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PubMed2000

Lessons learned--15 years of the WHO-NCTB: a review.

Based on expert recommendations, the World Health Organization (WHO) recommended the Neurobehavioral Core Test Battery (NCTB) in 1983 to detect neurotoxicity in world-wide populations. The NCTB consists of 7 neurobehavioral tests (Digit Symbol, Digit Span, Benton visual memory test/recognition form, Santa Ana dexterity test, Simple Reaction Time, Pursuit Aiming II, and Profile of Mood States). Research with the NCTB provides the context for the results of a mini-symposium held in 1999 to discuss the lessons learned about using the NCTB in working populations. Speakers from Africa, Asia, Europe, and North America reviewed data from 94 studies using the NCTB, including 63 from China, 13 from Korea, 11 from Poland, three from South Africa, three from the USA, and one from Ecuador. Although a consensus was not sought in the symposium, the key lessons learned that emerged from the various presentations, were: * The NCTB is effective in testing adults with 12 or more years of formal education, but can not reliably test persons with less than 9 years of education. * People from cultures very different from those in Europe and North America (eg, aboriginal and African cultures) may not be tested effectively by the NCTB, although others such as at least some Asian populations, can be. To address this problem, the construct validity of the NCTB should be established in a wide range of countries. * The POMS measures of emotion proved to be very sensitive to neurotoxic exposures in several countries, but the POMS was the NCTB test most affected by cultural differences. The Digit Symbol or the Milan modification of that test was also highly sensitive to neurotoxic exposures. * Examiner drift following training to administer the NCTB is a significant problem in technically trained Examiners. Pursuit Aiming II is very difficult to score reliably.

Adult↗
PubMedDate not supplied

Comparison of stress and coping in male and female dentists.

This study was designed to examine how female dentists withstand the pressures of dental practice in comparison to male dentists. Two-hundred thirty-eight dentists responded to a national survey that collected demographic data, information about the kinds and degree of stress experienced, coping strategies used and coping effectiveness. The greatest amount of stress experienced was attributed to interactions with patients. The business aspects of dentistry were also associated with significant amounts of stress. In general, male and female dentists' responses to stress were similar, although female dentists experienced more personal/domestic stress. The coping styles of males and females were similar in most respects, except that females were more inclined to discuss their problems. Coping strategies were seen as moderately effective by both sexes. It was suggested that dental students receive training in interpersonal skills, stress management and practice management along with technical training to better prepare them to cope with the realities of dental practice. An alternative suggestion was to address these nontechnical topics through continuing education programs designed for dentists beginning their practice.

Adaptation, Psychological↗
PubMedDate not supplied

[Education general surgery: viewpoint of the candidate surgeon].

An opinion poll about the surgical training performed among the Flemish surgeons in training showed us rather critical results. 54 of 62 assistants consider the technical training capable of improvement, 48 of 62 surgeons in training believe their is a lack of possibilities for a sound theoretical education. To improve the present day needs the following changes are suggested: the reduction of the number of training centers, the raise of the operative (and supervised) activities and more possibilities for a good theoretical education, changes more achievable in case of reduction of the overload with nonoperative tasks. The surgeons in training should have their say in the reorganisation of the training in surgery.

Adult↗
PubMedDate not supplied

[Midwives' perception of reproductive risk factors].

Midwives in rural areas of the State of Morelos are one of the most important resources used by rural women for health care of pregnancy, delivery and the puerperium. This work was aimed at identifying midwives perceptions of pregnant women's risk factors, in order to include this knowledge in reproductive health programs which articulate institutional and traditional health systems. We applied a questionnaire to all midwives in the Municipalities of Ocuituco, yecapixtla and Zacualpan, Morelos (n = 35). Four key informants were selected and interviewed. These instruments enabled us to measure variability in perception of risk factors. Knowledge of risk factors is defective among midwives. Previous training made a big difference. Sixty three per cent of midwives who attended training courses are better qualified from an academic medicine point of view. Only 28.7 per cent of non-trained midwives (43% for both groups), indicating that sociocultural aspects prevail over technical training in midwives perceptions of reproductive risk factors.

