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PubMed1980

Expanding food-animal veterinary services through nutritional consultation.

Practitioners can increase their value to their clients as well as increase the gross veterinary product by developing supplemental expertise in nontraditional disciplines. This can be accomplished through continuing education and the utilization of technical support services such as the professional nutritionist. In addition, contemporary technology such as the electronic moisture tester and the pH meter can be implemented in the acquisition of nutritional diagnostic data. A comprehensive herd health program is precisely the delivery system into which such complimentary expertise can be integrated successfully.

Animal Feed↗
PubMed1993

Continuing education for general practice. 1. Experience, competence and the media of self-directed learning for established general practitioners.

The arrangements under which continuing education for general practice is provided and attendance by general practitioners is rewarded have now been in operation for three years. More recently, reaccreditation has emerged as a significant issue for the profession. For these reasons it appears timely to review the whole basis of ongoing learning by established general practitioners. In this the first of two papers, learning by established professionals is considered in relation to the educational development of the learner, the role of experience and the goals of competence and performance. It is concluded that self-directed learning based on experience should form the centre-piece of continuing education for general practice and that educational provision should adopt a complementary role in sustaining motivation to learn and by enabling learning from experience to be shared and enriched. A model of self-directed learning, connecting experience and competence through systematic application of three learning media, reading, reflection and audit, is proposed and related to appropriate educational participation by established general practitioners.

Clinical Competence↗
PubMedDate not supplied

The JICA training course, community-based cancer prevention for the Asian Pacific countries, fiscal years 2004 and 2005 (epidemiological approach).

Communicable diseases are still major causes of deaths in developing countries. Cancer incidence, however, increased 19% between 1990 and 2000, mainly in this same developing world (Stewart and Kleihaus, 2003), and malignant neoplasms are now the second leading cause of mortality in these countries (WHO, 2003). Limitations of medical facilities and equipment mean that prevention is indispensable for cancer control (Mikheev et al., 1994). However, human resources concerning cancer prevention are limited, and encouragement of their development should be taken as a first priority. To assist in this aim, the present training course was designed by the Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Japan, and has been annually conducted since 1999, supported by the Japan International Cooperation Agency (JICA) (Takezaki, 2001; 2002; 2003; Wakai, 2004). The course targets doctors and public health workers who are responsible for community-based cancer prevention in developing countries to promote the introduction of comprehensive procedures, focusing mainly on primary prevention but also including screening for secondary prevention of cancer.

Adult↗
PubMed1990

Continuing education needs of health care professionals.

Formal continuing education for health professionals continues to grow around the base of courses, conferences, and general reading. These formats serve the indispensable function of keeping health professionals abreast of the state of medicine. Since most formal continuing education activities are planned for groups, they cannot address the specific information needed in the care of individual patients. Furthermore, the knowledge gained is memory-based, and it is misguided to believe that facts learned in lectures will be remembered accurately enough for patient-care applications. A recent study has demonstrated that physicians often want additional knowledge when they are caring for patients and that access to knowledge is often difficult and time consuming. Advances in computer and telecommunications technology may ultimately permit immediate short answers to specific questions that arise during medical practice. It is time to expand the activities of the National Library of Medicine and the libraries within the Regional Medical Library (RML) network that provide valuable information for health professionals by developing methods to answer specific questions on the spot while health professionals are caring for patients.

Education, Medical, Continuing↗
PubMed2005

A study of continuing nurse education in Malta: the importance of national context.

