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PubMed2005

Current perspectives in assessment: the assessment of performance at work.

BACKGROUND: Traditional assessment has improved significantly over the past 50 years. A number of new testing methods are now in place, the computer is improving both the fidelity and efficiency of examinations, and the psychometric principles on which assessment rests are more sophisticated than ever. AIM: There is growing interest in quality improvement and there are increasing demands for public accountability. This has shifted the focus of testing from education to work. The purpose of this paper is to describe the assessment of work. DISCUSSION: In contrast to traditional assessment, there are no 'methods' for the evaluation of work because the content and difficulty of the examination are not controlled in any fashion. Instead it is a matter of identifying the basis for the judgements (outcomes, process, or volume), deciding how the data will be gathered (practice records, administrative databases, diaries/logs, or observation), and avoiding threats to validity and reliability (patient mix, patient complexity, attribution, and numbers of patients). FUTURE DIRECTIONS: Overall, the assessment of doctors' performance at work is in its infancy and much research and development is needed. Nonetheless, it is being used increasingly in programmes of continuous quality improvement and accountability. It is critical that refinements occur quickly to ensure that patients receive the highest quality of care and that doctors are treated fairly and provided with the information they need to guide their professional development.

Clinical Competence↗
PubMed2002

Teaching and learning by example: empowerment principles applied to development, delivery, and evaluation of community-based training for HIV service providers and supervisors.

This article describes and recommends a participatory method of developing, implementing, and evaluating a learner-driven community-based continuing education effort for HIV workers and supervisors. The Boston University School of Social Work (BUSSW) created and delivered a training program in partnership with the Massachusetts Department of Public Health HIV/AIDS Bureau (the Bureau). Because teaching empowerment-based practice was an overarching goal, every step of the process modeled collaboration and self-determination. The program was unusual in several ways: the workshops focused on basic helping skills rather than the medical aspects of HIV; community stakeholders shaped the workshops in consultation with staff from the Bureau and BUSSW; a formative evaluation led to adaptations of the curriculum in the first few months of the project; objectives were set in part by learners, who evaluated themselves on goal attainment; and follow-up interviews explored the effects of the workshops on practice. Most supervisors and direct care workers reported that the workshops were highly relevant to their work and that they were able to incorporate their learning into practice, suggesting that the empowerment approach has utility. The report includes the genesis and necessity of the project; the principles underpinning it; the use of empowerment at each stage; and implications for administrators, service providers, and educators in the HIV field. We propose that resources dedicated to collaborative or participatory curriculum development, implementation, and evaluation are well spent.

Attitude of Health Personnel↗
PubMed2003

Organising access to Evidence-Based Medicine resources on the Web.

The continuing education is a challenge for health care professionals, considering the growing amount and variable quality of information in this field. In this context, we developed a method allowing clinicians to have a centralised access to the best current medical evidence supporting medical decision-making. Relevant data has been gathered according to the rules stated for Evidence-Based Medicine (EBM) and organised in a free-of-charge Web site, created by using common software applications. The general aim of our study was to encourage individual practice of EBM by providing tutorials as well as a selection of free access tools for searching medical information on the Web. In addition to the education part, we provided clinicians, through a Web interface, with up-to-date, accurate and quality data obtained from heterogeneous sources and presented in a full text format when available. The developed methodology has been applied to human prostate cancer. URL address: http://www.ebm.lib.ulg.ac.be/prostate/index.htm.

Artificial Intelligence↗
PubMed2002

Development of innovative teaching materials: clinical pharmacology problem-solving (CPPS) units: comparison with patient-oriented problem-solving units and problem-based learning--a 10-year review.

