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PubMed2005

Nutrition knowledge and practices, and consumption of vitamin A--rich plants by rural Nepali participants and nonparticipants in a kitchen-garden program.

Food-based nutrition interventions, including kitchen gardens and nutrition education, offer a potentially sustainable approach to reducing multiple nutritional deficiencies, but they have been poorly evaluated in developing countries. In a poor region of the terai (the flat, subtropical agricultural region that borders on India) in rural Nepal, we developed and evaluated the impact of a nutrition program added to the Market Access for Rural Development (MARD) Project. The primary objective of the MARD Project was to augment household income by increasing the production of high-economic-value crops. The objective of the nutrition program was to increase vitamin A and iron intakes by promoting kitchen gardens (training, technical assistance, and seed distribution) and nutrition education. One-third of the kitchen-garden program participants also attended nutrition education or agricultural training sessions that were part of the MARD Project. The program was evaluated after 36 months by a cross-sectional nutrition survey in 430 MARD households with kitchen gardens and 389 non-MARD control households. The lack of knowledge about nutrition, including the causes, prevention, and treatment of night-blindness and anemia, was remarkable. However, compared with control households, the kitchen-gardens group had significantly more nutrition knowledge (38% vs. 13% knew one of the causes of night-blindness, and 17% vs. 3% knew one of the causes of anemia), were more likely to feed special complementary foods to infants and to preserve food, and consumed more of 16 types of home-produced micronutrient-rich vegetables and fruits. Although the cross-sectional nature of the study limits our ability to attribute these differences to the program, we observed a striking lack of nutrition knowledge in these communities, and a clear opportunity to increase the intake of vitamin A through home production of vitamin A-rich plants.

Adult↗
PubMed2006

Surgical simulation: a systematic review.

OBJECTIVE: To evaluate the effectiveness of surgical simulation compared with other methods of surgical training. SUMMARY BACKGROUND DATA: Surgical simulation (with or without computers) is attractive because it avoids the use of patients for skills practice and provides relevant technical training for trainees before they operate on humans. METHODS: Studies were identified through searches of MEDLINE, EMBASE, the Cochrane Library, and other databases until April 2005. Included studies must have been randomized controlled trials (RCTs) assessing any training technique using at least some elements of surgical simulation, which reported measures of surgical task performance. RESULTS: Thirty RCTs with 760 participants were able to be included, although the quality of the RCTs was often poor. Computer simulation generally showed better results than no training at all (and than physical trainer/model training in one RCT), but was not convincingly superior to standard training (such as surgical drills) or video simulation (particularly when assessed by operative performance). Video simulation did not show consistently better results than groups with no training at all, and there were not enough data to determine if video simulation was better than standard training or the use of models. Model simulation may have been better than standard training, and cadaver training may have been better than model training. CONCLUSIONS: While there may be compelling reasons to reduce reliance on patients, cadavers, and animals for surgical training, none of the methods of simulated training has yet been shown to be better than other forms of surgical training.

Computer Simulation↗
PubMed1996

Fluorophore-assisted carbohydrate electrophoresis in the separation, analysis, and sequencing of carbohydrates.

Carbohydrate analysis has traditionally been viewed as a specialty science, performed only in a few well-established laboratories using conventional carbohydrate analysis technology (e.g. NMR, gas chromatography-mass spectroscopy, high-performance liquid chromatography, capillary electrophoresis) combined with the specialized technical training that has been essential for accurate interpretation of the data. This tradition of specialized laboratories is changing, due primarily to an increase in the number of scientists performing routine carbohydrate analysis. As a result, many scientists who are not trained in traditional carbohydrate analytical techniques now need to be able to perform accurate carbohydrate analysis in their own laboratories. This has created a need for technically simple and inexpensive methods of carbohydrate analysis. In this review, we present application vignettes of a technically simple, yet analytically powerful method called fluorophore-assisted carbohydrate electrophoresis (FACE). FACE can be used for performing routine oligosaccharide profiling, monosaccharide analysis, and sequencing of a variety of carbohydrates.

Carbohydrate Sequence↗
PubMed1992

A training project helps the poor. A rural healthcare facility offers job training, gains employees.

