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Social policy practice: tasks and skills.

The problem addressed is the gap between practice and social work education in state and local policy practice. The purpose of the study is to facilitate development of effective curriculum by providing baseline data in an area of policywork termed policy analysis/synthesis. Seventy-two policy practitioners completed two instruments allowing them to identify and describe their work tasks and skills. The findings support administrative training for even the most technical-oriented planning student and suggest educating baccalaureate social workers for this practice.

Curriculum↗

[Nurse training from the competence perspective: a short reflection].

The new curriculum directives for undergraduate courses in the health area require reflection and awareness of the direction of nursing teaching. The transition between the basic curriculum and curriculum by directives; educational objectives and training by ability; ability in the working world and professional training; in addition to human and technical development, are some elements that need to become part of nurses' everyday practice in all the areas in which they work. It is important to start reflecting on these questions at this time, and that is the purpose of this text.

Brazil↗

Laser safety programs in general surgery.

General surgery represents a speciality where, while any procedure can be performed with lasers, there are no procedures for which the laser is the sine quo non. The general surgeon may perform a variety of procedures with a multitude of laser wavelengths and technologies. Laser safety in general surgery requires a multidisciplinary approach. Effective laser safety requires the oversight of the hospital's "laser usage committee" and "laser safety officer" while providing a workable framework for daily laser use in a variety of clinical scenarios simultaneously. This framework must be user-friendly rather than oppressive. This presentation will describe laser safety at the Rochester General Hospital, a tertiary care, community-based teaching hospital. The safety program incorporates the following components: input to physician credentialing and training, education and in-servicing of nursing and technical personnel, equipment purchase and maintenance, quality assurance, and safety monitoring. The University of Rochester general surgery residency training program mandates laser training during the PGY-2 year. This program stresses the safe use of lasers and provides the basis for graded hands-on experience during the surgical residency. The greatest challenge for laser safety in general surgery centers on the burgeoning field of minimally invasive surgery. Safety assurance must be balanced so as to maintain a safe operating-room environment while ensuring patient safety and the ability to permit the surgery to proceed efficiently. Safety measures for laparoscopic procedures must be sensitive to the needs of the surgical team while not providing confusing signals for the "gallery" observers. This task is critical for the safe operation of lasers in general surgery. Effective laser safety in general surgery requires constant vigilance tempered with sensitivity to the needs of the surgeon and the patient as laser technology and its applications continue to evolve.

Credentialing↗

Counselor training as a treatment method for alcohol and drug abuse.

Based on the "helper-therapy" principle, a group of predominantly chronic alcohol- and drug-dependent individuals were trained for new careers in alcohol-drug counseling. A 2-month preinternship in alcohol or drug treatment centers served as a screening procedure for motivation and sobriety. Prior to training, measures of personality and self-concept were taken as well as demographic information. A 4-month training course covered broad educational and technical areas, including counseling procedures with participation, and physical conditioning. The 13% who dropped out were compared to the completers and found to differ only in extent of past antisocial history and less certainty about social drinking and abstinence. The pre-post measures of the completers indicated significant improvement in all areas of self-concept and on most of the MMPI scales. A 1-year post follow-up self-report questionnaire revealed that 74% of the respondents were employed, 59% in counseling or related areas. Less than 10% reported moderate regular use of drugs of alcohol, less than 2% heavy usage or addiction. Overall the program appears to have had sustained positive effects.

Alcoholism↗

First 100 CustomCornea commercial eyes.

PURPOSE: With the advent of wavefront-guided custom abalation we not only try to reach a target of 20/20 vision, but strive for improvement in what has always been most important--the quality of this vision. METHODS AND RESULTS: Insights are presented, based on clinical experience at Durrie Vision with our first 100 commercial CustomCornea eyes. We highlight key points for preparing a clinical practice for this new technology, such as staff training, marketing, and pricing. We discuss technical aspects such as patient selection and target adjustment as they relate to the Alcon LADARWave system. CONCLUSION: In our practice we have thus far had clinical success with CustomCornea; patient acceptance has been high, and by closely monitoring our first few patients we were able to reduce the number of future enhancements.

Astigmatism↗

Anterior transsternal approach to the upper thoracic spine.

