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PubMed1975

A biomedical information source: the National Clearinghouse for Alcohol Information.

The National Clearinghouse for Alcohol Information (NCALI) is an information resource developed by the National Institute on Alcohol Abuse and Alcoholism of the U.S. Department of Health, Education, and Welfare. It provides numerous alcohol-related information services to professionals in a wide spectrum of biomedical and other disciplines, services that are designed to aid information users in the discrimination and selection of useful literature from the volumes of available information. One such service will provide the biomedical professional, working in an alcohol-related field, with announcements of recent information in categories that he selects from 110 possible fields of interest. Another information service is the quality evaluation of technical documents. The quality evaluation system, which is under continuing development and refinement, serves the literature user by providing a literature quality prescreening process designed to aid users in their literature review and monitoring activities. Additional information services provided by the clearinghouse include Grouped Interest Guides, Subject Area Bibliographies, a quarterly magazine and a periodic general interest information service, and a wide range of special publications. Reference services provide a suitable depth of response to information requests through services that range from assemblages of standard information materials, such as pamphlets and similar publications, to automated data base searches for more technically oriented information requests.

Alcoholism↗
PubMed1998

Nursing students' experiences of the effects of continual process-oriented group supervision.

AIM: To describe and analyse the nursing students' experiences of the effects of process-orientated group supervision. BACKGROUND: There is a need to promote the development of the nursing student's professional identity and preparedness to act as well as to provide the opportunity for reflection and setting up a group supervision programme. METHOD: This paper is an in-depth study using both quantitative and qualitative methodologies. An open-ended interview form including 24 items and four open-ended questions was used and 80 nursing students answered a questionnaire. The data were analysed by a factor analysis with varimax rotation and by open coding. FINDINGS: The three analysis factors were labelled: 'Increased patient attentiveness', Increased empathy ability', and 'Increased insight and security'. From the findings of the qualitative analysis two main categories emerged: 'Increased ability to communicate' and 'Personal growth'. CONCLUSIONS: The findings of this study suggest that there is an association between the effects of group supervision and the nursing students' development of a nurse identity.

Attitude of Health Personnel↗
PubMedDate not supplied

Numbers of minority health professionals: where do we stand?

This overview has pointed to a continuing racial and ethnic imbalance in the health professions that applies to North Carolina as well as the nation. Great strides have been made early in the development of programs to enhance racial and ethnic representation, but they have generally reached a plateau in terms of growth and progress. Resistance to affirmative action programs and subsequent uncertainty over their legal standing can be cited as one factor thwarting progress, but that issue has been resolved and schools, professions, and the North Carolina General Assembly can move forward with a clear understanding of how to proceed. A full generation has matured with the benefit of positive emphasis on increasing the proportion of minorities in the health professions. The coming generations must build and expand on the programs and initiatives that brought the nation and the state to where we are now. But these goals must be re-stated, and intensified efforts are required if any reasonable parity in representation of minorities among the health professions is to be achieved.

Cultural Diversity↗
PubMed1997

Recommended framework for presenting injury mortality data.

Injuries are a substantial and preventable public health problem and account for approximately 6% of deaths in the United States. Many injury epidemiology and injury control programs depend on injury mortality and morbidity data aggregated by external cause of injury codes (E codes) for program planning and evaluation. This report provides a framework for the uniform tabulation and analysis of injury mortality data classified by the Ninth Revision of the International Classification of Diseases (ICD-9) (a subsequent report will address the application of this framework to injury morbidity data). Standard ICD-9 E-code groupings are presented in the form of a matrix and are depicted as mechanism by intent of injury. All cells in the matrix are mutually exclusive. Injury mortality data from the National Center for Health Statistics (NCHS) are presented in the matrix for 1993 to illustrate numbers of deaths within each cell Justifications are given for assigning E codes to major categories and subcategories within the matrix. The groupings of external causes presented in this framework were developed by CDC (National Center for Injury Prevention and Control [NCIPC] and NCHS) in collaboration with members of the American Public Health Association's Injury Control and Emergency Health Services Section (ICEHS). These groupings are intended to assist persons involved in planning and evaluating injury control programs at national, state, and local levels and are relevant for all persons who collect, code, analyze, and report injury data. Public health researchers and other public health professionals are encouraged to adopt or adapt these groupings as a minimum framework for tabulating injury deaths and death rates. For historical continuity, vital statistics programs will continue to use tabulation standards based on both the guidelines of the World Health Organization and derivative lists developed by CDC (NCHS) for presentation of national mortality statistics. The proposed framework can be used to supplement these tabulation standards by providing more detailed presentations of injury deaths and death rates, which are useful for making policy decisions and planning injury prevention activities.