As poor Americans look for work, healthcare facilities face a shortage of workers. One facility, Saint Francis Medical Center in Grand Island, NE, found a way to help some of the area's financially disadvantaged persons receive technical training and employment as it eased its own personnel shortage. Saint Francis leaders assembled a team of representatives from the hospital's staff, the Greater Nebraska Job Training Program, Lincoln, and Central Community College, Grand Island, to establish the Rural Allied Medical Business Occupations program. The team reviewed several job descriptions to help it decide which jobs to include in the program and surveyed area hospitals to ensure the positions selected were experiencing shortages. The program received a grant as a demonstration project from the U.S. Department of Education. After identifying participants who had the aptitudes and interests for the jobs, the Rural Medical Allied Medical Business Occupations program arranged for participants' training and assistance with items such as tuition, child care, and transportation. Participants received training at Central Community College and at Saint Francis Hospital. Saint Francis Medical Center deemed the program a success. The hospital has hired seven healthcare workers who would not have been available if they had not been trained through this program. Moreover, the program provides yet another way for the hospital to help fulfill a major portion of its mission: to help the poor.

Allied Health Occupations↗
PubMed2005

Implementation of a quality systems approach for laboratory practice in resource-constrained countries.

Under the direction of the US Global AIDS Coordinator's Office, Department of Health and Human Services, the CDC Global AIDS programme helps resource-constrained countries to address the global HIV/AIDS pandemic. Activities include laboratory capacity and laboratory infrastructure development in 25 resource-constrained countries. Medical practitioners and public health programme leaders in industrialized countries rely on the use of quality laboratory data for evidence-based medical decision-making to determine policy for the implementation of disease control measures, to monitor disease to determine the impact of control programmes, and to support surveillance activities. In these countries, laboratory data to support decision-making processes have a level of quality attributable to laws, regulations and guidelines developed over many years. However, resource-constrained countries have not had similar experiences. Few countries have developed laws, regulations or guidelines, nor is there a data-use culture (e.g. evidence-based medicine) for those in the decision-making environment in resource-constrained countries. The strengthening of laboratory capability and capacity in resource-constrained countries is an important goal to improve accurate and reliable data for the diagnosis, treatment and monitoring of disease.A process for the implementation of a quality systems approach for a laboratory is presented: (i) acknowledgement of the need to improve the laboratory programme in the country at the Ministry of Health and at all decision-making levels within the provinces/states of the country; (ii) assessment of capabilities, capacities, infrastructure, and training needs; (iii) implementation of a national meeting of laboratorians; (iv) designation of a national Quality Assurance Office and leadership within that office; (v) the development and provision of technical training.

Developing Countries↗
PubMed1981

[National meeting on birth control techniques ends].

210 million contraceptive operations, which include vasoligation, tubal ligation, and implanting of IUDs, were carried out in China in the 9 years from 1971-1979, according to sources from a national working conference on birth control techniques which closed here yesterday. The conference was called to help implement China's birth control policy with stress on the rural areas. The goal is to limit the country's population to 1200 million by the turn of the century. The Ministry of Public Health has issued regulations on dispensing of the various methods of contraception, the conference said. Health workers are instructed to popularize all methods and increase their proficiency. At the conference, proposals were raised on how to spread knowledge of birth control, promote research, production and supply of contraceptive drugs and devices and introduce safe and simple methods and highly-efficient contraceptive pills. At present, a network of technical guidance teams, stations, research institutions, and operation service groups have been set up in all provinces, municipalities and autonomous regions across the country. Great efforts are being made to train technically proficient medical workers in all counties, the conference said.

Asia↗
PubMed1985

[Rehabilitation prognosis in the onset of epilepsy following entry into professional life].

The type of occupation proposed as well as factors determining these proposals, i.e. vocational prognosis, were examined in 58 persons to be rehabilitated who already had been integrated into working life at the time of epilepsy onset and participated in a one- to three-week vocational assessment programme in a vocational training center. Suggestions for vocational retraining were made to 49 of the 58 clients, with clerical occupations proposed to almost half of them, manual ones to appr. one third, and technical training to a sixth of the clients. This distribution of training suggestions is the reverse of the clients' former occupations, and did not always meet the wishes expressed by the clients. Careful evaluation and counselling might reduce some of these discrepancies. The level of the occupational training proposed was influenced most strongly by work rate, with dosage of anticonvulsive drugs being the most important factor in slowing the clients' pace. Psychological problems were common, did however not primarily influence the level of training proposed, but rather the decision between vocational training vs. invalidity pension or medical treatment.

Adult↗
PubMed1999

New surgical procedures in postgraduate medical education.