The First Teaching Clinic in Clinical Pharmacology, sponsored by the American College of Clinical Pharmacology in September 1992, was designed for the preparation and development of new clinical pharmacology problem-solving (CPPS) units. CPPS units are case histories that illustrate pertinent principles in clinical pharmacology. Each unit consists of the following sections: introduction, learning objectives, pretest, four clinical pharmacology scenarios, posttest, answers to pre- and posttest questions, and selected references. The clinical pharmacology content of the CPPS units place greater emphasis on clinical information, drug selection, and risk/benefit analyses, and thus they complement the basic pharmacology presented in the patient-oriented problem-solving (POPS) units. In general, the CPPS units are intended for use by students more advanced in clinical pharmacology than first- and second-year medical students. The CPPS unit "Clinical Pharmacology of Antiepileptic Drug Use: Clinical Pearls about the Perils of Patty" was developed for use by third- and fourth-year medical students doing rotations in neurology or clinical pharmacology; advanced pharmacy students; residents in neurology, pediatrics, internal medicine, and family practice; fellows in clinical pharmacology, and those taking the board examination in clinical pharmacology. The CPPS unit titled "Geriatric Clinical Psychopharmacology" was written for third- and fourth-year medical students; residents in psychiatry, family practice, and internal medicine;fellows in clinical pharmacology; and those studying for boards in clinical pharmacology. The CPPS unit "Anisocoria and Glaucoma" was written for more advanced students of clinical pharmacology. The CPPS unit titled "Antiepileptic Drugs" was intended for second-year medical students. The second teaching clinic was held in November 1993 and focused on the development and editing of the CPPS units and their evaluations by faculty and students from academic centers. Evaluations by faculty and students have been overwhelmingly positive. Requests to use the CPPS units in various clinical pharmacology teaching programs were received from numerous schools within the United States and from abroad. The third teaching clinic in September 1995 included a follow-up focused on the uses of drug information databases in case problem exercises. These examples are presented to demonstrate the variety of educational activities the American College of Clinical Pharmacology is sponsoring to fulfill its strategic initiative dedicated to offer innovative teaching programs and to develop new teaching materials in clinical pharmacology. Collectively, all of the teaching clinics, symposia, and workshop efforts, sponsored by the various academic professional societies alone or together over the past decade, are necessary if new and innovative teaching materials in the field of basic science and in the fields of pharmacology and clinical pharmacology are to be continuously developed to keep pace with the new, rapidly changing developments in medicine to provide the best treatment for patients in the 21st century.

Anisocoria↗
PubMed2005

Social workers' educational needs in end-of-life care.

A survey of 391 health care social workers assessed educational content and skills needed for competence in practice with those facing the end of life. Content perceived as most needed included psychological and social needs of patients and families; psychosocial interventions to ameliorate distress; and the influence of dying on family dynamics. Assessing complex needs of patients/families; communication of psychosocial needs of patient/family to team members; facilitation of effective family and team communication; and provision of crisis intervention were the skills perceived to be required for competence in end-of-life care practice. Results of these data can be used to develop model end-of-life care curricula for continuing education programs and to identify content for possible inclusion in social work programs.

Clinical Competence↗
PubMed1995

A framework to develop a sexual abuse prevention program.

In 1993, the Province of Ontario proclaimed the Regulated Health Professions Act (RHPA) and 21 health profession acts, including the Medical Radiation Technology Act. Under the RHPA, 21 health care regulatory colleges were created to ensure that Ontario patients receive safe, competent and quality care. Programs administered by the colleges ensure that all patients are treated with dignity and respect, and include measures for preventing or dealing with the sexual abuse of patients. This article sets out a framework and discusses issues related to the development and implementation of a sexual abuse prevention program. Key components include: establishing a patient-relations committee, preparing a statement of philosophy, defining sexual abuse, setting guidelines for professional behaviour, and educating members, staff and the public. Other aspects of such programs include procedures for complaints and discipline, mandatory reporting and penalties, and funding for therapy and counselling for patients who have been sexually abused by members.

Communication↗
PubMed2005

Psychosocial and psychological interventions for prevention of postnatal depression: systematic review.