Cause of Death↗
PubMed1996

Implementation of a comprehensive skin care program across care settings using the AHCPR pressure ulcer prevention and treatment guidelines.

Healthcare professionals in the Central Midwest identified the need for a comprehensive skin care program for pressure ulcer prevention and treatment across care settings. A multidisciplinary team, representing acute, extended and home care, was formed to create a program for all three settings based upon the AHCPR pressure ulcer guidelines. The team performed literature reviews on which to base the development and use of tools, conducted prevalence studies, and developed educational approaches. Implementation of the program was tailored for each setting. Some of the approaches used were a skin care fair, quality studies, continuous quality improvement concepts, a "Product Book" and educational presentations. Outcomes include improvement of continuity of care across settings and the use of the Braden Scale and the NPUAP pressure ulcer staging system. The focus has turned toward patient outcomes. Professionals have a better understanding of the care that is provided by other disciplines. Referrals are made based upon decision trees. Appropriate resources are used. Other outcomes anticipated include a decrease in nosocomial pressure ulcers, shortened wound healing time, appropriate referral of unresponsive chronic wounds, decreased discrepancies in wound documentation, decreased length of stay, improved financial outcomes, and improved client knowledge and participation.

Aged↗
PubMed1999

[Continuing medical education and the professional career].

The great scientific and technical advances in medicine make it necessary that the professional competence of the doctor needs to be brought up to date every now and then by the use of a continuing medical education (CME). The complexity and diversity of the professional subjects and the different areas of specialization give us reasons why the education of the doctor to-day should not be limited to the years of studying for a degree at university but that this education should be prolonged to include successive stages of specialized education and of the CME. The way of doing the latter (CME) is varied by means of different types of activities and it is recommended that it should be of a voluntary nature, through the personal motivation of the doctor, although he should also be spurred on because of different types of "prizes", as, for instance, social recognition, prestige, promotion to higher posts, etc. The organization of the activities of the CME should look to the recognition of the quality of the work by means of the corresponding accreditations according to uniform criteria established by a national central commission which should also establish the credits necessary for obtaining periodically the certificate for the bringing up to date of professional competence. This certificate, which should be gained in periods of 3 or 4 years duration, constitutes the basis, along with other elements (works of investigation, publications, years of tests, etc.) for the professional career of the doctor, the possible structure and development of which is shown in this presentation.

Accreditation↗
PubMed1992

An integrated approach to curriculum development.

This paper explores some aspects of what is meant by integration in a nursing curriculum, by looking at both integration of course content and subject matter, and a consequent move away from separated academic disciplines towards a thematic approach, and at integration of the student group, so that different groups of nurse learners study and learn together for a certain proportion of the programme. We consider reasons for adopting an integrated approach by discussion: issues related to learners and the learning context (these include theories of how adults learn and our perspective on the part to be played by experiential learning); the potential implications for client/patient care and the need for transferable skills to work as a member of a team; and staff development for the teachers, including moves away from possible isolation towards team-teaching. We then go on to describe a model for curriculum development devised in our own institution and based on these principles, which incorporates the development of learners professionally, educationally and personally. This paper discusses the topic from a mainly theoretical perspective, and many of the issues will be relevant to a wide range of courses.

Clinical Competence↗
PubMed2001

Professional and organizational learning: analysing the relationship with the development of practice.

BACKGROUND: Organizational and professional learning are interrelated processes that underpin the contemporary drive for a quality evidence-based delivery of health care in the United Kingdom (UK). DESIGN: A soft systems methodology was used to explore the pervasiveness of practice developments. Three case study sites were identified using matrix sampling and data collected through 29 individual interviews and two focus group interviews, with the interviews augmented with a tool designed to maximize analysis of the processes of developing practice. FINDINGS: The resultant model of developing health care practice includes three processes: using and creating knowledge, understanding and practice of patient care, and effecting development. The whole model was underpinned by professional and organizational learning in which 'expert thinkers' engaged in double loop learning to reconceptualize care rather than just perpetuate existing patterns of care delivery.

