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PubMed2006

Driving and dementia in older adults: Implementation and evaluation of a continuing education project.

PURPOSE: We aimed to develop and evaluate a multimedia workshop curriculum to educate physicians and other health professionals about (a) driving-related assessment in older adults with dementia, and (b) strategies to encourage driving retirement for impaired individuals. DESIGN AND METHODS: A curriculum developed by the Older Drivers Project of the American Medical Association was expanded for presentation by a multidisciplinary team. One pilot and seven test workshops were offered. A program evaluation method-testing knowledge, confidence, attitudes, and practice behaviors-was employed at four points in time: T1 (Time 1; pretest focusing on the previous 12 months), T2 (Time 2; same-day post-test), T3 (Time 3; post-test at 3 months), and T4 (Time 4; post-test at 12 months). RESULTS: At T1, participants (N = 147) expressed high agreement that an assessment of driving ability is an important issue in clinical dementia care, but they reported low knowledge of assessment strategies, resources, and state reporting requirements. Modest gains in knowledge and confidence were demonstrated at both T3 (n = 93) and T4 (n = 63). In addition, the frequency of driving-related practice behaviors (i.e., incorporation of driving-related questions into clinical evaluation, chart documentation, reporting of impaired drivers) had increased significantly by T3 and T4. IMPLICATIONS: The results indicate that a focused workshop curriculum, with practical and immediate applications to care, can motivate measurable changes in clinical practice. Once they are informed, health professionals can address issues of driving ability in older patients with dementia and, with the support of available resources, encourage impaired individuals to retire from driving for the safety of everyone on the road.

Aged↗
PubMed1978

Professional dietetic education in the U.S. Historical notes.

Since its founding in 1917, The American Dietetic Association has been concerned with the development and improvement of educational programs for the professional dietitian. This article traces the evolution of professional dietetic educational programs from its beginning in the early cooking schools in the nineteenth century through the development of educational standards, the requirement for training beyond the bachelor's degree, and the establishment of academic requirements. The continued importance of educating the professional dietitian is evidenced by the inclusion of academic requirements as a prerequisite to membership in the Association.

Curriculum↗
PubMed1987

Harvey A.K. Whitney lecture. Intimations on a profession: retrospect and prospect.

The evolution and development of institutional pharmacy and its pathfinders are discussed, and future directions for the profession are suggested. From the Bulletin of the American Society of Hospital Pharmacists to the American Journal of Hospital Pharmacy, hospital pharmacy literature has helped the profession evolve by providing specialized information while continuing to meet practitioners' changing needs over time. Editorials help to establish unity of purpose among members by encouraging consensus development. Other publications and programs of ASHP extend its mission into institutions nationwide. To achieve unity of purpose, the profession relies on the formal organization (ASHP and its chapters) for providing order and the informal organization (meetings) for exchanging information and providing motivation. Pharmacy "trains its own" via residency programs, whose prototypes, nonacademic internships, were designed by pathfinder preceptors like Harvey A. K. Whitney. These programs have ensured continuity in improving practice standards and a source of skilled professionals. Women have been leaders in the history and development of hospital pharmacy. The sound economic management of the Society has led to accelerated developments for institutional pharmacy. In the future, ASHP should seek to become more involved in public policy issues concerning health care in general; develop a written set of ethical standards to guide institutional practitioners; and prepare an updated history of ASHP and the hospital pharmacy movement, including an interpretation of events, or a cultural perspective. ASHP has established a strong foundation for hospital pharmacy as envisioned by the early pathfinders; young pharmacists are the pathfinders for future progress.

Ethics, Professional↗
PubMed2005

Analysis of information and communication needs in rural primary health care in developing countries.

This article presents three studies dealing with information and communication needs in rural primary health care from Peru and Nicaragua. Results show that primary health-care systems in rural areas of developing countries are very inefficient. Among the main reasons we found factors related to communication infrastructure, information sharing, and continuous training of health professionals. We conclude that telemedicine systems can improve this situation, but the lack of infrastructures, low income levels, and other conditions, impose strong limits to the introduction of new technologies. The main conclusion is that differences in needs and conditions between developing countries and industrialized ones force to use different solutions and approaches. This article presents some proposals on technology requirements and how to deal with the use of telemedicine in rural areas of developing countries. These proposals can be useful to all kind of actors (national public administrations, multilateral institutions, industry, academy, civil society, etc.) in order to promote really relevant and sustainable proposals in telemedicine for rural regions of developing countries.