OBJECTIVE: To assess the effects of psychosocial and psychological interventions compared with usual antepartum, intrapartum, or postpartum care on the risk of postnatal depression. DATA SOURCES: Medline, Embase, CINAHL, Cochrane central register of controlled trials, Cochrane pregnancy and childbirth group trials register, Cochrane depression, anxiety, and neurosis trials register, secondary references and review articles, and experts in the field. STUDY SELECTION: All published and unpublished randomised controlled trials of preventive psychosocial or psychological interventions in which the primary or secondary aim was a reduction in the risk of postnatal depression. All trials recruited pregnant women or new mothers less than six weeks postpartum. Eligible studies were abstracted, assessed for methodological quality, and pooled with relative risk for categorical data and weighted mean difference for continuous data. RESULTS: Fifteen trials with 7697 women were included. Although there was no overall statistically significant effect on the prevention of postnatal depression in the meta-analysis of all types of interventions (15 trials, n = 7697; relative risk 0.81, 95% confidence interval 0.65 to 1.02), these results suggest a potential reduction in postnatal depression. The only intervention to have a clear preventive effect was intensive postpartum support provided by a health professional (0.68, 0.55 to 0.84). Identifying women "at risk" assisted in the prevention of postnatal depression (0.67, 0.51 to 0.89). Interventions with only a postnatal component were more beneficial (0.76, 0.58 to 0.98) than interventions that incorporated an antenatal component. In addition, individually based interventions were more effective (0.76, 0.59 to 1.00) than group based interventions (1.03, 0.65 to 1.63). CONCLUSIONS: Diverse psychosocial or psychological interventions do not significantly reduce the number of women who develop postnatal depression. The most promising intervention is the provision of intensive, professionally based postpartum support.

Continuity of Patient Care↗
PubMedDate not supplied

A nursing portfolio: documenting your professional journey.

Professional profiling may enhance one's career development. The opportunities to use a current profile abound, and include applying for a new position, a leadership role in a professional society, a scholarship or an award, or career advancement. The true professional updates the profile on an annual basis, emphasizing significant personal and professional accomplishments. Documentation and validation of one's credentials may require substantial effort-but such effort is worth it. Profiling is a step toward recognition and success.

Career Mobility↗
PubMed1998

Development of an aromatherapy service at a Cancer Centre.

The aromatherapy service at the Cancer Support and Information Centre (CSIC) of this regional Cancer Centre has been continually assessed since its inception in 1993. New methods of assessing complementary therapies, based on the 'therapy-as-practised', have been explored. The present study evaluates the service following changes made after an initial pilot. The professional aromatherapist developed an evaluation tool, and formal questionnaires were limited to the Hospital Anxiety and Depression Scale (HADS). HADS was completed before and after a course of six aromatherapy sessions. Of 89 patients referred, 58 patients completed the six sessions. Referrals were made by health professionals working in the Cancer Centre and in the CSIC. The majority of patients were female with breast cancer and were receiving radical oncological treatment. Tension, stress and anxiety/fear were the most common reasons for referral, and this was reflected in high initial HADS scores. There were significant improvements in HADS scores in the 58 patients completing the course (mean anxiety, depression, and combined scores dropped from 8.9 to 6.2 6.1 to 4.0 and 15.0 to 10.2, respectively, P < 0.001). Fifty per cent or more of the sample reported a significant improvement in the eight most commonly assessed symptoms. The therapist was initially cautious about using questionnaires, but she gained confidence in using HADS as an assessment tool. The areas covered by her own evaluation tools were broadly comparable to established instruments such as the EORTC QLQ-C30. We conclude that aromatherapy massage has a role in reducing psychological distress, and improving symptom control in cancer patients. Further service evaluation is needed to promote appropriate referral and effective planning of treatment, and to justify cost. Given the multifaceted nature of complementary therapies, the need to develop new research methodologies is acknowledged.

Adult↗
PubMed2003

Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged.

UNLABELLED: Postoperative pain can have a significant effect on patient recovery. An understanding of patient attitudes and concerns about postoperative pain is important for identifying ways health care professionals can improve postoperative care. To assess patients' postoperative pain experience and the status of acute pain management, we conducted a national study by using telephone questionnaires. A random sample of 250 adults who had undergone surgical procedures recently in the United States was obtained from National Family Opinion. Patients were asked about the severity of postsurgical pain, treatment, satisfaction with pain medication, patient education, and perceptions about postoperative pain and pain medications. Approximately 80% of patients experienced acute pain after surgery. Of these patients, 86% had moderate, severe, or extreme pain, with more patients experiencing pain after discharge than before discharge. Experiencing postoperative pain was the most common concern (59%) of patients. Almost 25% of patients who received pain medications experienced adverse effects; however, almost 90% of them were satisfied with their pain medications. Approximately two thirds of patients reported that a health care professional talked with them about their pain. Despite an increased focus on pain management programs and the development of new standards for pain management, many patients continue to experience intense pain after surgery. Additional efforts are required to improve patients' postoperative pain experience. IMPLICATIONS: A survey of 250 US adults who had undergone a recent surgical procedure asked about their postoperative pain experience. Approximately 80% of patients experienced pain after surgery. Of these patients, 86% had moderate, severe, or extreme pain. Additional efforts are required to improve patients' postoperative pain experience.

