesus monkey model. It showed that osteotomy and fixation resulted in subtle changes in skull shape and that the severity of the deformity was related to the complexity of the fixation employed. Deformities were seen with wire fixation alone, however. A study using a rabbit model showed that the revascularization and resorption of onlay bone grafts immobilized with a microscrew occurred primarily in the cancellous portion of the graft. This led Chen et al to speculate that the volume of cranial bone grafts persists better than with iliac crest grafts, because they contain relatively less cancellous bone and more cortical bone, which is slower to revascularize and resorb. Fiala et al studied the artifacts seen in CT and MR scans associated with plate and screw fixation devices. They showed that, compared with stainless steel and vitallium, titanium resulted in less "starburst" and "black hole" artifact in CT and MR images, respectively. Amarante et al compared butyl-2-cyanoacrylate adhesive fixation with fixation by plates and screws of osteotomized bone segments in a minipig model. They found it to be as effective as plates and screws for bone fixation in this model. In the future, this material, together with resorbable plates and screws, may provide a means of fixation of the craniofacial skeleton and can be anticipated to receive further experimental and clinical study.

Animals↗

PubMed1994

Identifying and addressing the challenges of oral care for the elderly patient.

Growth in the proportion of elderly in the US population and the dropping rate of edentulousness are resulting in an increasingly diverse geriatric dental population. This paper focuses on oral hygiene provision in older patients, because the provision of effective daily oral care is a key factor for rehabilitative and maintenance plans. Both intraoral and extraoral impediments to oral care are discussed with reference to the older patient. Strategies to address these impediments are offered, including specific suggestions for the involvement of other family members and other health care providers.

Aged↗

PubMed1994

[Complementary-addressed photomodification of nucleic acids by arylazide and perfluoroarylazide oligonucleotide derivatives. III. Oligonucleotide reagents with a photoactive group at the end or inside the chain; tandem reagents].

Photomodification of target oligonucleotides with reagents bearing p-azidotetrafluorobenzamide group at various positions of the oligonucleotide address was investigated. The photoactive group was attached to the 5'- or 3'-terminal phosphate or at the C5-position of a deoxyuridine residue at the 5'-end or inside the oligonucleotide chain. The reagents with the internal photoactive group modified the target with 50-55% efficiency (fraction of covalent adducts reagent-target), whereas the derivatives with a terminal reactive group were more effective (70%). The main point of the modification was the guanosine residue of the target which located near to the photoactive group and was not involved into the duplex formation. Tandems of reagents which are complementary to neighbouring sites of the target modify predominantly the same guanosine residue, with up to 80% extent.

Azides↗

PubMed1993

[In honor of Paracelsus--Einsiedeln 1993. Anniversary address and honoring of Paracelsus on Saturday, 6 November 1993, in Cloister Einsiedeln].

The introductory address to the final ceremony of the anniversary of Einsiedeln attempts to show how a peregrine physician of the beginning New Age assesses the relation between the native place and the foreign country. A view on the life and work of Theophrastus von Hohenheim shows this relation to be full of tension and to be included in the relation of earthly pilgrimage to the heavenly home land. Paracelsus' spiritual greatness and the wideness of his points of view are thus evident from a vital factuality.

Alchemy↗

PubMed1993

Addressing the public's concerns about human immunodeficiency virus transmission in health-care settings.

BACKGROUND: The 1990 report of a cluster of patients infected with the human immunodeficiency virus (HIV) associated with a Florida dentist with acquired immunodeficiency syndrome attracted considerable media coverage and legislative attention. A number of polls found that the public favored mandatory HIV-antibody testing of health-care workers. The Centers for Disease Control and Prevention, Atlanta, Ga, conducted a two-phase study to understand how public concerns regarding potential HIV transmission in health-care settings can be addressed by the medical and public health communities. METHODS: Sixteen focus group discussions in nine US cities were conducted to explore the public's perceptions, concerns, and behavioral responses regarding HIV transmission in health-care settings. Using this information, a questionnaire was developed and administered to a nationwide probability telephone sample of 1150 adults. RESULTS: Concern about contracting HIV in health-care settings was highest for emergency department treatment and lowest for treatment by a personal physician. Two factors directly related to patient care, ie, the health-care professional's willingness to discuss acquired immunodeficiency syndrome and the presence of acquired immunodeficiency syndrome educational materials in the waiting room, were considered useful factors for determining potential risk of transmission of HIV in a health-care setting. CONCLUSIONS: Public concern about the potential for HIV transmission in health-care settings remains high. Active steps on the part of health-care professionals, such as providing educational materials and initiating discussions about infection control procedures and about HIV and acquired immunodeficiency syndrome, could likely have positive effects in terms of alleviating these concerns.