Developing Countries↗
PubMedDate not supplied

Recognizing the talent within: preparing clinicians for a role in professional development.

BACKGROUND: Ongoing professional development is recognized as crucial to the psychiatric and mental health nursing profession; however, implementing effective professional development programs has proved problematic. The Centre for Psychiatric Nursing Research and Practice in Victoria, Australia, developed a clinician-trainer course to overcome some of the identified problems. METHOD: An evaluation was conducted to measure participant satisfaction with the program. RESULTS: The initial evaluation suggests the course delivery and content were considered useful and relevant to participants, although areas for improvement were identified. CONCLUSION: The model developed is potentially effective but a longitudinal evaluation is required to determine the impact of the course on the implementation of professional development in the clinical domain.

Education, Nursing, Continuing↗
PubMed1990

A joint course for general practitioner and practice nurse trainers.

An experimental multidisciplinary course for prospective general practitioner and practice nurse trainers is described. Factual knowledge and attitudes were measured before and after the course and some of the changes measured emphasized the importance of multidisciplinary training. The ideas generated by the group of nurse trainers in terms of their future professional development were identified.

Education, Medical, Continuing↗
PubMed2005

Distance delivery of nutrition education.

Questions often arise about the quality of an educational experience in a distance format. Debate exists as to whether the relatively new format of on-line education can offer an equivalent learning experience for students, and the perception remains that virtual learning is impersonal. We examined students' experience in an introductory undergraduate nutrition course that had been remodelled as an asynchronous, active-learning, student-centred model. The investigation used the framework of instructional message design, a concept based on cognitive science principles, to highlight themes in student survey and focus group data. Results indicate that a motivating and accessible quality educational experience is possible in an on-line format through a student-centred model. Such a model provides a means to offer education to a diverse and larger audience. Further investigation is needed to determine faculty professional development needs and cost-effective ways to expand the model. Such a model provides alternatives to expand delivery to encourage interest in the field, and to provide continuing education for allied professionals and the general public.

Adult↗
PubMed2003

Continuous glucose monitoring by means of the microdialysis technique: underlying fundamental aspects.

The microdialysis technique allows extraction of substances (e.g., glucose) from fluids in the human body for quantitative measurements ex vivo. The microdialysis catheter can be inserted in many different tissues; for continuous glucose monitoring it is most often implanted in the subcutaneous fat tissue in the abdominal region. Perfusion of the thin catheter with an isotonic solution without glucose leads to a diffusion of glucose available in the interstitial fluid along the concentration gradient across the semipermeable membrane into the catheter. The glucose levels in the dialysate are measured quantitatively outside the body by means of specific sensors. A number of factors have a profound impact on the amount of glucose extracted (i.e., the glucose levels in the dialysate can be considerably lower than that in the interstitial fluid). However, as long as this proportion remains constant (independent of the prevailing glucose level), the sensor signal, which is related to the glucose level in the interstitial fluid, can be calibrated to the blood glucose level by means of a conventional blood glucose measurement. The microdialysis systems that are commercially available or in clinical development allow (after a run-in phase of some hours) continuous glucose monitoring with a good reliability over several days. Insertion of the microdialysis catheters cannot be performed by the patients themselves but requires professional help. From a technological point of view the microdialysis technique is demanding; consequently the costs of continuous glucose monitoring using this approach are considerable. However, further developments probably will allow development of cheaper patient self-care systems that can be used for longer periods of time.

Biosensing Techniques↗
PubMed1998

The effects of continuing professional education on the clinical practice of nurses: a review of the literature.

In recent years, nurse education in the United Kingdom has undergone some major organisational changes, not least the move into higher education institutions. Concurrently, developments in the professionalisation of nursing through the UKCC's post registration education and practice reforms have led to nurses being required to identify their own educational needs. Having identified their own needs, nurses are then faced with a plethora of post registration education programmes which are aimed to facilitate their learning and, directly or indirectly, improve patient care. However, do these programmes positively influence nursing practice and the standard of care delivered? This paper reviews the literature regarding the effects that continuing professional education (CPE) programmes have upon the clinical practice of nurses. The review draws on papers primarily from North America and the UK and highlights the methodological approaches used to discover if and how nursing practice is influenced. The impact of CPE on nurses as individuals is detailed along with the effects of CPE on the delivery of patient care.