Attitude of Health Personnel↗
PubMedDate not supplied

[Social implications of physician professional and certification quality].

The paper analyzes the social implications of the professional quality of physicians and of their process of certification. The adequate competencies of physicians are especially relevant in countries that have broad social asymmetries and cultural plurality. This diversity of social and epidemiologic conditions demands a profile of physicians able to work in a wide range of environments and able to achieve the best professional practice, making the best use of the available resources for medical care. Medical competencies and quality of care are interrelated. The process of coupling universal knowledge and local conditions creates a synchronic diversity of professional practices. Medical certification must be viewed as part of the process of diffusion of innovations. The development of a variety of abilities to cope with innovations contributes to the production of a diachronic diversity of medical practices. In the light of continuing quality improvement, it is necessary that certification systems be articulated with both continuing medical education and the accreditation and progress of healthcare institutions. Otherwise, there is the risk of increasing inequality in medical practice that, in the last analysis, blames the victim.

Certification↗
PubMed1996

Can educational accreditation drive interdisciplinary learning in the health professions?

BACKGROUND: Accreditation in higher education serves as a means of assuring the public of academic program quality and of promoting continuing review and self-improvement by educational units. Educational program accreditation is a means of seeking continuous improvement in the academic activities of programs and institutions. Discussions of interdisciplinary education raise questions about the responsiveness of accreditation to such approaches. ACCREDITATION AS A STIMULUS FOR CONTINUOUS IMPROVEMENT: Some health professions accrediting agencies have followed the lead of industry and have adapted their approach and philosophy of evaluation to a continuous improvement philosophy, while others continue to perpetuate an "inspection" mentality. The perpetuation of such an approach limits the value of the accreditation process. Accrediting agencies need to focus attention instead on stimulating professional preparation to develop in students the knowledge, skills, and competencies needed for health professions practice. Since such practice frequently occurs in team or interdisciplinary settings, the accreditation evaluation can support practice by incorporating an interdisciplinary perspective. THE CHALLENGES OF INTERDISCIPLINARY EDUCATION FOR ACCREDITATION: As models of interdisciplinary education are developed in the health professions, accreditation will be challenged to evolve in its effectiveness to evaluate interdisciplinary learning experiences. The accrediting community will need to recognize the barriers posed by interdisciplinary learning, as well as the special skills and situations needed to offer effective interdisciplinary experiences. Without this perspective the usefulness of accreditation will be diminished. A CHARGE FOR THE FUTURE: Standards and procedures for accreditation will need to be revised to address the unique characteristics of interdisciplinary education. A set of mock accreditation standards to guide the evaluation of interdisciplinary health professions education learning experiences is proposed. Finally, questions are posed about the role of accreditation in the context of interdisciplinary health professions education.

Accreditation↗
PubMed2001

Training physicians in communication skills with adolescents using teenage actors as simulated patients.

Role-play exercises with simulated patients may serve the purpose of training professionals to develop appropriate communication skills with adolescents. Authentic adolescent responses toward the physicians may be achieved by actors who themselves are in their teenage years. We describe our experience in continuing medical education programmes for primary care physicians aimed at improving their skills in communicating with adolescents, using simulation methodology with teenage actors. Eight 16-17-year-old actors from the drama department of a high school for the arts were trained to simulate 20 cases with characteristic adolescent medical problems, as well as confidentiality issues and home and school problems. The actors performed in front of large groups of 20-30 paediatricians, family practitioners, or gynaecologists in continuing medical education. Diagnostic issues as well as therapeutic and management approaches were discussed, while the actors provided feedback to the trainees about their understanding and their feeling regarding the issues raised during the exercises. Normally, smaller learning groups are more suitable for such training purposes; nevertheless the participants could appreciate learning the principles of careful listening, a non-judgmental approach and assuring confidentiality. A collaboration of medical schools and postgraduate programmes with high schools which have drama departments may be fruitful in the teaching of adolescent medicine with special emphasis on communication skills with teenagers.

Adolescent↗
PubMed1996

Clinical integration: an interdisciplinary approach to a system priority.