Adult↗
PubMed1997

Physiological analysis to quantify training load in badminton.

OBJECTIVE: To estimate the training load of specific on court training regimens based on the magnitude of variation of heart rate-lactate response during specific training and to determine the magnitude of variation of biochemical parameters (urea, uric acid, and creatine phosphokinase (CPK)) 12 hours after the specific training programme so as to assess training stress. METHODS: The study was conducted on six national male badminton players. Maximum oxygen consumption (VO2), ventilation (VE), heart rate, and respiratory quotient were measured by a protocol of graded treadmill exercise. Twelve training sessions and 35 singles matches were analysed. Heart rate and blood lactate were monitored during technical training routines and match play. Fasting blood samples collected on two occasions--that is, during off season and 12 hours after specific training--were analysed for serum urea, uric acid, and CPK. RESULTS: Analysis of the on court training regimens showed lactate values of 8-10.5 mmol/l in different phases. The percentage of maximum heart rate ranged from 82% to 100%. Urea, uric acid, and CPK activity showed significant changes from (mean (SD)) 4.93 (0.75) mmol/l to 5.49 (0.84) mmol/l, 0.23 (0.04) to 0.33 (0.06) mmol/l, and 312 (211.8) to 363 (216.4) IU/l respectively. CONCLUSION: Maximum lactate reported in the literature ranges from 3-6 mmol/l. Comparatively high lactate values and high percentage of maximum heart rate found in on court training show a considerable stress on muscular and cardiovascular system. The training load needs appropriate monitoring to avoid over-training. Workouts that are too intensive may interfere with coordination, a factor that is important in sports requiring highly technical skill such as badminton.

Adult↗
PubMed1997

Research in neurosurgical training: clinical reviews and trials.

A well prepared intellectual basis is at least as important as a sound technical training for a safe, successful Neurosurgeon. Correct decisions depend as much upon clinical information and experience as upon biomedical theory and an appreciation of the science of real life clinical research is more valuable than experience in laboratory techniques. Understanding of what makes up a good study, providing a reliable basis for clinical practice, is best gained through the training conducting personal research. The training must provide an enquiring, motivating, intellectual environment, as well as disciplined organisation and support. Successful clinical research is difficult and demanding but is one of the clearest testimonies to the quality of both trainer and trainees.

Clinical Trials as Topic↗
PubMed1997

Use of the new media for medical education.

The use of an advanced communication network for education has been an integral part of practice at the Mayo Clinic since 1986. The network has been used for patient care, research coordination and administrative support, as well as for educational programming. In 1994, 2655 hours were broadcast by satellite. There were 42,292 participants, representing a total of 47,364 contact hours. Over half of this activity was educational. In using the satellite system, a number of background support systems have been found to be essential to effective communication. First, highly trained technical staff are required to support the communication system. Second, presenters require formal training in adapting audiovisual materials, such as slides and transparencies, to broadcast media. Third, as use of the system has grown, scheduling and prioritizing among the many users has become an increasingly time-consuming and challenging task.

Computer Communication Networks↗
PubMed2006

Teaching technical skills to surgical residents: a survey of empirical research.

We review a series of empirical studies on the use of simulators and bench models in training technical skills and subsequent retention of those skills. We discuss recent research on the transfer of training from bench models and simulators to the clinical setting and provide a theoretical structure to organize the findings. The transfer of training from inanimate bench models and simulators to live patients has recently been demonstrated in a number of areas. The effectiveness of this training is enhanced if focus is placed on the operative, or process-oriented, aspects of the procedure, with suspension of disbelief regarding the physical structure of the training platform. The retention of trained skills is an area of research only beginning to evolve, with recent results suggesting that effective retention can be demonstrated if training is tightly focused and involves an entire procedure. An emerging area of research involves the use of simulators as assessment instruments for high-stakes testing, and recent results involving simulated trauma management support this novel application. Based on these findings, we encourage the use of a wide variety of high- and low-fidelity platforms, with emphasis on training procedural knowledge involving an entire procedure.

