Medical schools: are we paying for education or for technical training?
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Geographical focus. Proteomics initiatives in Spain: ProteoRed.
The Spanish National Network of Proteomic Facilities--ProteoRed has been created as an initiative for the coordination, integration and development of the proteomics facilities and laboratories distributed throughout Spain. ProteoRed's main objective is to give support to the scientific community allowing them wide access to emerging proteomics technologies and thus encouraging the science of proteomics. In addition, standardization of protocols and robustness of workflows are addressed by multi-centric laboratory activities. Educational, training and dissemination issues are part of the core activities of ProteoRed. To reach these objectives, specific activities have been developed through six working groups (WG1-WG6) covering functional, technical, educational and scientific aspects of proteomics.
Computational Biology↗
[Continuing evaluation of health educational activities in Aarau and Nyon].
In view of the numerous and diverse health-education interventions within the NRP 1A, a comparably diverse set of evaluation instruments had to be developed. The continuing evaluation of health-education technics is a complex and resource-consuming process. However, it has the advantage to deliver continuously the data base for the optimization of the different activities. The two main aspects of the continuing health-education evaluation system within the NRP 1A are the statistical documentation of all participating individuals and the measurement of the effects of mass-media campaigns.
Cardiovascular Diseases↗
Humanistic and social education for physicians: the experience of the Colombian School of Medicine.
Medical education at the Colombian School of Medicine has undergone a reconceptualization and reorganization so as to encompasses three fundamental elements of medical practice: 1) development of general abilities and standards necessarky for appropriate professional medical practice; 2) technical education which makes it possible to utilize the bases that science and technology have provided for the development and application of knowledge, and in turn, to expand this base through research and development; and 3) humanistic education to guide students into ethical professional practice.
Colombia↗
Humanistic and social education for physicians: the experience of the Colombian School of Medicine.
Medical education at the Colombian School of Medicine has undergone a reconceptualization and reorganization so as to encompasses three fundamental elements of medical practice: 1) development of general abilities and standards necessary for appropriate professional medical practice; 2) technical education which makes it possible to utilize the bases that science and technology have provided for the development and application of knowledge, and in turn, to expand this base through research and development; and 3) humanistic education to guide students into ethical professional practice.
Colombia↗
The positive force of vocational education: transition outcomes for youth with learning disabilities.
Successful transitions to postsecondary settings are associated with such adult outcomes as continuing education, independent living, and employment. The purpose of this article is to present research that supports the use of vocational education programs to improve the adult outcomes of students with learning disabilities as they transition to employment. The literature review focuses on four major topics: (a) data from follow-up and follow-along studies illustrating the relationship between vocational-technical education and adult outcomes; (b) recent program trends in vocational education; (c) current practices in vocational education regarding placement and access, instructional and setting demands, and teacher attitudes and preparation; and (d) speculations about the effects of school reform and pending legislation.
Adolescent↗
Improving adequacy of hemodialysis in Northern California ESRD patients: a final project report. Provider Participants and Medical Review Board of the TransPacific Renal Network.