The literature recommends that in the light of the constant changes in the contexts in which nurses perform [Buerhaus, P., 1997. The future of the nurse labour market. Image 29(4), 313-318], nurse education systems should incorporate specialised and continuing education [Lenera, V., 1987. The Nurse and the Future: Role and Function. In: Health Care and Nurse Education in the 21st Century. Commission of the European Communities, Brussels; Castledine, G., McGee, P., 1998. Advanced and Specialist Nursing Practice, Blackwell Science Ltd., Oxford; Chiarella, M., 1998. Developing the credibility of continuing education. Nurse Education Today 10, 70-73 ]. Using a qualitative approach, the research study reported in this article explored views of student and qualified nurses in Malta about such educational opportunities. Data were collected using questionnaires administered by post to student and qualified nurses in Malta (n=172) [Fenech Adami, M., 2002. An exploratory study of the adequacy of the nurse education system in Malta. PhD Thesis. University of Aberdeen.]. In congruence with the literature, the findings revealed widespread support for and interest in specialised and continuing education in general [Nolan, M., 1994. Continuing professional education: identifying the characteristics an effective system. Journal of Advanced Nursing 22, 551-560; Wilson-Barnett, J., 1994. Evaluating the clinical nurse specialist - a review. International Journal of Nursing Studies 31(6), 561-571]. However, some of the findings challenge that which is recommended in the literature. The findings should contribute to the effective development of specialised and continuing education opportunities in Malta. Moreover, by their divergence from the literature, these findings illustrate that nurse education should always be planned against a backdrop of the context in which it is to be delivered. In turn, the findings point out the importance of researching education within specific contexts rather than simply extrapolating research evidence and subsequent recommendations on nurse education from one national context to another.

Attitude of Health Personnel↗
PubMed2003

[The main tasks of Czech perinatology at the beginning of the 21st century].

OBJECTIVE: To identify the main goals of the Czech perinatology at the beginning of the 21st century. DESIGN: Retrospective epidemiologic analysis of selected perinatal care quality indicators. SETTING: Institute for the Care of Mother and Child, Prague. METHODS: Analysis of selected indicators of perinatal care and their trends in the Czech Republic and comparison with other countries. RESULTS: When we reached the same low level of perinatal mortality as the other most developed countries, we have observed unchanged values for last three years. The priorities established 15 years ago are still important to preserve the current situation, however the further development in perinatology requires now goals related to development of selected indicators of perinatal care and their international comparisons. These are: 1) change of definition of stillbirth including newborns of 500-999 grams (currently registered as spontaneous abortions), 2) termination of the continuous increase of Caesarean section, 3) inclusion of the criteria of quality of perinatal care, especially a) deaths during late neonatal and postneonatal periods with perinatal causes; b) perinatal morbidity (impaired neuro-sensoric and psychological development of the child due to perinatal causes). Both these tasks will require collaboration of professionals from obstetrics and neonatology with specialists from other fields. CONCLUSIONS: The 4 main tasks were established on the basis of development of selected perinatal care quality indicators and their international comparisons: the change of definition of stillbirth, the termination of continuous increase of Caesarean sections, and inclusion of other indicators of perinatal care, first related to mortality after 7th day of life due to perinatal causes, and second the perinatal period related morbidity in later periods of infant life.

Cesarean Section↗
PubMed2001

Public health physicians: an endangered species.

BACKGROUND: Questions have arisen regarding the competency levels of the various professions within the public health sector, including those of physicians. Protection of the nation's health requires that physicians on the public health team be competent practitioners of both medicine and public health. Physicians practicing in this arena are required to possess a vast array of knowledge, skills, and attitudes to be effective contributors in the field. METHODS: Using focus groups of key informants in public health, the context of practice, inventory of required competencies, current competencies, and identified gaps in these competencies, measures to address the situation were identified and discussed. RESULTS: Recommendations from the focus groups include: use of distance-based learning, development of educational materials and programs, use of the American College of Preventive Medicine as a facilitator, improved remuneration, changes to the certification process, utilization of mentoring programs, introduction of new marketing strategies, use of professional publications, and increased governmental/agency support. Contributors to this endeavor are identified. CONCLUSIONS: While we strive to improve the physician workforce entering the field, creative strategies for continued lifelong learning are urgently needed to facilitate ongoing development of physicians in the current public health workforce. This situation presents a major research agenda for public health practice. Identification of the essential knowledge, skills, and attitudes for public health physicians is the first step toward narrowing gaps in required competencies.