Adolescent↗

PubMed1993

Hysteroscopy: where have we been, where are we going? Honorary luncheon address.

A quiet resurgence of interest in an old endoscopic technique began in the late 1960s. Today hysteroscopy, both diagnostic and operative, has become an integral part of the gynecologist's technique. The question, "Hysteroscopy: where have we been, where are we going?" can be addressed by an examination of the past, present and future. Tribute will be paid to the pioneers. The clinical applications as practiced today are described. Critical appraisal of the risks and benefits of these procedures will permit predictions to be made about the future of gynecologic hysteroscopy.

Female↗

PubMed1993

Support groups address residents' personal development.

Graduate medical education traditionally has emphasized the teaching of biomedical knowledge and technical skills. However, physicians-in-training also need opportunities to explore their emotional reactions that occur during the process of patient care and medical training. The promotion of personal growth and self-awareness should be important components of graduate medical education. Easily implemented, a resident support group is one forum that addresses this obvious gap in medical education. This article reviews the goals and structure of support groups, with the hope that more training programs will implement them.

Education, Medical, Graduate↗

PubMed1993

Addressing ethical boundaries among nurses.

Sexual intimacy is the primary boundary issue studied and reported in the literature, though it is not addressed directly in the ANA Code of Ethics. However, perhaps equally important are behaviors which may stem from nurses' meeting their own social and emotional needs through their work. Results of "Boundaries" workshops for more than 3000 nurses and other healthcare professionals are summarized. Recommendations are made, relative to both personal and professional behavior, along with a list of suggestions for nurse managers.

Codes of Ethics↗

PubMed1995

Addressing sexual dysfunction following radiation therapy for a gynecologic malignancy.

PURPOSE/OBJECTIVES: To review the aspects of normal sexual response, current incidence of sexual dysfunction following radiation therapy for a gynecologic malignancy, nursing interventions for each symptom that may occur, and nursing research priorities. DATA SOURCES: Published articles, book chapters, American Cancer Society materials, healthcare professionals working in the field of radiation oncology, and patients. DATA SYNTHESIS: Radiation therapy frequently is the treatment of choice for a gynecologic malignancy. High-dose radiation to the pelvis causes varying degrees of sexual dysfunction because of its effects on the ovaries and vagina. CONCLUSIONS: Sexual dysfunction resulting from the effects of radiation therapy on the ovaries and vagina can be prevented, minimized, or managed when the nurse is aware of the needs, desires, and expectations of patients receiving this treatment. IMPLICATIONS FOR NURSING PRACTICE: Sexuality is an important aspect of quality of life that most healthcare professionals do not address. Nursing assessment and practical care strategies for sexual dysfunction can be implemented. Additional nursing research on this subject is warranted.

Female↗

PubMed1996

Addressing difficult areas in body contouring with emphasis on combined tumescent and syringe techniques.

The combined use of the tumescent and syringe techniques is a logical choice in addressing difficult areas in body contouring. Each technique complements the other. The magnification of the deformity by the tumescent technique allows for a more uniform and accurate contour correction. The syringe technique provides precision and accuracy that further contribute to body contouring refinement. The combined use of the tumescent and syringe techniques has allowed greater refinement and precision in achieving satisfactory body contouring and in minimizing complications associated with traditional techniques.

Anesthetics, Local↗

PubMed1995

Glove-associated reactions: addressing an increasing concern.

Increasingly, the dermatology professional will be called upon to assist in establishing protocols for recognizing, differentiating, and managing glove-related reactions. Addressing preventative measures upfront will decrease possible morale problems, long-term treatment and compensation expenses, as well as potential career-limiting situations.

Decision Trees↗

PubMed1996

Addressing the credibility gap in general practice research: better theory; more feeling; less strategy.

A substantial international network of general practice researchers has grown up over the past 30 years, and the literature of the discipline is now extensive and diverse. Nevertheless, there is considerable ambivalence within the profession about what research can offer, where its weight should be being put and how best the opportunities its insights create can be taken advantage of. The sometimes disappointingly low credibility of research and researchers needs to be addressed. The issues of the adequacy of underlying 'theory' and of ownership of research agendas may contain the basis of a way forward.

Attitude of Health Personnel↗

PubMed1996

Local health department effectiveness in addressing the core functions of public health: essential ingredients.