The National Core Indicators Project, initiated in 1994, has brought progressive changes in adequacy of dialysis for end-stage renal disease (ESRD) patients in the TransPacific Renal Network and across the United States. The 1998 Core Indicator Project showed each Network's standing for percentage of patients with urea reduction ratio (URR) > or = 0.65 and average URR. The TransPacific Renal Network ranked 12(th) among the 18 Networks for this adequacy measure. The goals of this project were to improve the Network standing in the United States for the percent of patients with URR > or = 0.65, eliminate or reduce the barriers to achieving adequate dialysis, and evaluate URR versus KT/V data and the variances occurring with these measures. In January 1999, data were collected from all 113 Northern California hemodialysis facilities for quarter 4, 1998, to evaluate adequacy. Each facility provided patient population (N) for KT/V and URR samples, facility averages for KT/V and URR, number of patients with KT/V > or = 1.2 and URR > or = 0.65, and data on post-blood-urea-nitrogen (BUN) sampling methods. A random selection of 10% (12) providers with data below the US and Network standards was selected for an intensive assessment. Using baseline measurements, on-site data were collected from a random selection of the patient population. Chart data were reviewed, analyzed, and discussed in an exit interview with the facility management. On-site visits were performed in July/June 1999. The primary focus included adequacy data and process of care that affect adequacy outcomes, concurrent review of patients receiving treatment at the time of the site visit, and general medical record review. In Phase I, only 12 facilities showed an average URR below 0.65. All facilities reported an average KT/V greater than the DOQI target of 1.2. Forty-two facilities had their percentage of patients with a URR below the national benchmark; only 18 facilities had their percentage of patients with a KT/V below the national benchmark. Only 9% (n = 8) of the 113 providers had a variance in post-BUN sampling methodologies that could be related to the clinical measure of adequacy. In Phase II, a random selection of 12 providers with data below US and Network standards was made for an intensive assessment. A total of 217 patient records were reviewed from a population of 1,027. In addition to comparison of baseline data, each facility was assessed for barriers to achieving adequacy outcomes. The number of problems was extensive and specific to each facility; however, a common reoccurring theme in the majority of events was the lack of supporting documentation for changes to the plan of care when variances occur. The most common occurrences were incorrect blood flow and dialysate flow with no supporting documentation on record for the prescription not being met. In Phase III, Network interventions for facilities not meeting US and Network standards for adequacy as measured by URR and KT/V included required quarterly reporting on their facility-specific quality improvement programs for adequacy. In addition the 12 facilities that participated in the intensive assessment had additional interventions that included an educational "tool box" focused on documentation, legal implications of charting, and general medical records management, and an educational program to review information to be shared with facility staff. All on-site facilities reported ongoing quality improvement programs. In some facilities they did provide a focus on processes and not only a measurement of an indicator. All facilities reported a team concept of some type used in their program. Although there were similarities in the facilities, each facility presented with a unique combination of barriers. In addition to a large patient-to-RN ratio, the lack of technical education for the unlicensed assistive personnel on processes and outcomes appears to play a significant role in the achievement of
Ambulatory Care Facilities↗
[Occupational risks among public safety and security forces].
The present paper tries to identify the occupational risk factors (physical, chemical, biological, psychological), variable depending on jobs and tasks, to which the heterogeneous public safety/security workers are exposed. The fight against criminality and public order maintenance imply (sometimes fatal) traumatic risks, and expose to psychophysical and sensorial tiring, unfavourable macro- and microclimatic conditions, the risk of baropathy (air navigation, underwater activities), noise (generated by firearms and several other sources), vibrations and shakings (automatic weapons, transport vehicles), the risk of electric injury, ionizing (X and gamma rays) and non-inonizing (ultraviolet rays, microwaves and radiofrequencies, electromagnetic fields) radiations. Chemical hazards include carbon monoxide and other combustion products (fires, urban traffic), substances released in chemical accidents, tear gases, lead (firing grounds, metal works, environmental pollution), solvents, lubrificants and cutting oils (mechanic repair and maintenance), laboratory materials and reagents, irritant and/or sensitizing agents contained in gloves. The main biological risks are tetanus, blood-borne diseases (viral hepatitis, AIDS), aerogenous diseases (e.g., tuberculosis, Legionnaire's disease, epidemic cerebrospinal meningitis), dog- or horse-transmitted zoonosis. Finally, emotional, psychosomatic and behavioural stress-related disorders (e.g., burn-out syndrome, post-traumatic stress disorder) are typically frequent. The presence of numerous and diversified hazards among public safety/security forces imposes the adoption of occupational medicine measures, including risk assessment, health education, technical and environmental prevention, personal protective devices, sanitary surveillance and biological monitoring, clinical interventions (diagnosis, therapy and rehabilitation of occupational accidents and illnesses), prompt medico-legal evaluation of occupational-related compensation claims.
