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At least 1,477 records · Page 82Linked to original sources
PubMed1996

Experience with 800 hysteroscopic endometrial ablations.

STUDY OBJECTIVE: To determine the safety and efficacy of hysteroscopic endometrial ablation in women with menometrorrhagia. DESIGN: Retrospective record review. SETTING: A credentialing program in teaching and nonteaching hospitals. PATIENTS: Eight hundred women who underwent endometrial ablation in 54 hospitals, with indications of abnormal uterine bleeding disrupting lifestyle, postmenopausal bleeding during hormone replacement therapy, poor surgical risk for hysterectomy, or desire to preserve the uterus. INTERVENTIONS: Seventy percent of the patients were treated with danazol 100 to 600 mg/day for 6 to 12 weeks, 8% received gonadotropin-releasing hormone analogs, 7% received progestins, and 15% were given no preoperative treatment. Under appropriate anesthesia the cervix was dilated to 10 mm and the uterine cavity was distended with 1.5% glycine solution under gravity inflow of 80 to 100 cm water and outflow suction of 80 to 100 mm Hg pressure. Electrocoagulation with or without resection was completed using 100 and 125 W, respectively. MEASUREMENTS AND RESULTS: At 12 months 60% of patients reported amenorrhea, 29% hypomenorrhea, 6% eumenorrhea, and 5% no change. Repeat ablation was performed in 4% of patients. An additional 2% had hysterectomy for malignancy (endometrium 2, sarcoma 1, atypical hyperplasia 1), pelvic pain (4), fibroids (4), persistent bleeding (3), and endometritis (2). The complication rate was 3.9%: false passage during cervical dilatation (6), uterine perforation (dilator 4, resectoscope 2, Laminaria 1), fluid absorption greater than 1500 ml (8), minor bleeding (5), endomyometritis (4), and intrauterine pregnancy (1). CONCLUSIONS: Hysteroscopic endometrial ablation is a safe and effective treatment for women with menometrorrhagia.

Adolescent↗
PubMed1996

Optometric Testing in the Laparoscopic Surgeon

Teaching and credentialing for endoscopic surgery are highly desirable, but they used instructional methods and testing criteria that have not been scientifically validated. Furthermore, it is unclear whether performing inanimate endosurgical exercises in a repetitive manner is the most efficient means of developing skills. Optometric testing in elite athletes is a quantifiable method of assessing specific tasks involving hand-eye coordination. We hypothesized that such methods of testing and improving athletic performance are applicable to evaluating and teaching endoscopic surgery skills. The first phase of this research was to perform a wide range of 12 tests in 53 laparoscopic surgeons to determine which tests correlate with superior skill. Results indicated that contrast sensitivity (the ability to discriminate fine detail), speed of recognition, rapid eye tracking (fine ocular motor skill), near-far focus (ability to accommodate), and eye-hand cross-dominance all correlated with endoscopic skill. The implications of these and other findings should be explored further to improve teaching endoscopic surgery.

Journal Article↗
PubMed1996

Decreased Performance of Skilled Laparoscopic Surgeons at Microlaparoscopy versus Traditional Laparoscopy

The skill requirements for microlaparoscopy are significantly higher than those for the traditional technique. This program was designed to meet the demands of compensated two-dimensional depth perception, instrument accuracy, and ambidexterity. Three specialized drills were constructed and 60 experienced laparoscopists with advanced operative skills were evaluated. The three skill-assessment tasks were first performed using traditional laparoscopic instrumentation (10-mm laparoscopes, 5-mm accessory instruments). The performance of the study group was compared with an extensive database of over 1000 laparoscopic surgeons from around the world and did not reveal any significant deficits with traditional-size equipment. Next, the tasks were performed using miniature 2-mm laparoscopes and accessory instruments. Performance levels for all tasks were significantly lower than with traditional-size equipment. These results demonstrate the increased difficulty of performing laparoscopy with 2-mm instruments and underscore the importance of formal training and objective skill assessment. The relationship of skill to credentialing must be considered.

