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At least 955 records · Page 53Linked to original sources
PubMed2002

A qualitative assessment of 1st-year internal medicine residents' perceptions of evidence-based clinical decision making.

BACKGROUND: Residents' perceptions about evidence-based clinical decision making remain largely unexplored. PURPOSE: To understand how residents perceive and use evidence-based medicine in clinical decision making. METHODS: Qualitative study using a semistructured questionnaire and focus group in a postgraduate training program in internal medicine at an academic U.S. medical center. Seventeen 1st-year internal medicine residents in their 1st postgraduate year were interviewed. Six additional 1st-year residents formed a validation group. RESULTS: The interplay of time and expertise modified how physicians-in-training incorporate evidence into clinical decision making. When time was available, the residents preferred to answer their questions by searching and critically appraising the literature. This "self-acquired" expertise empowered them to help patients by using participatory decision-making styles. When time was limited, the residents turned to experts. Residents assumed that experts practiced evidence-based medicine. This "borrowed" expertise was thought to be the most efficient way of integrating evidence and clinical expertise, but it led to the use of a parental style when answers were taken back to the bedside. CONCLUSION: The practice of evidence-based medicine empowers 1st-year residents and appears to affect their choice of decision-making style. Further research is needed to better understand the link between decision-making style and evidence-based medicine.

Decision Support Systems, Clinical↗
PubMed2006

How well trained are clergy in care of the dying patient and bereavement support?

Although comparatively few people have regular contact with a church or spiritual leader, during times of terminal illness or bereavement, clergy are expected to be available and able to provide support. This study was carried out to determine the perceptions of clergy on the training they had received in supporting the dying patient and the bereaved. A sample of clergy working in the diocese of Sheffield was sent a questionnaire to assess what skills and knowledge clergy believed they had in this area, together with areas where they would wish for further training. The questionnaire was developed with input from hospital, hospice, and academic chaplains, and palliative care consultants. A subsidiary questionnaire was sent to clergy training colleges to evaluate the teaching offered. There was a trend across all denominations that those who had trained more recently were more likely to have received relevant training. Most clergy believed that they possessed adequate liturgical skills, but 13% felt they possessed none or little skill in pastoral care of the dying. Seventy-one percent indicated that they would like further training in pastoral care of the dying and 66.3% desired training in care of the bereaved. Of the 50% of training colleges that responded, the number of hours of training on pastoral care of the dying ranged from 6 to 36 hours (median 23 hours and mean 25 hours) and only 26% believed that their training in pastoral support skills was comprehensive. This study suggests that care of the dying and the bereaved is identified by clergy as an area in need of further training by the majority of clergy and should be part of the core curriculum within clergy training colleges and late training programs.

Christianity↗
PubMed1977

Training physicians for primary care: trends and hazards.

Programs to train physicians more effectively for careers in primary care are being organized within academic departments in internal medicine and pediatrics, while the number of training programs in family practice continues to grow rapidly. However, the field of primary care training is expanding without a common vocabulary and with inadequate communication between the specialties involved. If decisions concerning health care policy are to be made rationally, the development of multiple distinct models for primary health care delivery must be encouraged and these models must then be evaluated. The distinction between family practice and family medicine must be made clear if the latter discipline is to realize its potential application to all specialties. The relative exclusion of family practice from universities and the absence of experienced practitioners in university primary care programs are conditions that threaten the future of both types of programs and deserve thoughtful attention from medical educators.

Education, Medical↗
PubMed2002

A seminar series in applied biostatistics for clinical research fellows, faculty and staff.

Familiarity with experimental design and statistical analysis techniques is necessary for investigators to conduct state-of-the-art research in clinical medicine. A wide range of options for biostatistical training is available. These include formal academic courses for credit, one-on-one education offered under the guise of consultation, self-paced textbook or computer learning, intensive short courses, portions of extended courses spanning an assortment of other subjects, and a continuing series of seminars or lectures covering selected topics in statistics. The latter structure is described in this article. We offered an eight-week lecture series focusing on a new topic in biostatistics each week. The course targeted clinical faculty, postdoctoral fellows, residents, and other interested research staff at a large medical research institution. The series focused on interpretation of medical journal articles with regard to statistical issues. Another objective was to provide information to increase a participant's expertise in the design of research studies. Guidance was offered for effective communication with collaborating biostatisticians. The format and contents of the seminar series are described. Aspects of the course that proved to be successful are discussed.

Biometry↗
PubMed2000

Training to Improve Calibration and Discrimination: The Effects of Performance and Environmental Feedback.

This study investigated whether calibration and discrimination are distinct or related aspects of probability judgment accuracy by examining the effects of two different training techniques. Participants received either performance feedback or environmental feedback, and we measured their improvement in calibration and discrimination as a function of feedback type. Whereas performance feedback reduced participants' overconfidence and environmental feedback improved discrimination, neither type of feedback led to an improvement on the other component. In fact, environmental feedback led to an increase in overconfidence. We take these results as evidence that calibration and discrimination are dissociable abilities that require separate training techniques for improvement. Copyright 2000 Academic Press.