Burnout, Professional↗
Distance learning in toxicology: Australia's RMIT program.
RMIT University was the first to offer a comprehensive Masters of Toxicology in Australasia 19 years ago. In 2001 the program was transformed into two stages, leading to a Graduate Diploma and Master of Applied Science in Toxicology. Now, these programs are fully online and suitable for graduates living and working anywhere in the world. The modular distance-learning courses are specifically designed to equip students with essential skills for entering fields such as chemical and drug evaluation; risk assessment of chemicals in the workplace; environmental and food toxicology. RMIT's online course delivery system has made it possible to deliver the toxicology programs, both nationally and internationally. The learning material and interactive activities (tests and quizzes, discussion boards, chat sessions) use Blackboard and WebBoard, each with a different educational function. Students log in to a Learning Hub to access their courses. The Learning Hub enables students to extend their learning beyond the classroom to the home, workplace, library and any other location with Internet access. The teaching staff log in to the Learning Hub to maintain and administer the online programs and courses which they have developed and/or which they teach. The Learning Hub is also a communication tool for students and staff, providing access to email, a diary and announcements. The early experience of delivering a full toxicology program online is very positive. However this mode of teaching continues to present many interesting technical, educational and cultural challenges, including: the design and presentation of the material; copyright issues; internationalization of content; interactive participation; and the assessment procedures.
Australia↗
[Training of surgeons in laparoscopic surgery of the digestive system. Experience in 1,818 interventions without accidents and mortality].
UNLABELLED: Since the beginning or laparoscopic surgery on University of Sao Paulo Medical School Clinics Hospital, the Digestive Surgery Division established an educational program for surgeons of the alimentary tract. PURPOSE: The course structure includes the information on medical school, extension in laparoscopic surgery league, and surgical formation during the residence, mainly in the fourth year, with a three months period in the Laparoscopic Surgery Unit. METHOD: This model of surgical formation is certainly responsible for the excellent results obtained. RESULTS: An example is the performing of 1818 cholecystectomies in the Laparoscopic Surgery Unit from 1990 till 1998, with 0.9% convertion, and no mortality. The absence of operative accidents or complications give support to the orientation assumed in our Division. CONCLUSION: In a university hospital there is the necessity of professional formation in a well structured program, with humanistic and technical education, in a large period of rotation, but with a solid information and practical structure.
Cholecystectomy, Laparoscopic↗
Project planning, training, measurement and sustainment: the successful implementation of voice recognition.
Computerized voice recognition systems (VR) can reduce costs and enhance service. The capital outlay required for conversion to a VR system is significant; therefore, it is incumbent on radiology departments to provide cost and service justifications to administrators. Massachusetts General Hospital (MGH) in Boston implemented VR over a two-year period and achieved annual savings of $530,000 and a 50% decrease in report throughput. Those accomplishments required solid planning and implementation strategies, training and sustainment programs. This article walks through the process, step by step, in the hope of providing a tool set for future implementations. Because VR has dramatic implications for workflow, a solid operational plan is needed when assessing vendors and planning for implementation. The goals for implementation should be to minimize operational disruptions and capitalize on efficiencies of the technology. Senior leadership--the department chair or vice-chair--must select the goals to be accomplished and oversee, manage and direct the VR initiative. The importance of this point cannot be overstated, since implementation will require behavior changes from radiologists and others who may not perceive any personal benefits. Training is the pivotal factor affecting the success of voice recognition, and practice is the only way for radiologists to enhance their skills. Through practice, radiologists will discover shortcuts, and their speed and comfort will improve. Measurement and data analysis are critical to changing and improving the voice recognition application and are vital to decision-making. Some of the issues about which valuable date can be collected are technical and educational problems, VR penetration, report turnaround time and annual cost savings. Sustained effort is indispensable to the maintenance of voice recognition. Finally, all efforts made and gains achieved may prove to be futile without ongoing sustainment of the system through retraining, education and technical support.