Journal Article↗
PubMed1997

Practice characteristics of the dual certificant--CPAN/CAPA.

Little information is available regarding the practice of nurses who hold two perianesthesia certification credentials (CPAN/CAPA) and their motivation in achieving a dual certification distinction. Achievement of certification in both areas of perianesthesia nursing is a significant accomplishment. Nurses with dual certification are a valuable asset to the profession, their employer, and the perianesthesia patient. The characteristics of this unique group were surveyed by the American Board of Perianesthesia Nursing Certification, Inc. The findings have implications for nurse managers, educators, and perianesthesia colleagues.

Ambulatory Surgical Procedures↗
PubMed2000

Specialisation in nursing. A survey of reactions of Victorian nurses to the national review of specialist nurse education.

This article reports on the opinions of specialist nurses practising in Victoria toward recommendations proposed in the National Review of Specialist Nurse Education (Specialist Review) (Russell et al 1997). Seventy-five nurses undertaking a range of specialist nursing courses offered by three educational providers (a university, major teaching hospital and professional organisation) completed a survey questionnaire to establish the extent to which they agreed with the major recommendations from the Specialist Review. Results showed strong endorsement for most recommendations but with less agreement about issues of minimum credentials and future provisions. Comparison of responses across age, experience, employment and professional education subgroups identified significant differences of opinions on some recommendations. Findings from this study are discussed in relation to the Specialist Review and to implications for the future development of specialist nursing education in Australia.

Adult↗
PubMed2004

Guidelines for operative vaginal birth.

OBJECTIVE: To provide guidelines for operative vaginal birth in the management of the second stage of labour. OPTIONS: Non-operative techniques, episiotomy, and Caesarean section are compared to operative vaginal birth. outcome: Reduced fetal and maternal morbidity and mortality. EVIDENCE: MEDLINE and Cochrane databases were searched using the key words 'vacuum' and 'birth' as well as 'forceps' and 'birth' for literature published in English from January 1970 to June 2004. The level of evidence and quality of recommendations made are described using the Evaluation of Evidence from the Canadian Task Force on the Periodic Health Examination. RECOMMENDATIONS: 1. Non-operative interventions such as one-to-one support, partogram use, oxytocin use, and delayed pushing in women using epidurals will decrease need for operative birth. (I-A) 2. Manual rotation may be used alone or in conjunction with instrumental birth with little or no increased risk to the pregnant woman or to the fetus. (III-B) 3. Routine episiotomy is not necessary for an assisted vaginal birth. (II-1E) 4. When operative intervention in the second stage of labour is required, the options, risks, and benefits of vacuum, forceps, and Caesarean section must be considered. The choice of intervention needs to be individualized, as one is not clearly safer or more effective than the other. (II-B) 5. Failure of the chosen method, vacuum and/or forceps, to achieve delivery of the fetus in a reasonable time should be considered an indication for abandonment of the method. (III-C) 6. Adequate clinical experience and appropriate training of the operator are essential to the safe performance of operative deliveries. Hospital credentialing boards should grant privileges for performing these techniques only to an appropriately trained individual who demonstrates adequate skills. (III-C). VALIDATION: The Clinical Practice Obstetrics Committee and Executive and Council of the Society of Obstetricians and Gynaecologists of Canada approved these guidelines.

Canada↗
PubMedDate not supplied

Integration into professional nursing by graduates of an innovative entry-level MSN program.