Clinical integration, a Mercy Health Services (MHS) system-wide priority, addresses MHS's ability to provide appropriate, effective clinical care across the continuum and to improve care outcomes. MHS chartered a Clinical Integration Priority Team (CIPT) that developed a common language for clinical integration; began to build infrastructure for coordinated systems of care in such areas as information systems and pharmacy; improved methods and technology for clinical decision making and care delivery; and educated clinicians to improve care processes, manage care for populations, and measure outcomes. Clinical professionals in corporate staff roles have supported clinicians' efforts across the system by providing direction, coaching, educating and supporting in activities to improve patient care.

Continuity of Patient Care↗
PubMed2004

Current trends in teaching ethics of healthcare practices.

The unprecedented progress in bio-medical sciences and technology during the last few decades has resulted in great transformations in the concepts of health and disease, health systems and healthcare organisation and practices. Those changes have been accompanied by the emergence of a broad range of ethical dilemmas that confront health professionals more frequently. The classical Hippocratic ethical principles, though still retaining their relevance and validity, have become insufficiently adequate in an increasing range of problems and situations. Healthcare that has been practised for centuries on the basis of a direct doctor-patient relationship has been increasingly transformed into a more complex process integrating the health-team, the patient (healthcare seeker) and the community. Systematic review of the specialised literatures revealed that Healthcare Ethics education has become a basic requirement for any training programme for health professionals, and should cover the different stages of undergraduate, postgraduate and continuing education. Both theoretical foundations and practical skills are required for the appropriate ethical reasoning, ethical attitude and decision-making abilities. There is growing evidence that physicians' professional and moral development is not only determined by the formal curriculum of ethics; rather more, it is determined by the moral environment of the professional practice, the 'hidden curriculum' which deserves serious consideration by medical education.

Biomedical Technology↗
PubMed1998

The work of the American emergency physician.

The organisation of the American emergency health care system has changed rapidly during recent years, but it remains very different to the system in the United Kingdom. American emergency departments are organised around an attending physician based service, rather than a consultant led service. As a result, the work of the American emergency physician differs considerably from that of the United Kingdom A&E consultant. The problems associated with working in an attending physician based service include antisocial hours of work, sleep deprivation, decreased job satisfaction, and "burn out," all in the context of a relatively hostile medicolegal climate. Although there appear to be no easy answers to some of these problems, the A&E specialist should be aware of the potential future difficulties for A&E medicine as it develops within the United Kingdom.

Burnout, Professional↗
PubMed2000

Using communicative action in the primary prevention of cancer.

The primary prevention of disease, including cancer, has been a major part of health promotion and health education for decades. However, the long-term results of these strategies have been mixed, and primary prevention as an instrument of cancer control continues to fail to live up to either public or professional expectations. The authors identify and critique two possible factors contributing to this failure and then offer a model for the development and implementation of primary prevention strategies that addresses these factors. The model used is based on Habermas's theory of communicative action and recognizes the importance of a critical dialogue in health education and health promotion. The primary prevention programs currently being conducted by the Cancer Centre for the Southern Interior are presented as an example of the model in action.

British Columbia↗
PubMed2001

Principles for pressure ulcer prevention in the community.

This article aims to examine the prevention of pressure ulcers in the community. Pressure ulcers continue to cause needless distress and anxiety for patients, carers and their families. Health professionals in the community often face extreme challenges when caring for patients who are at risk of developing pressure ulcers. This could be due to lack of appropriate assessment skills and having insufficient time to conduct an appropriate assessment. Having an understanding and awareness of the function of the skin and the aetiology of pressure ulcer development can assist the health professional in attempting to take a proactive approach to prevent pressure ulcer formation in the community setting.

Community Health Nursing↗
PubMed1998

Determining preferred educational methods for neurological surgery residents regarding organ donation.

Design and implementation of professional education, especially physician education, continues to challenge procurement professionals. At the request of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons, the United Network for Organ Sharing undertook a project to develop educational materials for neurological surgery residents. A survey tool was developed and administered on site at 11 neurological surgery residency programs in the United States. The survey explored the types of learning environments, teaching methods, educational resources, and audiovisual aids that neurological surgery residents typically experience during their residency programs. In addition, the survey sought to uncover the residents' informational needs regarding organ and tissue donation presentations as well as their educational program preferences. Based on our findings, neurological surgery residents prefer presentations that are brief and to the point, that are easily understood, that require no reading, that contain limited important information, and that always include food.

Attitude of Health Personnel↗