Certification↗
Regulation and its role in the prevention of building-associated illness.
Many groups have as their common goal the maintenance of acceptable indoor air quality, which protects occupants from adverse health effects and discomfort, but no one group possesses the interest or expertise to deal with all of the IAQ issues. Nonetheless, conclusions can be made regarding available alternatives to mitigate indoor air quality problems, including building-associated illness. It has been suggested that congressional action is needed in three areas related to BAI and IAQ: Recognition that controlling outdoor air only--even if "health based"--will not result in substantial improvement of public health; Definition of responsibilities for achieving healthful indoor environments; and Resolution of jurisdictional disputes between various federal agencies. Through their studies of buildings whose occupants complained of building-associated illness, NIOSH and others have concluded that inadequate supply and distribution of outdoor air to indoor spaces are the most common causes of SBS. Nonetheless, there are no reports of follow-up studies which confirm that the recommended ventilation upgrades actually solved the IAQ problems. Other reports indicate that maintenance, energy management, and air distribution are as important as ventilation rate. Corrective action, therefore, should include these issues. Systematic research directed toward providing cost-effective and innovative solutions should be the driving force. Rather than regulation, governments should assist in funding the necessary research, providing educational, technical and legal assistance, and developing policy options directed at reducing indoor air pollutants. In those cases where the specific causes of IAQ problems can be identified, remedial actions should be immediately implemented utilizing available technology. It has been suggested that "sick buildings" resulted from too much emphasis on efficency and safety and not enough on occupant health and well-being. Because health has been defined as "a state of complete physical, mental and social well-being not merely the absence of disease or infirmity," greater emphasis should be given to the concept of control and maintenance of healthy indoor environments (i.e., "healthy buildings") through utilization of quality assurance measures. Also, human response, system performance, and service factors should be utilized to assure an acceptable building performance. Finally, building designers, contractors, owners, managers, and operators must be knowledgeable regarding indoor air quality problems and their consequences and work together to build and maintain healthy buildings. This includes developing training, education, monitoring, and preventive maintenance programs to assure accountability for the proper management of the building systems. The certification (or licensing) of those responsible for providing indoor air quality has been suggested.
Air Pollutants, Occupational↗
[Delineation of the professional role of health education specialists: a technical proposal].
The responsibilities, competencies and subcompetencies of the Health Education Specialists of the State Health Department of S. Paulo are assessed in this study with a view to verifying the agreement, or otherwise, between the proposals for the technical activity of these health professionals in Brazil and in the United States. With this end in view the document entitled "A Framework for the Development of Competency-based Curricula for Entry--level Health Education" was utilized as the basis for the questions included in the questionnaires submitted to health educators. The results describe the degree of importance attributed to the technical responsibilities and the frequency with which these are performed in the service network of the State Health Department of S. Paulo, Brazil.
Brazil↗
A microcomputer system for clinical signal analysis of vestibular laboratory.
A vestibular laboratory system was implemented for clinical testing and medical examination of patients with balance disorders. Programs for analysis of postural control and eye movements were made for a microcomputer. The microcomputer system can be used by a nurse without technical education. The system has now been used for two years at the laboratory.
Eye Movements↗
Standard setting for outpatient gynaecology procedures: a multidisciplinary framework for implementation.
This chapter describes the changing cultural background of health care from which any service is delivered. In particular, the authors hope to outline cultural, educational, technical and environmental changes that have been used as opportunities to develop a quality-assessed outpatient hysteroscopic service. Examined within the chapter will be the roles and limitations of evaluation and audit, research and the multidisciplinary team. The importance of process, relationships and collaborative working within organizations will be explored, and outpatient hysteroscopy will be used as a working example of how these inform a model of practice development.
Ambulatory Surgical Procedures↗
Laparoscopy for renal cell carcinoma: diffusion versus regionalization?