Clinical Competence↗
PubMed1997

Resource document for curriculum development in cancer genetics education. American Society of Clinical Oncology.

PURPOSE: The rapid growth in the use of genetic testing for heritable cancers and other diseases has led to the establishment of many committees to assess the status and future implications of such testing. The American Society of Clinical Oncology (ASCO) published a statement on genetic testing for cancer susceptibility in May 1996. In that statement, ASCO recognized the need for a major initiative to develop courses and other educational materials for ASCO members and other health care professionals that were pertinent to cancer genetics and the role of cancer predisposition testing in clinical oncology. These curriculum guidelines represent an effort to promote formal instruction on the assessment and management of familial cancer risks in training programs and continuing education courses. DESIGN AND RESULTS: An Ad hoc Task Force was created from the ASCO membership and other professional organizations. Goals of ASCO's cancer genetics education initiative, curriculum guidelines, and plans for implementation of the curriculum have been developed. To gain understanding and competency in cancer genetics and cancer predisposition testing, the curriculum emphasizes formal instruction in: (1) basic concepts and principles of genetics; (2) an understanding of the role of genetics in the etiology, diagnosis, and management of different malignancies; (3) an understanding of the ethical, legal, and social issues that surround predisposition testing; and (4) long-term management plans for individuals at high risk for cancer. This document is broad in scope and applicable to all types of malignancies. It should be considered as the framework around which cancer genetics education is developed. It is expected that implementation of training activities over the next few years will allow ASCO to fulfill its obligations to the membership. CONCLUSION: This curriculum should prove a valuable guide to those who wish further education on cancer genetics and the appropriate use of cancer predisposition testing.

Curriculum↗
PubMed2002

Searching the health care literature efficiently: from clinical decision-making to continuing education.

Searching the health care literature is an activity in which infection control professionals must routinely engage to seek evidence-based answers to specific practice questions and to stay abreast of developments in the field. Without the appropriate tools, the tremendous volume of clinical literature makes both of these daunting tasks. In this article, we illustrate techniques for searching MEDLINE efficiently, both as a means of answering particular clinical questions and for generating periodic updates on topics of general interest. With use of a specific example relevant to infection control, we demonstrate the identification of appropriate Medical Subject Headings terms that capture a given question or topic and the development of effective searches with use of these terms. We also touch on the advantages of targeting systematic reviews and meta-analyses in searching for evidence and staying abreast of the literature in general.

Decision Making↗
PubMedDate not supplied

Nurses organizational commitment: the discriminating power of gender.

The study of the organizational commitment has risen interest within the organization's researchers, who have been trying to understand the intensity and stability of the individual's dedication to the organization. The interest that this construct has raised is based on the idea of the existence of an association of the organizational commitment with variables considered important to the increase of the organizational effectiveness and productivity. The aim of this article is to describe organizational commitment, in its affective, normative, and continuance dimensions, from nurse practitioners, and to analyze the differences of that commitment regarding gender. Data were collected by questionnaire. The sample is constituted by nurse practitioners who develop their professional activity in 6 Portuguese hospitals. Data were analyzed using means, standard deviation, and independent samples t test. The sample consists of 1201 nurses. The organizational commitment of the studied nurses is, on average, 2.87+/-0.69 (in 5-point scale). When we make an analysis regarding gender, we verify that the organizational commitment is higher in women, being the difference statistically significant (t = -2.07; P < .05). There are different levels of commitment in male and female nurses, and it is higher in all dimensions in female nurses; however, the difference is only significant to the organizational and continuance commitment.

Adult↗
PubMed2006

Overseas nurses' experiences of equal opportunities in the NHS in England.