Journal Article↗
PubMed2000

Protecting research integrity.

It is not controversial to state that acts of fraud do not belong in the academic world. What is debated is the best way to minimise the risk of fraudulent behaviour. Broadly speaking there are two different approaches to this problem. They differ with regard to whether the main focus is on internal or external control. In this article I argue that the main emphasis should be on internal structures in order to achieve the desired end. Only when the internal structures are in place is it meaningful to adopt external, supportive means to the same end. Invitation to the academic project as such, education and training in research ethics and good research practice, the implementation of good documentation procedures and the implementation of a procedure for investigation of suspicions of fraud which is characterised by efficiency, impartiality and competence are the four primary ingredients in the cure. The first three are suggested to build up the necessary foundation before a structure of investigation procedures are established.

Biomedical Research↗
PubMed1977

Increasing awareness of ergonomics by in-company courses--a case study.

There are some traditional ways for instruction and training in ergonomics, for example the academic method or the empirical way of self-taught practitioners. Because of a usually disinterested management, the last way is very often difficult to achieve. This report deals with experiences where a lucky chance happened and the idea of ergonomics arose from the management and became an inspiration of the whole plant.

Journal Article↗
PubMed2005

Youth violence prevention curriculum for undergraduate nursing and allied health students.

This paper presents the curriculum-development process, implementation, and relevant evaluation outcomes of the Introduction to Violence Prevention in Children and Youth (INTD 4065) course designed by the Center for Hispanic Youth Violence Prevention (CHYVP) of the University of Puerto Rico. The training curriculum was implemented in the academic year 2003-2004 as an undergraduate interdisciplinary three-credit course for nursing and allied health students at one of the schools of the Medical Sciences Campus, University of Puerto Rico. Objectives for the curriculum include developing competencies in child and youth violence prevention in undergraduate allied health and nursing students and promoting involvement of undergraduate health professionals in child and youth violence prevention efforts.

Adolescent↗
PubMed2007

A stitch in time saves nine: intervention strategies for the remediation of competency.

The mission of medical educators in all fields is to perfect the science and the art of training competent physicians and the next generation of leaders. To do this, outcomes research regarding effective training and supervision techniques and curricula, the optimal educational environment, assessment, and remediation of competency is needed. It is incumbent upon training directors to continue to provide the primary leadership for the field of training. The areas that are ripe for research and development include effective curricula, effective evaluation and remediation of competency, and leadership skill development. As medicine becomes more complex, so does the task of training physicians. Joint monitoring and outcomes research of the training enterprise are the scholarly and academic missions of the present and the future.

Adolescent↗
PubMed1994

Home care: the next frontier of pediatric practice.

An overview of pediatric home care issues reveals the breadth and scope of services available to permit pediatricians to provide care at home. This care option has undergone explosive growth and represents one of the fastest-growing health expenditures. Paradoxically, direct physician involvement in the home has been limited during this expansion because of the way home care has been designed and organized with inadequate reimbursement for physician participation, and lack of awareness by, and education of, physicians concerning their roles and responsibilities. The rationale for physician involvement in home care includes the need for determination and reevaluation of the medical necessity of home care services. Future changes in health care delivery and payment will encourage even more consideration of alternative care sites. Physician participation in program and protocol design will facilitate and encourage the appropriate use of the home as a care setting. For the pediatrician to know about home care requires the development of a curriculum to be implemented in academic centers for physicians-in-training and in professional associations for continuing medical education. This curriculum should enable physicians to become primary participants in home care and should lead to research opportunities to evaluate the benefits of home care.

Child↗
PubMedDate not supplied

Sharing mental health care. Training psychiatry residents to work with primary care physicians.

Overcoming problems in communication between psychiatry and primary care requires new models of collaboration. Their success will depend upon the ability of participants to work productively with each other, which will require psychiatry residency programs to offer appropriate preparation for future graduates in working with primary care physicians. This article, based on the training at McMaster University in Hamilton, Ontario, describes a brief curriculum for training psychiatry residents to work effectively with primary care physicians that can be easily integrated with current training rotations and looks at adjustments academic departments need to make to support such programs.

Curriculum↗
PubMed1998

Future role of the allergist-immunologist.

The future role of the allergist/immunologist is dictated by current training and research, which promise to broaden the expertise of practitioners of this discipline. Specialists in allergy and immunology are certified by the American Board of Allergy and Immunology following specialized training in allergic diseases, clinical immunology, procedural skills, clinical principles and analytic methods, clinical laboratory test proficiency, and research. The expanding role of clinical immunology in the management of multiple diseases suggests that specialists in allergy and immunology will continue to broaden their expertise in the care of disorders with an immune component. The discipline of allergy and immunology offers a number of career advantages in both the practice of allergy and immunology and in the application of training in allergy and immunology to opportunities in the pharmaceutical industry and academics. Manpower assessments suggest that the number of allergists and immunologists in training are insufficient to meet the current needs.