An outstanding role in developing the recent nation-wide postgraduate accreditation process in Hungary has been played by University Medical School of Pécs. GRADUATE TRAINING: By providing opportunities for students to practice basic surgical interventions on living tissues, the Department of Experimental Surgery has served as a bridge between theoretical and clinical phases of their education. Students benefit from the infrastructure of surgical training we provide, including even access to microsurgery and laparoscopic techniques. POSTGRADUATE TRAINING: One category of postgraduate training offered by our department is further training of young physicians in special branches of surgery, with emphasis on microsurgery and laparoscopy. The other category is in the form of special courses. A great number of applicants from across Hungary highlight the need for running such courses. Throughout Europe such training is available only at very high prices. With the invaluable assistance of Prof. Z. Szabo (San Francisco, USA), we have been able to create the right environment and offer expert technical training in laparoscopic procedures since 1995. We face new challenges in the year 1999. As part of the new resident training system, Department of Experimental Surgery will provide not only training in traditional surgical procedures, but also include training in the most up to date techniques. Organizing such sources, apart from financial backing, requires genuine professional commitment.

Animals↗
PubMed1997

Technology versus responsibility: immigrant physicians from the former Soviet Union reflect on Israeli health care.

About 13,000 physicians from the former Soviet Union have found themselves in the saturated medical market in Israel as a result of the latest wave of immigration. This paper examines the gap in professional attitudes and practices between Israeli and Soviet MDs and the cognitive mechanisms employed by immigrant physicians in the process of adjustment to the new medical culture. The study draws on 25 semistructured interviews with recent (about three years in Israel) immigrant doctors who were at various stages of obtaining a local medical license. Reflecting on the need to redefine themselves as professionals and to confront negative stereotypes regarding ex-Soviet doctors, many respondents stressed the strong sides of Soviet medical training and work style. In their collective self-portrait, immigrant doctors emphasized devotion to patients, clinical intuition, manual skills, and empathy, while flaws were regarded as superficial and improvable by technical training. Conversely, the alleged flaws of Israeli doctors were perceived by these informants as pertaining to the core of medicine: "Excessive dependence on technology," "lack of responsibility toward patients," and "weak preventive orientation of Israeli colleagues were repeatedly criticized. The paper sheds light on the significant conceptual differences between the Soviet and Western medical traditions and provides a vivid example of the sociocultural construction of medicine. Our findings are also indicative of the interpretative processes and coping strategies that immigrants in general may develop in saturated professional markets.

Adaptation, Psychological↗
PubMed2006

Web-based technical assistance and training to promote community tobacco control policy change.

In 1998 the tobacco industry was released of claims that provided monetary relief for states. A significant expansion of tobacco control activity in many states created a need to develop local capacity. Technical assistance and training for new and experienced staff became a significant challenge for tobacco control leadership. In Colorado, this challenge was addressed in part through the development of a technical assistance and training Web site designed for local tobacco control staff and coalition members. Researchers, technical Web site development specialists, state health agency, and state tobacco control coalition staff collaborated to develop, promote, and test the efficacy of this Web site. The work group embodied a range of skills including tobacco control, Web site technical development, marketing, training, and project management. Persistent marketing, updating of Web site content, and institutionalizing it as a principal source of information and training were key to use by community coalition members.

Colorado↗
PubMed1993

[Environmental health promotion in municipalities--resources, organization and activities].

The Municipal Health Services Act with amendments from 1988 defines environmental health promotion activities directed at physical, chemical, biological and social factors as mandatory for the local Norwegian health authorities. In addition, the municipal health services are responsible for health surveillance and for initiating cross-sectorial preventive measures. In 1991, we undertook a national survey among the Norwegian municipal health services to monitor planning activities, manpower resources, cross-sectorial cooperation, and project-oriented activities within the field of environmental health promotion. Less than one-third of the municipalities employed technically trained hygienic personnel. However, three of four municipalities had carried out some environmental health promotion projects within the last two years. The following factors were all independently related to level of environmental health promotion activity: the availability of technical assistance, the level of cross-sectorial cooperation and the size of the population in the municipality. We conclude that this area of health promotion should be improved by better planning, a higher level of technical hygienic competence within the municipal health services, more inter-sectorial cooperation and greater emphasis on visible projects of limited duration.

Environmental Health↗
PubMed1984

Pharmacy technician training in the United States Army.