OBJECTIVES: Objective 8.14 of the U.S. Healthy People 2000 objectives calls for 90% of the population to be served by a local health department (LHD) which is effectively carrying out the core functions of public health (assessment, policy development, assurance). This study seeks to describe the structural and service characteristics of an effective LHD. METHODS: Data from a 1993 national random sample survey of LHD practice were merged with data from the 1992-1993 National Association of Country and City Health Officials (NACCHO) profile of local health agencies. Using a definition of effectiveness related to the core functions of public health, the correlates of effectiveness were examined for 264 health departments in the matched sample. RESULTS: Effectiveness of local health agencies was not related to jurisdiction size of type. Inputs (structural factors) associated with effectiveness included having a full-time agency head, a larger budget derived from a greater number of funding sources, and a larger number of staff. With respect to outputs (services), effective health departments were also more likely to provide a greater number of services directly, particularly personal preventive and treatment services. CONCLUSIONS: Only a few inputs are correlated with core-function related effectiveness. However, a profile of an effective health department emerges. Effective LHDs appear more likely to have full-time leadership which is able to tap diverse funding sources to provide the mix and match of community and personal prevention and treatment services needed to address community needs and improve the public's health.

Community Health Services↗

PubMed1997

Assessing and addressing the library needs of health care personnel in a large regional hospital.

A needs assessment survey was conducted by the Medical Library staff of St. John's Health System, Inc., in Springfield, Missouri, to document the library needs of non-physician health care personnel. The intended use of the survey was threefold: first, to collect baseline data from non-physician health care employees; second, to gather recommendations from both library users and non-users to be included in library planning and improvements; and third, to promote the library during the survey process. Study results, along with an implementation report detailing actions taken to enhance strengths and address weaknesses identified in the needs assessment survey, are presented. Opportunities for further investigation of library needs are also reported.

Allied Health Personnel↗

PubMed1996

In search of effective programs to address students' emotional distress and behavioral problems part III: student assessment of school-based support groups.

Emotional distress and behavioral problems are common in high schools. This report describes the efficacy of an in-school program based on participation in volunteer-facilitated peer support groups in addressing these problems. Two hundred and fifty students who experienced such problems participated in weekly 50-minute peer support groups led by adult nonmental health professional volunteers. The students anonymously evaluated their progress and program acceptability using an instrument developed specifically to evaluate the group experience. Analysis of the evaluation of the 131 respondents documented the reliability of a proposed Self-Assessment Questionnaire which showed that participation led to improvement in school, interpersonal, and internal domains. The program was highly accepted and showed other signs of success: half of the alcohol and substance users reduced their intake, and 60% of those who considered dropping out of school continued their education. The results provide preliminary evidence that peer support groups show promise as an economical and well-accepted method for early recognition and management of emotional and behavioral problems in high schools. For some adolescents, these groups may be the only acceptable or available therapeutic modality.

Adolescent↗

PubMed1997

Addressing the repressed needs of the Arabic client.

In comparison to families in Western society, the traditional Arabic family plays a relatively greater role in providing support for adult progeny. This serves to condition adult offspring to continue to comply with the will and values of the family. Therefore, in exchange for familial support, Arabic individuals learn to repress authentic needs and emotions, and within that process they relinquish the need for self-actualization. Arabic society discourages individualism and opposes self-actualization by means of simultaneous punishment and moralization. Thus, there is a relatively greater development of the social value system (or superego) and comparatively less development of the self (or ego). In comparison to Western society, Arabic individuals continue to experience greater oppression during adulthood. Given these cultural differences, the processes of reliving and activating repressed needs and emotions, which ultimately serves to promote self-actualization, will transform intrapsychic conflicts into interpersonal and social ones. Thus, personal actions typically encouraged during Western psychotherapy are likely to produce significant social oppression. Indeed, promoting awareness of repressed needs and emotions often leads the Arabic client to become more helpless, because such wishes will rarely be socially sanctioned or satisfactorily fulfilled. Therefore, when addressing repressed needs and emotions in psychotherapy, ego strength, cultural identity, and degree of strictness of the client's family of origin must be considered.

Adolescent↗

PubMed1997

Strategies to address the methodological challenges of client-satisfaction research in home care.

While there is an abundance of recent client satisfaction research, methodological difficulties continue. This paper addresses common methodological challenges in securing useful feedback from elderly clients receiving home-care services. The methodological challenges include socially desirable response sets (SDRS), fear of reprisal, acquiescent response sets (ARS), and negative or positive wording of items. These contribute to an inability to capture salient dimensions of satisfaction and dissatisfaction important to home-care clients. Several data-collection strategies are proposed: guided interactive interviews, story-telling, scenarios, and rating of the importance of the dimensions of satisfaction and dissatisfaction identified from interview data. Each strategy is discussed using illustrations from a study on elderly clients' satisfaction with home-care services. Nurses and other health-care providers require credible feedback about client satisfaction in order to develop policy and to provide more appropriate and effective services to home-care clients.

Home Care Services↗