Recently, nursing programs that admit nonnurse college graduates to graduate study in nursing have emerged around the country. The University of Texas at Austin has such a program called the Alternate Entry Master of Science in Nursing (AEMSN) program. Using a grounded theory approach, 13 telephone interviews were conducted with alumni of the AEMSN program to examine the socialization of these nontraditional graduates into the profession of nursing. Participants reported some anxiety as they approached graduation. They were particularly aware of a disconnection between their academic credentials and their limited professional nursing experience. To manage others' and their own expectations of them, the participants chose various strategies, such as using positive self-talk and seeking a manager who understood and favored the AEMSN program. Eventually the graduates found places where they felt comfortable and where they could hone their skills. As they began to function in roles that they believed were consistent with master's level nursing, the AEMSN graduates began to embrace the identity of master's-prepared nurses.

Career Choice↗
PubMed2002

Paracelsus, Paracelsianism, and the secularization of the worldview.

This paper examines Paracelsus and Paracelsianism in the light of the ideas of Max Weber concerning the social consequences of the Reformation, with special reference to his theories of Entzauberung and secularization. He linked these tendencies both to the rise of capitalism and the growth of experimental science. The detailed case study of Paracelsus' account of diseases linked with saints, in common with his interpretation of many other conditions, demonstrates that he self-consciously extended the boundaries of medicine and eroded the role of magic and witchcraft associated with the church. On the other hand, Paracelsus adopted the Neoplatonic worldview, was immersed in popular magic, and evolved a system of medicine that self-consciously revolved around magic. These factors seem to place a distinct limit on his role in the demystification of knowledge. However, the magic of Paracelsus entailed a decisive break with the entrenched elitist and esoteric tradition of the occultists and hermeticists. It is argued that this reconstructed magic re-establishes the credentials of Paracelsus as a significant contributor to the disenchantment and secularization of the worldview.

Europe↗
PubMed2000

The quality of forensic psychological assessments, reports, and testimony: acknowledging the gap between promise and practice.

During the past decade, the field of forensic psychological assessment entered a period of standard setting, reflected in the publication of specialty guidelines for practice and in the proliferation of educational opportunities, training programs, and credentialing and certification procedures for forensic examiners. Representing significant efforts to advance the quality of psychological assessments in legal contexts, these developments foreshadow the promise of forensic assessment. During this same time period, new evidence emerged regarding the quality of forensic practice. This article reviews this evidence and evaluates current practice against the promise of forensic assessment. Forensic reports appear to be of higher quality than those described by commentators in the 1970s and early 1980s; nevertheless, the level of practice falls far short of professional aspirations for the field. The review identifies significant areas of weakness that demand the attention of professional organizations, accrediting agencies, educators, lawmakers, practitioners, and consumers.

Child↗
PubMed2000

Psychiatric training and practice under managed care.

Today's psychiatry residents are facing many challenges that were unknown to their predecessors who received training before the managed care era. The author explores such challenges including the shift in treatment approach from psychoanalysis toward neurobiology, psychopharmacology, and cognitive and behavioral models of psychopathology and psychotherapy. Other demands that practitioners in training must deal with under managed care are accountability, loss of autonomy, and administrative burdens. Despite these challenges, managed care appears to have brought about positive changes in ways that psychiatry is practiced, such as standardization of credentialing and of authorization forms, and greater use of technology to improve administrative efficiency. Most importantly, systems of care necessarily involve people working together, not in isolation, which should be the central lesson of residency training and private practice under managed care.

Curriculum↗
PubMed2004

Rewarding results: Improving the quality of treatment for people with alcohol and drug problems.