Adolescent↗
PubMed2005

Primary care teams: New Zealand's experience with community-governed non-profit primary care.

Community-governed non-profit primary care organisations started developing in New Zealand in the late 1980s with the aim to reduce financial, cultural and geographical barriers to access. New Zealand's new primary health care strategy aims to co-ordinate primary care and public health strategies with the overall objective of improving population health and reducing health inequalities. The purpose of this study is to carry out a detailed examination of the composition and characteristics of primary care teams in community-governed non-profit practices and compare them with more traditional primary care organisations, with the aim of drawing conclusions about the capacity of the different structures to carry out population-based primary care. The study used data from a representative national cross-sectional survey of general practitioners in New Zealand (2001/2002). Primary care teams were largest and most heterogeneous in community-governed non-profit practices, which employed about 3% of the county's general practitioners. Next most heterogeneous in terms of their primary care teams were practices that belonged to an Independent Practitioner Association, which employed the majority of the country's general practitioners (71.7%). Even though in absolute and relative terms the community-governed non-profit primary care sector is small, by providing a much needed element of professional and organisational pluralism and by experimenting with more diverse staffing arrangements, it is likely to continue to have an influence on primary care policy development in New Zealand.

Community Participation↗
PubMed2003

Clinical practice guidelines in dentistry: opinions of dental practitioners on their contribution to the quality of dental care.

OBJECTIVES: To assess the opinions of general dental practitioners regarding the development and importance of clinical practice guidelines and their contribution to the quality of dental care. METHODS: A questionnaire was sent to a representative sample of 1656 dentists in the Netherlands. Factor analysis was conducted to identify scales of variables, and a reliability analysis was conducted to verify the reliability of the identified scales. The effect of the independent variables is expressed as odds ratio per scale part (standard deviation, SD). Regression analyses were conducted to study determinants of the opinions on clinical guidelines. RESULTS: The response rate was 73%; 54% of the respondents supported the development of clinical practice guidelines for dentists. Most respondents indicated that clinical practice guidelines could be used as a checklist, as a support in daily clinical decision making, and as a basis for continuing dental education. The factor analyses yielded four scale factors-contribution of guidelines to effectiveness of care (OR 1.95/SD), contribution of guidelines to professional autonomy (OR 1.70/SD), contribution of guidelines to quality of care (OR 2.52/SD), and contribution of guidelines to collaboration (OR 1.49/SD)-which complied with the criterion of Cronbach's alpha >0.60. Multiple regression analysis with the four scale factors as dependent variables yielded only extremely low correlations for practice and dentist characteristics (R(2)=0.01-0.04). CONCLUSIONS: Only about 50% of dentists support the development and implementation of clinical guidelines. Guidelines are seen as helpful in the provision of continuing dental education and as a support in daily clinical decision making. The most important barrier to successful implementation of clinical practice guidelines is the fear of dental practitioners that guidelines will reduce their professional autonomy. Practice and dentist characteristics are unrelated to dentists' opinions on clinical practice guidelines.

Adult↗
PubMed1994

Development of cancer pain relief and palliative care in the Philippines.

The article describes the development and progress of cancer pain relief and palliative care in the Philippines from 1986 onwards. The strategy employed was a stepwise progression that began with the establishment of government policy, followed by measures to improve availability and accessibility to oral morphine, and finally, continuing nationwide professional education. Key elements to successful implementation were the presence of a national cancer control programme; the active participation of the World Health Organization, the Department of Health, the Philippine College of Surgeons, and the Philippine Cancer Society Inc; and research development and utilisation. Data from three clinical studies are also presented, which showed the efficacy of the WHO Method of Cancer Pain Relief among samples of Philippine patients, and that cancer pain relief alone did not significantly improve overall quality of life, demonstrating the need for comprehensive palliative care.