Clinical Competence↗
PubMed2006

Impact of carotid artery stent trials on the education and training of vascular surgeons.

Clinical trials directed at evaluating the efficacy and safety of carotid artery stenting (CAS) have accelerated development of didactic and technical training programs for both newly trained and experienced vascular surgeons. This report reviews the current status of guidelines for CAS and the evolution of related educational programs necessary to impart the clinical, cognitive, and technical skills required for the optimal care of patients with this new technology.

Carotid Arteries↗
PubMed2003

Tribal benefits counseling program: expanding health care opportunities for tribal members.

American Indian tribal clinics hired benefits counselors to increase the number of patients with public and private insurance coverage, expand the range of health care options available to tribal members, and increase third-party revenues for tribal clinics. Benefits counselors received intensive training, technical assistance, and evaluation over a 2-year period. Six tribal clinics participated in the full training program, including follow-up, process evaluation, and outcomes reporting. Participating tribal sites experienced a 78% increase in Medicaid enrollment among pregnant women and children, compared with a 26% enrollment increase statewide during the same period. Trained benefits counselors on-site at tribal clinics can substantially increase third-party insurance coverage among patients.

Counseling↗
PubMed1998

System approach for a multicenter, multilingual international telemedicine conference.

Chinese Telemed 96, a three way international telemedicine conference was successfully held in November 1996. Over 1,000 physicians, allied health professional and medical students participated in this conference in Beijing, Hong Kong and London. This program demonstrated that the quality of telecommunication technology was suitable for the Chinese University of Hong Kong, Faculty of Medicine to use it in facilitating medical consultations and sharing expertise among widely dispersed colleagues. The consensus of Hong Kong participants was that the audiovideo and telecommunication technology used in this conference were adequate. In order to improve overall quality, however, a better co-ordination of the technical support across sites is required. Other felt that the conference suffers from the shortage of highly trained technical staff required to support the communication system. However, following the total evaluation of this conference, it is concluded that while technical support, site and location are important factors in a good telemedicine conference, a well run telemedicine conference is more dependent on a sound planning process and its execution.

Congresses as Topic↗
PubMed1997

Enumeration of CD34+ hematopoietic progenitor cells in peripheral blood and leukapheresis products by microvolume fluorimetry: a comparison with flow cytometry.

There is increasing interest in both standardization and simplification of methods for enumeration of CD34+ hematopoietic progenitor cells (HPC) to facilitate cellular therapies and to improve interinstitutional comparison of clinical and laboratory results. We evaluated a novel method for CD34+ cell enumeration based on microvolume fluorimetry (MVF) compared with our laboratory's routine flow cytometric method on samples of peripheral blood and leukapheresis products. The MVF method is semiautomated and uses a 633-nm light from a helium-neon laser to scan fluorochrome-labeled cells held in stasis in a capillary known volume. The performance of the MVF assay for enumeration of CD34+ cells was found to be comparable to our routine flow cytometric assay in linearity and accuracy in the range of 5-1500 cells per microliter. Precision of MVF for replicate assays on the same instrument was demonstrated by coefficient of variation (CV) values of 8.4% at a CD34+ cell concentration of 284/microliters for a sample volume of 0.8 microliters, and 15.7% at 12/microliters for a sample volume of 3.2 microliter. Precision among three different instruments was demonstrated, using sample volumes of 1.6 microliters, by CV values of 44% at 6 cells/microliters and 4.6% at 733 cells/microliters. In a field sample evaluation, precision of the entire assay system for paired measurements on 0.8-microliter sample volumes was demonstrated by CV values of 50%, 31%, and 15% for peripheral blood samples with concentrations of 0-10, 10-20, and 20-100 CD34+ cells/microliters, respectively, and 6.3%, 8.1% and 6.5% for leukapheresis samples with concentrations of 0-100, 100-1,000, and 1,000-2,500 CD34+ cells/microliters, respectively. The MVF assay was easy to perform, required minimal technical training time, and had a turnaround time of 40 min, of which less than 10 min was actual technical time. These observations suggest that the MVF method for CD34+ cell enumeration may prove useful to clinical laboratories providing support for HPC collection, processing, and transplantation services that require relatively simple, rapid assays for product quality control or to guide real-time clinical decisions.