PURPOSE: To explore the experiences of overseas black and minority ethnic nurses in the National Health Service (NHS) in the south of England. METHODS: Semi-structured in-depth interviews were conducted with 12 overseas black and minority ethnic nurses. All interviews were taped, transcribed verbatim and analysed using thematic analysis. All transcripts were read and re-read to elicit general themes. FINDINGS: Qualitative data analysis was undertaken using Van Manen framework and this enabled a number of themes to be identified that were part of overseas black and minority ethnic nurses' experience, however, two main themes would be discussed in this study. Firstly, unequal opportunities in career advancement and secondly, unequal opportunities for skill development and training. Both themes affected overseas nurses chances of promotion in the NHS. RESEARCH LIMITATION/IMPLICATIONS: The study has identified a notably gap in the implementation of equal opportunity policies and suggests that a more transparent implementation of such policies is needed in the NHS in the UK where this study was conducted. Additionally, more research is needed to determine whether overseas nurses in other areas experience similar problems. PRACTICAL IMPLICATIONS: The findings of this study could encourage managers to re-examine their equal opportunity policies in the light of these findings. Although this study has explored overseas nurses experiences, the findings cannot be generalised to the wider population. ORIGINALITY VALUE: The differences experienced by overseas nurses in relation to career opportunities and skill development and training.

Adult↗
PubMed1998

Quality management in medical specialties: the use of channels and dikes in improving health care in The Netherlands.

BACKGROUND: In 1989 a Dutch national policy was instituted to ensure that quality management is the responsibility of both health care professionals and management, with input from insurers and patients. In turn, quality management of medical specialists remained to a large extent self-regulatory, with accountability toward third-party payers and patients. Three programs for quality management-peer review, guidelines, and visitation-have sufficiently persuaded patient organizations and care insurers about medical specialists' ability to ensure the quality of the care they provide. PEER REVIEW: Operational since 1976, the national program for peer review in hospitals has stressed the need for explicit evaluative mechanisms. This program led to the foundation of the National Organization for Quality Assurance in Hospitals (CBO), which conducts peer review activities but also support efforts aimed at quality assurance in hospitals. Once it is linked with the other two quality management programs, peer review will realize its full potential as a profession-based method for standardizing and rationalizing medical specialty practice. PRACTICE GUIDELINES: Since 1982, more than 60 consensus guidelines have been developed for and by medical professionals, with input from patient organizations and third-party payers. Medical specialty associations have also created their own guidelines. Although the guidelines' impact has not been evaluated systematically, studies have shown effects on behavioral change and health outcomes. Solid, credible guidelines continue to be developed, although the successful implementation of these guidelines needs to be studied. VISITATION PROGRAM: Visitation, or onsite assessment of specialty practice sites (in training and non-training hospitals), has been a hot issue in Dutch medical quality assurance. All 28 scientific societies have visitation programs, focusing on areas for improvement such as process management, use of guidelines, and evaluation of patient satisfaction and treatment outcomes. Closely linked to other medical quality assurance activities, visitation programs also incorporate clinical guidelines into evaluations. CONCLUSIONS: Profession-driven peer review, practice guidelines, and visitation programs have been effective support tools for quality management in The Netherlands. Future challenges involve creating more synergy among these programs and between the profession-based quality management approaches and recently introduced hospital-based quality systems and maintaining the trust between third-party payers and patients.

Delivery of Health Care↗
PubMed2001

Continuing medical education. What do Minnesota physicians want?

CONTEXT: Continuing medical education (CME) is necessary for ongoing licensure and is critical in maintaining professional expertise. However, educators may not always consider their students preferences when developing new programs. OBJECTIVE: To determine physician preference for the format of CME programs and to learn what factors contribute to selecting a CME activity. DESIGN: Survey with 12 multiple response items pertaining to educational objectives, past educational experiences, and demographic information. PARTICIPANTS: A total of 1,967 Minnesota physicians were sent the survey; 385 physicians returned surveys within 2 months of mailing date (20% return rate). RESULTS: The vast majority of respondents reported participating in traditional CME programs during the preceding two years, and most said they planned to attend a traditional program in the next two years. CONCLUSIONS: Minnesota physicians overwhelmingly prefer attending traditional CME programs to participating in more interactive, technology-based activities. Before new technology such as the Internet can be widely used in CME, it must be made attractive to the practicing physician.