Pharmacy technician training in the U.S. Army is described. The training program, officially titled the pharmacy specialist course, is conducted at the U.S. Army Academy of Health Sciences on Fort Sam Houston in San Antonio, Texas. The 17-week program is conducted six times a year, accommodating up to 75 students per class. Before entering the course, the soldiers must complete basic combat infantry training and a general medical orientation course. Standardized examinations are given to ensure the students have the basic prerequisite knowledge. The curriculum emphasizes psychomotor skills with laboratory requirements supported by didactic instruction. During the first seven weeks of the course, the students receive instruction in pharmacy administration, pharmaceutical chemistry, pharmaceutical calculations, and pharmaceutical preparations. The last nine weeks of instruction focus on pharmacology, physiology and pathology, and hospital pharmacy practice. The laboratory simulates a hospital pharmacy and is used exclusively for the training program. The students are continually evaluated and provided with individualized supportive counseling by the faculty. Overall attrition has remained at approximately 22% for fiscal years 1981, 1982, and 1983. Following graduation and assignment to a medical-treatment facility, the technicians have several opportunities for advanced training and continuing education. The proficiency and competency of the graduates are continually monitored by an annual skill qualification test. The pharmacy specialist course conducted by the U.S. Army, accredited by ASHP, can serve as a standard for the comprehensive vocational and technical training of pharmacy technicians.

Accreditation↗
PubMed2003

Internet access and empowerment: a community-based health initiative.

OBJECTIVE: To determine whether access to health information via in-home Internet technology can positively influence empowerment among residents of a low-income urban community. DESIGN: In-home Internet access and training were provided to volunteers, who, along with a comparison group, were interviewed prior to and 1 year after initiation of the program. Community-based participatory research methods were used to design and implement the intervention. SETTING: A 57-block area on the West Side of Chicago. PATIENTS/PARTICIPANTS: Twenty-five community residents completed all phases of the technology intervention. Thirty-five randomly selected neighbors of these residents served as the comparison group. INTERVENTIONS: Members of the intervention group received Internet access via WebTV, training, technical support, and access to a community specific health-oriented web page during the course of the study. MEASUREMENTS AND MAIN RESULTS: Intervention group members were similar to comparison group members in terms of empowerment at baseline. After receiving Internet access and training, empowerment related to health decision-making improved significantly in the intervention group. Similar changes did not occur in the comparison group. Affinity for and appreciation of information technology also increased in the intervention group but not in the comparison group. As a result, differences in attitudes toward technology increased between the 2 groups over time. CONCLUSIONS: Using community-based participatory research methods, we found that Internet access to community-specific and general health information can lead to increased empowerment and appreciation of information technology. These benefits accrued among the intervention group but not among a random group of their neighbors.

Chicago↗
PubMedDate not supplied

Personal characteristics and job satisfaction among nurses in Lebanon.

OBJECTIVE: This study investigates the level of satisfaction of Lebanese nurses in their job and the influence of their personal characteristics. BACKGROUND: Given the current difficulties experienced by Lebanese hospitals in recruiting and retaining a sufficient number of nurses, the need to understand the reasons of nurses' dissatisfaction became urgent. Moreover, satisfaction at work is essentially a personal experience also affected by cultural factors. Therefore, it was necessary to study the links between personal characteristics and nurses' dissatisfaction. METHODS: The study included 421 registered nurses. A modified version of Measure of Job Satisfaction, developed by Taynor and Wade, was used to assess the effect of the personal characteristics, namely educational level, age, years of work experience, position, and marital and parental status, on 5 dimensions of satisfaction: personal satisfaction, workload, professional support, pay and prospect, and training. RESULTS: The findings suggest that personal characteristics have important influences on nurses' job perceptions. University graduate nurses reported more dissatisfaction with the quality of supervision and with respect and treatment they receive from their superiors. Nurses younger than 30 years and the technically trained were more dissatisfied with the available opportunities to attend continuing education courses. Results of staff nurses and unmarried nurses showed trends of more dissatisfaction than the married and nurses of higher positions. Moreover, the whole sample perceived that nursing provided a high level of personal satisfaction, but nurses were most dissatisfied with salary and lack of prospects for promotion. CONCLUSION: The results indicate the importance of personal characteristics on nurses' retention. Furthermore, intrinsic factors related to the nature and experience of nursing are more job satisfying than extrinsic factors.

Adult↗
PubMed1998

Prevention of HIV transmission by blood transfusion in the developing world: achievements and continuing challenges.