Substance use disorders are the nation's number one health problem, and lie at the root of many public safety and workplace issues. Improving quality of treatment is as important as improving access to treatment. Leadership for improvement must come from many sources: Congress, SAMHSA, state legislatures, state and local treatment agencies, criminal justice, welfare and other public agencies, employers and managed care organizations, providers, and community leaders. We hope that our report helps leaders see ways to improve treatment quality. Our recommendations can be summed up in a single phrase: reward results. We recognize that there are many avenues for treatment quality improvement, including training, credentialing, best practice dissemination, work force development, facility licensing standards, improvement and implementation of new models for treatment of dual diagnosis patients. We believe, however, that rewarding results is essential to motivating action for improvement. We also believe that if providers receive rewards for improved results, they will creatively open new avenues for improvement--a focus on results gives greater freedom than more detailed mandates for change. Finally, we believe that rewards for result may lead to a restructured treatment system with greater stability and correspondingly greater capacity to improve. While we have placed central emphasis on the role of institutional buyers and managers of care, we believe that the voices of patients and families must be heard. People who have progressed to the stage of recovery, and their families, often have essential insight into what did and did not work for them--their personal stories are frequently compelling and persuasive. We also believe that providers of treatment for substance use disorders are profoundly committed to serving their patients, and often have great understanding of what works. Wise managers will listen very carefully and systematically to the voices of consumers, their families, and their providers. We have advocated that buyers reward results as a central strategy for improving quality. We believe that this is the best long-term strategy, not only to effect quality improvement, but also to end stigmatization and increase resources. We wish, in closing, to reemphasize our shared beliefs that adequate resources are essential, that treating persons with substance use disorders is always emotionally challenging and often profoundly frustrating and alienating, and that those on the front line deserve our unequivocal support and our profound gratitude for their service. Legislators should adequately fund public treatment and mandate parity in insurance reimbursement for treatment of substance use disorders.

Health Planning Councils↗
PubMed2002

One cell, one antibody: prelude and aftermath.

This essay seeks to summarize one scientist's pilgrim's progress through the world of antibody formation, attempting to capture the flavor of problems as encountered within their times. It seeks to portray a world where the direct template hypothesis ruled the day, where the function of lymphocytes was unknown, let alone the difference between T and B cells, and where antibody genes were but a dream. Struggles to establish the credentials of the clonal selection hypothesis are presented in some detail, as are the implications which followed the 'one cell - one antibody' discovery. The other two main preoccupations of the author are presented more briefly, namely the essential features of the germinal center and the cellular basis of immunological tolerance within the B lymphocyte compartment. Naturally, the experiments become more sophisticated as both knowledge and technology mature. A continuing thread within the unfolding story is that one must not shy away from developing new techniques when problems demand them.

Allergy and Immunology↗
PubMed1994

A PsyD degree for every practitioner. Truth in labeling.

At present, nearly 70% of APA members are identified as health care providers. The PhD degree, a generic scholarly degree, is most commonly used to certify completion of doctoral studies in professional psychology. As a result, the consumer has difficulty determining which psychologist is qualified to provide health care. The Doctor of Psychology (PsyD) should identify those psychologists who provide doctoral-level health services. Licensed, qualified PhD psychologists could be awarded the PsyD retroactively on the basis of a credential review, as the JD degree was awarded to lawyers previously holding the LLB. Applicants for the PsyD would not relinquish their PhD degrees. Upon review and approval, they would identify themselves with both degrees: PsyD, PhD. Mechanisms for accomplishing the change are suggested.

Curriculum↗
PubMed1990

Interviewer predictions of applicant qualifications and interviewer validity: aggregate and individual analyses.

The relative effects of varied interviewee cues on line managers' hiring decisions were examined, as was the relative predictability of various criteria by line managers' interview impressions. Aggregate and individual regression analyses revealed that 3 nursing directors' impressions of 186 nursing applicants shaped their hiring recommendations more than did the applicants' resume credentials. Moreover, managers' interview impressions significantly predicted employees' job attitudes, though predictions of attitudes did not exceed predictions of performance. Finally, individual managers based hiring decisions on different interview impressions, and these impressions forecast employees' job attitudes with differential validity. Implications for future interviewing research are discussed.

Adult↗
PubMed1981

Sertoli-Leydig cell communication via an LHRH-like factor.