Clinical Competence↗
PubMedDate not supplied

Clinical staff development: a two-way solution.

This paper explains how a trust worked with a higher education institution to provide continuing education for clinical staff. The result was a staff development award that carries 60 CATS points at level 2. Evaluation shows that the award has not only helped staff in their practice but has also been cost-effective. In addition there have been benefits in terms of professional development for staff involved in running the programme.

Education, Nursing, Continuing↗
PubMed2001

Can assessment of psychosocial orientation assist continuing education program development in psychosocial oncology?

BACKGROUND: A pilot study was designed to aid in the development of a formal, interdisciplinary curriculum in psychosocial oncology for front-line health care professionals. METHOD: A 190-item questionnaire was distributed to psychosocial (PP) and non-psychosocial (NPP) oncology professionals attending a psychosocial skills workshop. A 38-item attitudinal survey of psychosocial orientation was used in an attempt to identify unperceived needs of the learners. RESULTS: Of the 150 questionnaires distributed, 104 (69%) were completed and returned. Overall scores for satisfaction with the workshop were high, and significantly higher in the PP group. No interdisciplinary difference existed in the preferred learning formats for future events, and both groups preferred interactive, experiential forums for developing skills relevant to patient management. The two groups' perceived learning needs differed. NPPs wanted to focus on skills such as communication, counseling, crisis intervention, palliative care, and coping with life-threatening illness. The attitudinal survey results demonstrated a significant difference between the psychosocial orientations of PPs and NPPs and suggested that NPPs would benefit from: 1) information to correct misconceptions about patients' psychosocial needs and experiences, 2) demonstrations of how to overcome contextual barriers to the delivery of psychosocial care. CONCLUSIONS: Front-line oncology professionals in many disciplines are interested in continuing education in psychosocial oncology. The attitudinal survey provided insight into unperceived learning needs that can help in designing future curricula. Its value as a tool to measure impact of these programs is worthy of future study.

Adult↗
PubMed1994

Office laboratory procedures, economics of practice, patient and parent education, and urinary tract infection.

This review highlights recent advances in four major areas that are relevant to office practice: office laboratory procedures, economics of practice, adolescent risk-taking behavior in terms of sexually transmitted diseases, and urinary tract infections. Who should be screened for diseases and where these screening tests should be done are addressed, keeping the practicing pediatrician in mind. Next we review current office economics, including whether professional courtesy should be continued, how our practices are going to be increasingly influenced by guidelines developed by the American Academy of Pediatrics, the Clinical Laboratory Improvement Amendments, and the new Clinton Health Plan if it survives Congress, and finally how all of these issues will affect our expected income in the years ahead. As pediatricians strive to retain adolescent patients in their practices, they will need to find appropriate ways of counseling these patients concerning risk behaviors that could result in sexually transmitted diseases or HIV infections. Should we leave the comfortable confines of our offices to participate in these counseling programs for adolescents, and are there lessons from existing successful International Health Programs that we can use? Finally, urinary tract infections (UTIs) continue to be a common cause of childhood infections with possible serious long-term sequelae. Can we do a better job of diagnosing UTIs, has improved treatment become available, and is prevention of recurrences possible? Once the diagnosis has been made, how can we best evaluate these children with UTIs for underlying urologic abnormalities? It is our hope that the practicing pediatrician will be better prepared to face these issues having read this review.

Adolescent↗
PubMed2005

Nursing experience and the care of dying patients.