Antigens, CD34↗
PubMed2003

Facing the terror of nuclear terrorism.

As America prepares for homeland security and the response to terrorism, more occupational safety professionals may find themselves called upon to deal with terror in their own neighborhoods. While thousands of safety professionals are well trained technically to deal with many types of terrorism, they may not be well prepared to deal with the greater challenge, namely the terror of terrorism. Dealing with terror requires hearing and responding to people's feelings before providing technical answers. For safety professionals to be most effective in dealing with terrorism, they can benefit from more training on how to deal with terror.

Fear↗
PubMedDate not supplied

An assessment of paramedic performance during invasive airway management.

OBJECTIVE: To assess the performance of paramedics, in a newly-initiated prehospital program, during invasive airway management. METHODS: An audit of paramedic call reports for a 12-month period from January to December 1997 was performed. Call reports that documented invasive airway management were retrieved and relevant data were extracted using a preformulated data-entry form. RESULTS: Paramedics attempted tracheal intubation in 453 patients and were successful in 408 (90.1%); 331 of the patients were in cardiopulmonary arrest with vital signs absent (VSA), 101 had medical emergencies, and 21 had trauma-related problems. In the VSA cohort, the tracheas of 96% of the patients were intubated successfully; 80.1% on the first attempt, 10.6% on the second, 4.5% on the third, and 0.9% after more than three attempts. In the medical cohort, the tracheas of 74.3% of the patients were intubated; 60.4% on the first attempt, 11.9% on the second, and 2.9% on the third. In the trauma cohort, 71.4% of the intubations were successful; 66.6% on the first attempt, 26.6% on the second, and 6.6% on the third. There was a difference (p < 0.001) in the incidence of successful intubations comparing the VSA cohort with the medical/trauma cohorts. There was also a difference (p < 0.001) between the success rate for nasal intubations (43 of 68, 63% of patients successfully intubated) and that for oral intubation (365 of 385, 94% of patients). CONCLUSION: This study demonstrated a difference in the paramedics' success rates for tracheal intubation in VSA patients compared with those with preserved airway reflexes and a lower success rate for nasal vs oral tracheal intubation. These differences may be due to inadequate training, technical difficulties experienced in the field, or lack of sufficient exposure to medical/trauma scenarios to gain management experience. Future training to address these issues, both in the initial training phase and in the continuing education program, may be beneficial in improving performance.

Emergency Medical Services↗
PubMed2004

Identifying and responding to technical assistance and training needs in tobacco prevention and control.

The Master Settlement Agreement generated expectations that significant, long-term funding would be available to the 46 participating states in reparation for the health costs incurred by tobacco use. Facing intense pressure to use anticipated funds for effective programming, states and national organizations considered how to supply the technical assistance and training at the state and local levels. This article reviews assessments by the American Legacy Foundation, the Tobacco Technical Assistance Consortium, and selected states of the current needs for support, technical assistance, and training in tobacco prevention and control. Key findings indicated the need for information, information exchange, mentoring, and training targeted to new staff, with advanced skill sets for experienced staff. As future funding is uncertain, all these organizations are exploring innovative ways to maintain infrastructure and programming at the state and local levels. Training and technical assistance can be the solution to sustaining impetus in the movement.

Humans↗
PubMed2000

The training of pediatric residents in the care of acutely ill and injured children.