In industrialized countries, the use of sensitive HIV screening tests, donor deferral, and more conservative use of blood have resulted in a dramatic decrease in the transmission of HIV infection by blood transfusion. The risk of HIV transmission in the USA by blood screened negative for HIV antibody was recently estimated at one in 440,000-660,000 donations. Despite this low risk, continued public concern has compelled blood collection agencies and policy makers to continue to search for more sensitive HIV screening tests. Genome amplification techniques are receiving increased attention and are being piloted in Germany. HIV-1 p24 antigen testing was implemented in the USA in March 1996. In the first 18 months of p24 antigen testing, an estimated 18 million blood donations were tested at a cost of US$90 million to detect three antigen-positive, antibody-negative donations. However, in many developing countries where severe anemia is widespread and the prevalence of HIV infection among blood donors is orders of magnitude greater than in industrialized countries, the blood supply is either incompletely screened or not screened at all for HIV antibody. Although the contribution of transfusion-transmitted infection to the HIV epidemic has not been accurately assessed, an estimated 5-10% of HIV infections in developing countries are due to blood transfusion. In a study conducted 1 year after implementation of HIV blood screening in the largest hospital in the capital city of the Democratic Republic of the Congo, an estimated 25% of pediatric HIV infections, and 40% of infections among children over 1 years of age, were due to transfusion. Lack of commitment by national governments and international aid organizations to this fundamental element of HIV prevention has resulted in a shortage of basic equipment, supplies, and trained personnel for blood screening. Moreover, provision of test kits alone cannot prevent HIV transmission by transfusion in resource-poor areas. More comprehensive programs are needed to improve the recruitment and retention of safe donors, essential laboratory services for blood banking and screening, technical training and supervision, appropriate use of transfusions, and the prevention of severe anemia. This article summarizes the steps being taken by developing countries to prevent HIV transmission by blood transfusion, lessons learned, and the work that still lies ahead.

Anemia↗
PubMed2006

HIV testing in 2006: issues and methods.

Infection with HIV and subsequent development of AIDS is a pandemic. The Joint United Nations Program on HIV/AIDS together with the WHO and many relevant funding bodies demand that those infected should be reliably identified so that people who need, or will need, therapy may be provided for over time. This means that there is a renewed interest in testing for HIV and in laboratories' performances and quality. Whatever the conditions under which testing is performed, and whatever the levels of training, the tests and their outcomes must exhibit equivalent, high standards of performance and reliable results. This is regardless of whether testing is conducted in the most sophisticated laboratories (either diagnostic or transfusion screening) to voluntary testing and counseling centers where those conducting testing may not be technically trained. This is not currently the case, especially in some places where HIV is most prevalent. To achieve uniformly high performance standards, quality assurance programs are imperative, but currently not sufficiently valued to be well supported with adequate funding or human resources. Accurate HIV testing is a cornerstone of blood safety, diagnosis of infection, patient management and surveillance.

Animals↗
PubMed1998

The activities of veterinary vaccine control laboratories.

The activities of veterinary vaccine control laboratories are reviewed. The National Veterinary Assay Laboratory (NVAL) in Japan is used as an example to describe a quality control system for veterinary vaccines. Veterinary vaccine control laboratories conduct tests on veterinary vaccines and perform studies to improve test methods to ensure quality, efficacy and safety. The primary responsibility of the veterinary vaccine control laboratory is the assay of animal vaccines for national use. In addition, vaccine control laboratories perform activities for the distribution of reference products, examinations, inspection of other laboratories to ensure implementation of 'good laboratory practices', technical training and other duties prescribed by the Ministry of Agriculture. The NVAL and veterinary control laboratories from other countries have participated in the work of the International Co-operation on Harmonisation of Veterinary Medicinal Products (VICH) group initiated by the Office International des Epizooties to harmonise technical requirements for registration of veterinary vaccines.

Animals↗
PubMed1975

Observations by a James IV traveler on British surgical centers.

In Great Britain and Ireland there were many well-trained, technically excellent, clinical surgeons practicing the art of surgery in a system that guarantees an equitable and even distribution of quality care. University departments tended to be small but were very effective and stimulating units without the administrative and clinical burdens of a large teaching hospital. Surgical training programs were superb, but long, and continued to be molded by service requirements. Clinical research protocols were everywhere in evidence and were patient oriented, well controlled, and of the highest quality. Although there are several new impressive clinical plants, hospitals tended to be old and facilities somewhat dated. There are fewer intensive- and critical-care units than we have become accustomed to. As hosts, the British and Irish are unsurpassed as the most gracious, interesting, and educated people I know.

Education, Medical↗