The primary function of the testosterone secreted by Leydig cells is the maintenance of spermatogenesis and hence fertility. This action of testosterone is mediated by the Sertoli cells which nourish and support the developing spermatozoa. As normal Sertoli cell function is so critically dependent on normal Leydig cell function, a regulatory influence of the Sertoli cells on the Leydig cells has been suggested. Indeed, follicle-stimulating hormone (FSH), which acts only on Sertoli cells, can also cause profound changes in Leydig cell function, although how this is effected is unknown. We recently hypothesized that the Sertoli cell might be the source of a luteinizing hormone releasing hormone (LHRH)-like factor which we detected in the interstitial fluid surrounding the Leydig cells. As injected LHRH agonists cause impairment of gonadal function and directly inhibit FSH-induced changes in Leydig cell function through specific membrane receptors, this 'LHRH-like' factor has all the correct credentials for the postulated messenger between the Sertoli and Leydig cells. Here, we strengthen this case by demonstrating that seminiferous tubules from both the rat and the stumptailed macaque (Macaca arctoides) contain a factor which has LHRH-like receptor-binding and biological activity in vitro, but which is immunologically distinct from native LHRH. We have also shown that this factor is secreted in vitro by cultured rat Sertoli cells.

Animals↗
PubMed2007

Technology Insight: recanalization with drugs and devices during acute ischemic stroke.

Revascularization therapy is pivotal to saving ischemic brain from infarction. Two major randomized trials of intravenous thrombolytic therapy have established clear clinical benefit, especially for strokes caused by small-vessel occlusion. Ischemic stroke caused by large-vessel intracranial occlusion carries higher morbidity, however, and intravenous thrombolytics are less capable of opening these large vessels. This observation makes a case for delivering thrombolytics directly into the clot, or simply removing the clot mechanically. Intra-arterial thrombolytic drugs have been shown to be effective for treating middle cerebral artery occlusions in a major randomized trial. In the past 2 years, a family of mechanical thrombectomy catheters designed to remove rather than dissolve the offending clot has received FDA clearance. Such devices offer alternative therapy to patients who cannot receive thrombolytics, and can also be used in combination with thrombolytics to safely restore cerebral perfusion. Mechanical techniques have not been directly compared with intra-arterial thrombolytic strategies, but these devices might be superior to thrombolytics within vessels with particularly high clot burden, such as the carotid terminus and the basilar artery. Comprehensive stroke centers are currently available in major metropolitan areas to treat stroke via intra-arterial means, and are likely to become 'hubs' to 'spoke' hospitals that are credentialed as primary stroke centers. This design will allow any patient timely access to state-of-the-art stroke treatment tailored to their needs.

Acute Disease↗
PubMed2005

Best practice recommendations for anesthetic perioperative care and pain management in weight loss surgery.

OBJECTIVE: To develop evidence-based recommendations that optimize the safety and efficacy of perioperative anesthetic care and pain management in weight loss surgery (WLS) patients. RESEARCH METHODS AND PROCEDURES: This Task Group examined the scientific literature on anesthetic perioperative care and pain management published in MEDLINE from January 1994 to March 2004. We also reviewed additional data from other sources (e.g., book chapters). The search yielded 195 abstracts, of which 35 references were reviewed in detail. Task Group consensus was used to provide recommendations when evidence in the literature was insufficient. RESULTS: We developed anesthesia practice and patient safety advisory recommendations for preoperative evaluation, intraoperative management, and postoperative care and pain management of WLS patients. We also provided suggestions related to medical error reduction and systems improvements, credentialing, and future research. DISCUSSION: Obesity-related comorbidities including obstructive sleep apnea place WLS patients at increased risk for complications perioperatively. Regarding perioperative safety and outcomes, conclusive evidence beyond the accepted standard of care in the reviewed literature is limited. Few reports specifically address the perioperative needs of severely obese patients. In this advisory, we synthesize current knowledge and make best practice recommendations for perioperative care and pain management in WLS patients. These recommendations require periodic review as further medical knowledge and evidence evolve.

Analgesia↗