OBJECTIVES: To describe the current educational experience of pediatric residents in pediatric emergency care, to identify areas of variability between residency programs, and to distinguish areas in need of further improvement. DESIGN: A 63-item survey mailed to all accredited pediatric residency training program directors in the United States and Puerto Rico. SETTING AND PARTICIPANTS: Pediatric residency programs and their directors. MAIN OUTCOME MEASURES: Primary training settings, required and elective rotations related to the care of the acutely ill and injured child, supervision of care, procedural and technical training, and didactic curriculum in pediatric emergency medicine (PEM). RESULTS: One hundred fifty-three (72%) of 213 residency programs responded. One hundred nine (71%) were based at general or university hospitals, the remaining 44 (29%) were based at freestanding children's hospitals. Residents most commonly saw patients in pediatric emergency departments (54%), followed by acute care clinics (21%), general emergency departments (21%), and urgent care clinics (5%). The mean number of weeks of PEM training required was 11, but varied widely from 0 to 36 weeks. Forty programs (27%) required their residents to spend 4 or fewer weeks rotating in an emergency department setting. The best predictor of the number of weeks spent in emergency medicine was residency program size, with small programs requiring fewer weeks (7 weeks for small [1-8 postgraduate year 1 residents] vs 13 for medium [9-17 postgraduate year 1 residents] vs 15 for large [> or =18 postgraduate year 1 residents]). Pediatric surgery (18%), orthopedic (8%), anesthesia (6%), and toxicology (4%) rotations were rarely required. Ninety-two percent of the programs had 24-hour on-site attending physician coverage of the emergency department. Supervising physicians varied widely in their training and included PEM attendings and fellows, general emergency medicine attendings, and general pediatric attendings. Small programs were less likely to have PEM coverage (57% at small vs 95% at large) and more likely to have general emergency medicine coverage (79% at small vs 29% at large). Reported opportunities to perform procedures were uniformly high and did not differ by program size or affiliated fellowship. Residency program directors were uniformly confident in their residents' training in medical resuscitation, critical care, emergency care, airway management, and minor trauma. Thirty-seven percent of all respondents were not confident in their residents' training in major trauma. Most programs reported that they had a didactic PEM curriculum (77%), although the number of hours devoted to the lectures varied substantially. CONCLUSIONS: Wide variability exists in the amount of time devoted to emergency medicine within pediatric residency training curricula and in the training background of attendings used to supervise patient care and resident education. Nevertheless, pediatric residency training programs directors feel confident in their residents training in most topics related to PEM. Residents' training in major trauma resuscitation was the most frequently cited deficiency.

Acute Disease↗
PubMed2004

The impact of training on outcomes in primary vascular access surgery.

BACKGROUND: There is evidence that the outcome of arteriovenous fistula surgery is dependent on the surgeon performing the operation. Vascular access surgery provides excellent technical training for surgical trainees. The effect of surgical trainees on the outcome of fistulas was evaluated. METHODS: The grade of the main operator for all first attempted (primary) upper limb arteriovenous fistulas, between February 1998 and August 2001, was identified. Median follow-up was 18.0 months (IQR, 6.5-30.1 months). Successful use of fistula for dialysis, fistula patency and survival were assessed. RESULTS: 441 primary fistulas were formed in the study period. Median age was 67.5 years (IQR, 54.0-75.2 years). 71% of all fistulas were formed at the wrist. Trainees performed 31.1% of all operations. The two groups (trainees and consultants) were well matched for age, sex, diabetes, and fistula type. Only 70.5% of patients proceeded to long-term haemodialysis. There were no significant differences in the successful use of AVF for dialysis or patency rates between the two groups. One and two year fistula survival in this group was 87.7% and 78.3% for trainees and 80.8% and 71.1% for consultants (P = 0.288 log rank). CONCLUSIONS: Surgical trainees can perform primary AVF surgery without significantly reducing fistula outcomes. Vascular access surgery can be utilised as a training operation.

Aged↗
PubMed2003

Microsurgery simulators in virtual reality: review.

Surgical training is undergoing a rapid transformation, which has been influenced by advances in computer modeling. Increased pressure to reduce the use of animals in technical training has led to a new approach in teaching microsurgery. This new technology may prove to be a cost-effective, portable, and nonhazardous way forward in microsurgical training. This paper reviews the current state of available technological models used in microsurgical training. In doing so, we review articles from the latest journals and authenticated Internet websites to compare and contrast these various methods. Finally, we look at the specific technique that has potential impact on the future modeling of microsurgical techniques.

Computer Simulation↗