Attitude of Health Personnel↗
PubMed1998

The future of end-stage renal disease care: nephrology enters a new millennium.

There are many challenges facing the discipline of nephrology as we enter the next millennium. There will be a continuing increase in the number of patients requiring renal replacement therapy, with older, sicker patients predominating. At the same time the available workforce to provide care to these patients is not growing quickly enough to keep up with the demand. In the broader health care delivery system, consolidation of services, vertical and horizontal integration, a continued move to for-profit entities, and constant pressure on cost containment will increasingly characterize the immediate future. The rapidity with which health care delivery and financing are changing will make it difficult for patients and health care professionals alike, but it will also offer opportunities. In nephrology, development of a collaborative model of care has already begun and will be an important part of the response to this changing care environment. Collaborative care and the application of the principles of chronic disease management to renal patients will provide the best opportunities to capitalize on new technologies and treatments as they become available and to streamline and improve the care delivery process. This should lead to improved quality of care for renal patients, while constraining costs and providing for continued professional growth and satisfaction.

Delivery of Health Care↗
PubMed1989

Training in quality assurance. WHO Working Group.

A WHO Working Group consisting of quality assurance specialists, physicians, nurses and medical educators met in 1985 to suggest a model curriculum for the training of health personnel in quality assurance. Since quality assurance activities and therefore also educational needs vary in the Member States, the Working Group focused on the broad principles of training in quality assurance. Having defined quality assurance as a problem-solving exercise, the report first looks at the general characteristics of educational objectives and their application to quality assurance curricula. It then proceeds to the identification of relevant learning experiences and description of principles of evaluation. Paying special attention to the principles of planned change, the next section describes how to introduce quality assurance into the curriculum of educational institutions for health professionals. The report finishes with recommendations for the introduction and development of training programmes to WHO, Member States, professional and licensing bodies, funding agencies and nongovernmental organizations active in the development of health manpower.

Curriculum↗
PubMed2001

Telemedicine for the delivery of professional development for health, education and welfare professionals in two remote mining towns.

Over a two-year period, telemedicine was used to deliver training and development services for health, education and welfare staff in two remote towns in South Australia - Roxby Downs and Coober Pedy. Both are mining towns but they have different profiles in terms of the community's mental health needs. The services were provided by the Child and Adolescent Mental Health Services (CAMHS) from the Women's and Children's Hospital in Adelaide, South Australia. The media used were videoconferencing, telephone, video-tapes, the Internet and printed material. During 1998-9, professional staff in the two locations participated in structured videoconferencing seminars that addressed important mental health topics, chosen in response to surveys of the needs of the participants. The videoconferencing sessions were sometimes used to discuss specific patient cases. Each remote town was also supported via videoconferencing by a nominated office of the CAMHS: Roxby Downs by the suburban office at Port Adelaide and Coober Pedy by the office in the industrial town of Port Pirie. This customized support was an important factor in the success of the professional development network.

Community Mental Health Services↗
PubMed1992

Telephone follow-up of ambulatory surgery patients following discharge is a nursing responsibility.

The ambulatory surgery nurse manages care for a diverse population of patients who may or may not be ideal candidates for early discharge after surgery. Integral to the nursing care is the postdischarge follow-up contact, which allows the nurse to assess the patient's level of recuperation and evaluate the care provided. A number of reasons, besides completion of the nursing process, indicate that this contact is a nursing obligation. These include compliance with national standards of care, improvement of quality of care, and reduction of the facility's liability exposure. These calls also show a sense of caring about patients and help to market the ambulatory surgery program in the community. The nurse develops a true sense of professionalism and often benefits by increased job satisfaction.

Ambulatory Surgical Procedures↗