Cervicothoracic junction and upper thoracic spine down to T4 can be reached through anterior approach via sternotomy. Transsternal approach is the best route to gain access to lesions localized within vertebral bodies of the upper thoracic spine allowing for their resection, interbody fusion and replacement with bone cement. Consecutive modifications of transsternal approach evolved towards less extensive osteotomy from full median sternotomy, through manubriotomy with clavicle resection to partial lateral manubriotomy. Less extensive modifications provide limited lateral exposure of the spine and are more demanding technically. We present two cases of the upper thoracic spine tumours operated on through full medial sternotomy. We believe that median sternotomy has several advantages over less extensive modifications: it is technically simple to perform approach for trained thoracic surgeon, safer as it provides better exposure of the mediastinum and thus sufficient control of great vessels including subclavian ones, gives better exposure of T3, T4 and even T5 vertebral bodies, allows perpendicular sight and attack to anterior surface of the upper thoracic spine and therefore good visualizing of the posterior longitudinal ligament and dura, do not destabilize shoulder girdle nor affect function of the upper limb. Additional caudal exposure of the thoracic spine as down as T5 can be obtained by dissecting a plane between the brachiocephalic vein, vena cava superior and ascending aorta.

Aged↗

Collaboration between developing and developed countries and between developing countries in occupational health research and surveillance.

Collaborative occupational health and safety studies between counterparts in developing and developed countries and between developing countries have demonstrated their potential for improving occupational health and safety. Such collaboration in occupational health and safety is encouraged in the development of infrastructure in research empowerment and capacity building. This action includes the setting of priorities, the identification and documentation of problems, sponsorship, data bases and surveillance systems, technical support, methodology, publishing, research and training programs, controlled intervention, information exchange, and networking. Examples of priorities in occupational health and safety in the developing world include the informal sector (informally hired and independent workers), temporary work, pesticides, accidents, dusts, carcinogens, solvents, ergonomics, women and child labor, human immunodeficiency virus/acquired immunodeficiencey syndrome (HIV/AIDS), and transfer of hazardous materials and technologies. The sustainability of occupational health and safety structures and functions in the developing countries is a primary concern. Socioethical principles emphasize local, national, mutual and global gains. Examples of collaboration are given. Pervasive problems and strategies toward their solution are highlighted.

Developed Countries↗

[Intensive care therapy of newborn infants (author's transl)].

Intensive care of newborn babies consists of immediate resuscitation during the very first minutes after birth, intensive management during the transportation and treatment at the intensive care unit. The importance of immediate resuscitation for the following therapeutic management is stressed. The modern system of correct and well-organized transport for newborn babies is also described. As to the diagnostic and therapeutic management in the intensive care unit, attention is called to the fact that it does not consist only of artificial respiration; in particular, temperature, blood glucose concentration, blood gas analysis and all vital functions must be constantly controlled. The importance of exact dosage of the administered oxygen during the intensive care of newborn babies is demonstrated. The indications, practical management and complications of artificial respiration are detailed. Finally, the good results which can be achieved in this field, with a significant reduction in mortality of artificially-respirated infants, are shown by the present investigation. Good organization, modern technical equipment and, especially, well-trained staff are indispensable foundations for the successful management of newborn infants requiring intensive care.

Austria↗

Laparoscopic surgery for pancreatic tumors, an uptake.

Laparoscopy is not universally accepted as the best approach for pancreatic tumor disease. It is considered an élite surgical approach especially because of the technical difficulties involved; and the highly trained surgeons that are required to perform these operations. In addition, long operation times and lack of reduction in length of hospital stay press for the use of the laparotomic approach instead of a laparoscopic one. Four major areas of interest have been focused on: pancreaticoduodenectomy, pancreas resection and enucleation, the increasingly important areas of diagnostic laparoscopy for staging of pancreatic cancer and laparoscopic palliation of unresectable pancreatic cancer. A review of the literature about laparoscopic management of pancreatic tumors disease has been examined: 14 laparoscopic pancreaticoduodenectomies, 93 pancreatic resections, 41 enucleations, 4 left pancreatectomies and 2 hand assisted enucleations have been described since 1994. The laparoscopic distal pancreas resection and enucleation appear to be the best treatment option for lesions located in the body and tail of the gland; conversely laparoscopy may not be indicated for lesions located in the head of the gland. The laparoscopic approach today, does not present advantages in terms of post-operative outcome and operation times than the laparotomic approach. The hand assisted approach may be helpful in difficult cases to facilitate the operation; it permits an easier and safer dissection still conserving a minimally invasive approach. Moreover, laparoscopy is also becoming the best approach for tumor staging and palliation, and many surgeons use the laparoscopy to obtain the most information with the minimal damage in a situation already compromised by a weakening disease.

Digestive System Surgical Procedures↗

[The status and outlook of the training of pathologists in the RSFSR].