Allergy and Immunology↗
PubMed1997

From apprenticeship to academia: an adult branch programme.

This paper describes aspects of the introduction an adult branch programme of a Diploma of Higher Education in Nursing course in a Scottish college of nursing and midwifery. It is argued that the Diploma of Higher Education in Nursing course represents a move from a so-called apprenticeship approach, that is the Scottish 1982 Modular Scheme of General Training, to a so-called academic approach under the auspices of the Project 2000 proposals which have been described as the most major development in the preparation of nurses in the UK for many years (UKCC 1986). This paper will discuss the challenges and difficulties encountered when designing the theoretical aspects of the course with respect to the nursing component. The implications of some of the major changes within the scheme of preparation for the clinical areas where the students gain experience will also be discussed. It will be suggested that practice supervision, a development of apprenticeship, is the way ahead.

Adult↗
PubMed2003

How to move pain and symptom research from the margin to the mainstream.

Pain, dyspnea, nausea, and other physical symptoms receive rather little study despite their major public health impact and the similar neural circuitry that makes these symptoms tractable therapeutic targets. Pain accounts for more than 20% of medical visits and 10% of prescription drug sales but only 0.6% of National Institutes of Health research funds. Clinical pain research remains clustered in the few clinical specialties of the founders of the field--neurology, anesthesia, cancer, and dentistry. Remarkable recent advances in basic science have not been widely applied by cardiologists, gastroenterologists, urologists, and gynecologists. Research funding in dyspnea and nausea is an order of magnitude smaller than funding in pain, despite mechanisms that may be common to all three. Political pressure from an aging population may soon influence funding agencies to train additional researchers in these areas. Academic health centers that develop the cross-disciplinary infrastructure to conduct this research will win major shares of this influx of funding and improve the diagnosis and management of many diseases.

Drug Industry↗
PubMed2001

Implementation and pharmacoeconomic analysis of a clinical staff pharmacist practice model.

The implementation and pharmacoeconomic analysis of a clinical staff pharmacist (CSP) practice model are described. Staff pharmacists at a large, tertiary care, academic medical center were selected and trained to perform clinical pharmacy services under the direction of clinical pharmacy specialist mentors. Clinical interventions by these CSP practitioners were evaluated in terms of direct cost savings (the difference in actual acquisition costs between therapies) and cost avoidance (the dollar value of adverse drug events [ADEs] avoided). The CSPs performed a total of 4959 interventions during a 12-month period. The interventions provided direct cost savings of $92,076 and an estimated cost avoidance of $488,436. Comparing cost savings and cost avoidance with the expenses of providing these services indicated a net economic benefit of $392,660. A new model of pharmacy practice that integrates staff pharmacists into existing clinical practice has the potential to minimize the risks, decrease the costs, and improve the outcomes associated with drug therapy.

Cost Savings↗
PubMed2002

Neural network predicts sequence of TP53 gene based on DNA chip.

UNLABELLED: We have trained an artificial neural network to predict the sequence of the human TP53 tumor suppressor gene based on a p53 GeneChip. The trained neural network uses as input the fluorescence intensities of DNA hybridized to oligonucleotides on the surface of the chip and makes between zero and four errors in the predicted 1300 bp sequence when tested on wild-type TP53 sequence. AVAILABILITY: The trained neural network is available for academic use by contacting steen@cbs.dtu.dk

Base Sequence↗
PubMed2004

Positive emotional priming of facial affect perception in females is diminished by chemosensory anxiety signals.

Chemosensory communication of anxiety is a common phenomenon in vertebrates and improves perceptual and responsive behaviour in the perceiver in order to optimize ontogenetic survival. A few rating studies reported a similar phenomenon in humans. Here, we investigated whether subliminal face perception changes in the context of chemosensory anxiety signals. Axillary sweat samples were taken from 12 males while they were waiting for an academic examination and while exercising ergometric training some days later. 16 subjects (eight females) participated in an emotional priming study, using happy, fearful and sad facial expressions as primes (11.7 ms) and neutral faces as targets (47 ms). The pooled chemosensory samples were presented before and during picture presentation (920 ms). In the context of chemosensory stimuli derived from sweat samples taken during the sport condition, subjects judged the targets significantly more positive when they were primed by a happy face than when they were primed by the negative facial expressions (P = 0.02). In the context of the chemosensory anxiety signals, the priming effect of the happy faces was diminished in females (P = 0.02), but not in males. It is discussed whether, in socially relevant ambiguous perceptual conditions, chemosensory signals have a processing advantage and dominate visual signals or whether fear signals in general have a stronger behavioural impact than positive signals.

Adult↗