PURPOSE: Recognizing the emergence of laparoscopy as a standard of care for surgical treatment in many patients with organ confined renal cell carcinoma, we explored the diffusion of this technology by examining temporal trends in the nationwide use of laparoscopic total and partial nephrectomy in patients with renal cell carcinoma. MATERIALS AND METHODS: Data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample were abstracted for 1991 through 2003. International Classification of Diseases-Ninth Revision, Clinical Modification 9 codes were used to identify patients undergoing open and laparoscopic total and partial nephrectomy for renal cell carcinoma. Using hospital sampling weights we calculated annual incidence rates for open and laparoscopic nephrectomy, thereby estimating the diffusion of laparoscopy. Bivariate and multivariate analyses were used to identify patient and hospital characteristics associated with the more frequent use of laparoscopic techniques. RESULTS: Data on 63,812 patients were abstracted from the Nationwide Inpatient Sample, yielding a weighted national estimate of 323,979 who underwent laparoscopic (4.9%) or open (95.1%) nephrectomy (total or partial) for renal cell carcinoma between 1991 and 2003. Although it is still infrequent, the use of laparoscopy has increased steadily since 1998 with a utilization peak in 2003 of 1.7 laparoscopic nephrectomies per 100,000 American population, representing 16% of all total and partial nephrectomies for renal cell carcinoma in 2003. Treatment year, overall hospital nephrectomy volume and teaching hospital status were the most robust determinants of increased laparoscopic use (each p <0.001). CONCLUSIONS: Although its use has increased progressively in the last decade, the dissemination of laparoscopy for renal cell carcinoma has been generally slow and limited in scope. The next step in this body of work is to identify specific technical, educational and policy interventions that will influence the diffusion of this alternative standard of care.
Carcinoma, Renal Cell↗
Variables that underlie cost efficacy of prenatal screening.
As genetic research and technology continues to expand, carrier testing for an increasing number of single gene disorders is becoming available. Tay-Sachs disease and cystic fibrosis are two common recessive conditions with large-scale health implications. Tay-Sachs disease was the first genetic disorder for which community-based screening efforts were utilized and has provided a foundation for the development of other screening programs. Cystic fibrosis testing, on the other hand, has additional complexities and the implementation of population-based screening has been under debate. The many issues (technical, educational, social, psychological and economical) which must be considered as preconceptional and prenatal genetic screening is incorporated into clinical practice are discussed here in the context of Tay-Sachs disease and cystic fibrosis.
Cost-Benefit Analysis↗
Medication use during the perinatal period.
OBJECTIVE: To briefly describe the drug therapy administered during the perinatal period of pregnancy for common maternal and fetal complications, and to identify those agents that should not be used for these conditions. DATA SOURCES: References were obtained from an ongoing literature search of peer-reviewed obstetric and gynecologic journals and other selected medical and pharmacy journals available in the English language. Primary search vehicle was a weekly review of the tables of contents of nearly 1,300 medical journals provided by Reference Update (Institute of Scientific Information, Philadelphia). MEDLINE searches were also conducted using key terms for each subtopic. STUDY SELECTION: Specific references were selected for each topic based on the adequacy of their study design, patient population, and a recent publication date. Reviews were used if a large number of primary references would have been required to adequately describe the topic. DATA EXTRACTION: Most references reflected the current opinions expressed in the Educational (Technical) Bulletin and Committee Opinion series published by the American College of Obstetricians and Gynecologists. Recent, well-conducted studies that arrived at different conclusions were also included. DATA SYNTHESIS: Data obtained from each reference reflected the conclusions of the authors based on their research or an analysis of the research on others on the appropriate use of the drug(s) for the specific condition being treated. CONCLUSION: Drug therapy during the perinatal period is frequently required and can be beneficial for the mother, fetus, and newborn. Many complications previously associated with severe morbidity and mortality, such as infections, premature rupture of membranes, preterm labor, hypertension, maternal pain during labor, and postpartum hemorrhage, are now controlled with appropriate pharmacologic therapy. All health professionals who provide services to pregnant women should be knowledgeable in this drug therapy.
Adult↗