PURPOSE/OBJECTIVES: To examine relationships among demographic variables and nurses attitudes toward death and caring for dying patients. DESIGN: Descriptive and correlational. SETTING: Two metropolitan hospitals in Detroit, MI. SAMPLE: 58 RNs practicing in oncology and medical/surgical nursing. The majority was female and white, with a mean age of 41 years. METHODS: Completed survey of three measurement tools: a demographic survey, Frommelt Attitudes Toward Care of the Dying (FATCOD) Scale, and Death Attitude Profile Revised (DAP-R) Scale. Of 60 surveys distributed, 58 were completed and returned. MAIN RESEARCH VARIABLES: Past experiences (level of education and death training), personal experiences (age, race, religion, and attitudes toward death), professional experiences (months or years of nursing experience and the percentage of time spent in contact with terminally ill or dying patients), and attitudes toward caring for dying patients. FINDINGS: Most respondents demonstrated a positive attitude about caring for dying patients. Nurses who reported spending a higher percentage of time in contact with terminally ill or dying patients reported more positive attitudes. No significant relationship was found between nurses attitudes toward death and nurses attitudes about caring for dying patients. Statistically significant relationships were found among certain demographic variables, DAP-R subscales, and FATCOD Scale. CONCLUSIONS: Regardless of how the nurses felt about death, providing professional and quality care to dying patients and their families was salient. IMPLICATIONS FOR NURSING: Developing continuing education programs that teach effective coping strategies to prevent death anxiety and identifying barriers that can make caring for dying patients difficult may make the journey from novice to expert nurse a gratifying and rewarding experience.

Adaptation, Psychological↗
PubMed2005

Ethnic differences in neonatal and postneonatal mortality.

OBJECTIVE: Ethnic disparities in infant mortality have been consistently documented in the United States, but these disparities are poorly understood. Although the infant mortality rate in the United States has fallen to record low rates, since 1971 the ethnic disparity between black and white infants has remained unchanged or increased. In 2001, the infant mortality rate among black infants was approximately 2.5 times higher than the rate among white and Hispanic infants. The objective of this study was to identify ethnic differences in neonatal and postneonatal mortality as well as the causes and risk factors among infants born in California. METHODS: Secondary analysis was performed of 1,277,393 singleton infants live-born to black, Latina, and white women from the California linked birth-infant death certificate from 1995 to 1997. The dependent variables were infant death (defined as an infant who died in the first year of life [death <365 days]), neonatal death (death during the first 27 days of life), and postneonatal death (death between 28 and 364 days of life). Cause-specific neonatal and postneonatal infant mortality rates (per 100,000 live births) were calculated for each ethnic group. Chi(2) and exact test statistics were used to compare the distribution of maternal and infant characteristics and cause-of-death rates by maternal ethnicity. Logistic regression analysis was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) to estimate the relationship between maternal ethnicity, maternal and infant factors, and risk of infant mortality. RESULTS: In both the neonatal and postneonatal periods, black women had higher infant mortality rates than Latina or white women for conditions originating in the perinatal period (including respiratory distress syndrome) and symptoms, signs, and ill-defined conditions (including sudden infant death syndrome). After adjusting for maternal and infant characteristics, there were no significant ethnic differences for neonatal mortality. For postneonatal mortality, black women had a higher risk (OR: 1.25; 95% CI: 1.10-1.42) and Latina women had a lower risk (OR: 0.80; 95% CI: 0.71-0.89) compared with white women after adjusting for maternal and infant factors. In analyses of all ethnic groups combined, as well as ethnic-specific analyses, the strongest predictors of neonatal and postneonatal death were infant birth weight of <2499 g and gestational age of <33 weeks. CONCLUSIONS: Causes of infant mortality and risk factors for infant mortality differed by maternal ethnicity, indicating a need to tailor prevention and education efforts, especially during the postneonatal period. To achieve national infant mortality goals, health professionals and policy makers should continue to emphasize the importance of early and continuous prenatal care and develop new strategies to reduce the incidence of low birth weight and premature infants. Ethnic-specific approaches may be needed to further reduce infant mortality rates and achieve our national goal to eliminate ethnic disparities in perinatal outcomes.

Adolescent↗
PubMed1986

Reflections on health management education.

Responses of 29 interviews summarise problems in health management and health management education and point to available options in response to these problems. Views are presented regarding accredited graduate programs and their strengths and weaknesses. Recommendations are made on various issues relating to the education of health services managers and include: revising curricula and exploring new methods of teaching health management; developing closer linkages with clinician educators and health managers; undertaking or expanding related missions of continuing professional education and multidisciplinary research and evaluation. Commentary follows in response to these recommendations from the perspectives of education and practice.

Attitude↗