Administration, Oral↗
PubMed1993

The impact of the prospective payment system: perceived changes in the nature of practice and clinical education.

BACKGROUND AND PURPOSE: Health care financing for teaching hospitals has undergone significant change in the past decade. This report describes changes in physical therapy practice and clinical education in three New England hospitals from 1984 to 1988. SUBJECTS: Hospital administrators, physical therapy managers, and clinical educators (N = 18) from the three teaching hospitals participated in this descriptive study. METHODS: Demographic, environmental, and participant interview data were gathered and examined to identify changes during this period. RESULTS: Perceived changes in practice include growth in specialized knowledge; increased emphasis on health care quality, efficiency, and accountability; new ethical dilemmas for practitioners; and a changing physical therapy role with new professional development opportunities. Perceived changes associated with clinical education were increased student performance expectations, unchanged resources for clinical education, greater emphasis on student self-directedness, and continued high valuing of this setting for physical therapy clinical education. CONCLUSION AND DISCUSSION: These results indicate significant change in the role of the physical therapist within these settings and suggest how these changes influence the clinical education of physical therapy students in these teaching hospitals.

Clinical Competence↗
PubMedDate not supplied

Issues surrounding professional portfolio development for nurses.

This article discusses issues that underpin professional portfolio development for registered nurses. The findings were informed by a review of the pertinent literature. The literature was obtained by undertaking searches of a number of electronic databases and hand searches of key journals. It was found that portfolio development has been a requirement for re-registration for a number of years. However, there appears to remain confusion and uncertainty among professionals regarding the meaning and implications of portfolio development for nurses. For example, in the review conducted, the terminology used was often found to be confusing and expectations of how a portfolio should look are unclear. Conclusions can be drawn that practitioners may be in a quandary of how to develop and present evidence in what is now a mandatory requirement for re-registration, the maintenance of a professional portfolio.

Career Mobility↗
PubMed2003

Continuing medical education: what delivery format do physicians prefer?

BACKGROUND: Although physicians are in a unique position to prevent life-threatening outcomes by counseling patients to stop smoking, many of them miss the opportunity to intervene in their patients' use of tobacco. Nicotine Dependence Across the Lifespan was developed as a continuing medical education (CME) program to teach and encourage physicians to deliver effective tobacco prevention and tobacco cessation counseling. METHODS: This CME program was offered to Texas physicians, free of charge, in three formats: live lectures, videotapes, and World Wide Web-based training. The program targeted physicians in four rural areas of Texas (San Angelo, Harlingen, Tyler, and Lubbock), where high smoking rates are prevalent and the number of professional smoking cessation services is low. We examined the sociodemographic characteristics of the participating physicians, factors in their decisions to participate in the program, and the extent to which their reported CME format preferences were associated with age, gender, race, profession, and location. RESULTS: The four factors identified--professional development, cost, personal control, and convenience/complexity--explained 76.9% of the variance describing the reasons physicians participated in the CME offering. The physicians' preferred CME format was live lectures; based on responses, this did not differ across age, gender, race/ethnicity, and location. DISCUSSION: Live lecture continues to be a preferred format of CME for physicians in four rural areas of Texas, yet research continues to show that lecture results in only the lowest level of behavioral change.

Chi-Square Distribution↗
PubMed2001

The state of ambulatory surgery and perianesthesia nursing.

The continued success of the ambulatory surgery environment of care has been achieved through patient, physician, and nursing staff satisfaction. The growth in this industry has been greatly influenced by advances in technology, as well as the development and administration of newer anesthetic agents. The implications delineated in this article provide an overview of what is in store for the specialty of perianesthesia nursing. Issues of competency, professional excellence, patient expectations, continuous quality improvement, research, and ethics have become part of the daily lexicon. Never before has the professional nurse been counted on for so much, and future expectations of the nurse continue to grow. To survive, the nurse needs to expand the boundaries of nursing practice as they have been defined. Nurses are the backbone of the delivery of patient care, nurses are on the front line guiding the patient through every care decision, and nurses are positioned to influence the continued evolution of ambulatory surgery and perianesthesia nursing care.

Ambulatory Surgical Procedures↗