Pathology service in the RSFSR suffers, at present, from the lack of pathologists: only 2393 (57.3%) of 4174 positions are occupied. Particularly difficult is the situation in Eastern Siberia and Moscow where only 47.7 and 48.6% positions, respectively, are covered. Lack of professional pathologists is aggravated by an artificial decrease of positions number as compared to real need, by the increase of proportion of persons retired or those having a preretirement age (30%), by a high percentage (over 30% of positions) of persons experiencing pathology as a second profession (65% of them do not have a sufficient knowledge and practice in pathology), by a low level of medical education in general and nonsufficient promotion of pathologists (only 39.3% pathologists have attestation categories). To solve the crisis the RSFSR Ministry of Health started in 1988/89 4-year training of pathologists at the pathology chairs of the RSFSR Medical Institutes: subinternship (1 year), internship (1 year), clinical internship (2 years). The realization of this program will result in turning out of 724 pathologists by 1994. The progress in pathologists training will require the improvement of technical basis of pathology chairs and departments and solution of certain organizational problems.

Certification↗

Real-time multi-wavelength fluorescence imaging of living cells.

We describe a new real-time fluorescence video microscope design for capturing intensified images of cells containing dual wavelength "ratio" dyes or multiple dyes. The microscope will perform real-time capture of two separate fluorescence emission images simultaneously, improving the time resolution of spatial distribution of fluorescence to video frame rates (30 frames/s or faster). Each emission wavelength is imaged simultaneously by one of two cameras, then digitized, background corrected and appropriately combined at standard video frame rates to be stored at high resolution on tape or digital video disk for further off-line analysis. Use of low noise, high sensitivity image intensifiers, coupled to CCD cameras produce stable, high contrast images using ultra low light levels with little persistence or bloom. The design has no moving parts in its optical train, which overcomes a number of technical difficulties encountered in the present filter wheel designs for multiple imaging. Coupled to compatible image processing software utilizing PC-AT computers, the new design can be built for a significantly lower cost than many presently available commercial machines. The system is ideal for ratio imaging applications; the software can calculate the ratio of fluorescence intensities pixel by pixel and provide the information to generate false-color images of the intensity data as well as other calculations based on the two images. Thus, it provides a powerful, inexpensive tool for studying the real-time kinetics of changes in living cells. Examples are presented for the kinetics of rapidly changing intracellular calcium detected by the calcium indicator probe indo-1 and the redistribution kinetics of multiple vital dyes placed in cells undergoing cell fusion.

Animals↗

Co-ordinated countermeasures of Caribbean countries against the illicit drug traffic: recent developments and prospects.

The illicit traffic in narcotic drugs and psychotropic substances presents a growing threat to the Caribbean countries and territories. The geographical location of the Caribbean subregion between the areas in South America producing illicit drugs and lucrative illicit markets in North America and Europe is an important factor contributing to an increasing involvement of the subregion in illicit drug trafficking operations. In addition, the archipelagic configuration of many of the countries and territories of the Caribbean makes it easier for traffickers to escape law enforcement action, thus providing a further stimulus to international drug trafficking. The Caribbean Governments have therefore initiated law enforcement countermeasures to combat drug trafficking and taken legal and administrative action to prevent and eradicate illicit cultivation of narcotic crops, as well as to prevent and reduce illicit demand for drugs. The Governments have also made increasing efforts to improve international and bilateral co-operation to combat drug trafficking and drug abuse. The decisive efforts of Caribbean Governments, however, are impeded, on the one hand, by the limited availability of trained professional manpower and of the technical and economic resources required to combat drug trafficking effectively, and, on the other hand, by the superior financial and technical capacity of the international drug trafficking organizations. The provision of technical and financial assistance by the international community to the countries and territories of the Caribbean is therefore needed to help overcome these constraints and to enable them to cope with the increasing drug problems in the subregion.

Cannabis↗

[Use of recorded music as a means of sensitization to empathic perception of affects in communication].

The authors elaborate on a new technical mean they are experimenting in training students to feel and test their own empathic potentialities, using lieder and songs of unknown language to the subjects. Preliminary results of a content analysis of images and impressions recorded by a group of subjects support their endeavor to evaluate the evolution of the empathic-intuitive process.

Affect↗

[Organizational aspects of the work of a centralized cytological laboratory].

An experience of organizing of activity of a centralized cytological laboratory is presented in the paper. It is based on an analysis of activity of leading cytological laboratories of the RSFSR. Certain issues of training of cytologists, laboratory assistants and technical staff on the basis of leading institutions of the country as well as problems of setting up control over reliability of cytological conclusions are discussed.

Cell Biology↗