Nemanqani, D.; Mourad, Walid A.; Akhtar, M.; Moreau, P.; Rostom, A.; Ezzat, A.; Amin, T.
Liposarcoma is one of the most common adult soft tissue sarcomas, beingsecond only to malignant fibrous histiocytoma. It ranges from thewell-differentiated lipoma-like and myxoid tumors, to extremely cellular orplemorphic malignant neoplasms. The clinical behavior is variable andreflects the variable microscopic picture. Clinicopathological studies ofliposarcoma in Saudi Arabia are lacking. In this study, we reviewed allliposarcoma cases reported at KFSHRC from 1981 to 1996. Seventy-three casesof liposarcoma were studied morphologically. The cases were classified usingthe WHO International Classification of Diseases (ICD). Data regardingfollow-up, mode of therapy, recurrence and survival status were available for37 cases (50.68%). Survival analysis was performed. The patient's ages rangedfrom 15-94 years, with peak incidence between the ages 40 and 60 years. Therewas a male predominance of 1.3:1. The most common location was the thigh (36cases), accounting for 49.3% of cases, followed by the retroperitoneum (16cases), accounting for 21.9%. The most common histologic type was myxoidliposarcoma (41 cases; 56.2%), followed by well-differentiated liposarcoma(16 cases; 21.9%), including dedifferentiated liposarcoma (5 cases; 6.8%),pleomorphic liposarcoma (13 cases; 17.8%) and round-cell liposarcoma (3cases; 4.1%). Twenty-two patients (59.45%) were treated by surgery only, and13 patients (35.13%) were treated by a combination of surgery andpostoperative radiotherapy. One patient was treated by surgery, radiotherapyand chemotherapy and died one month after diagnosis. Another patient wastreated by radiotherapy alone and is still alive after a four-year follow-upperiod. The correlation between survival and recurrence with tumor type,location in regard to surgical accessibility, and mode of therapy, was notstatistically significant. Site, histologic type and completeness of surgicalexcision were the most important factors in predicting prognosis and planningtherapy for patients with liposarcoma. The overall prognosis depends on manyvariable factors. Complete surgical excision reduces the recurrence rate. Therole of chemotherapy and radiotherapy is not well established. (author)
Objective: To analyse and document our experiences with maternal mortality with the view of finding the trends over the last seven years, common causes and attributing socio-demographic factors. Design: A prospective analysis of maternal mortality. Setting: State Specialists Hospital Bauchi, Bauchi Northeastern Nigeria.
Thirty of the 75 (2-7 day-old) jaundiced neonates delivered at the Irrua Specialist Teaching Hospital, Irrua, in, Edo State were studied. Of the males, 55.6% were kernicteric, compared to 41.7% of the females. Two neonates who had sepsis had mean weight of 2.51 ± 0.86kg, indicating low birth-weight associated with ...
This study was set in an acute Irish health care setting and aimed to explore the activity of the clinical nurse specialist (CNS) in this setting. Quantitative methodology, using a valid and reliable questionnaire, provided descriptive statistics that gave accurate data on the total population of CNSs in the health care setting. The study was set in an acute-care 750-bed hospital that had 25 CNSs in practice. The sample consisted of all 25 CNSs who are the total population of CNSs working in the acute health care institution. The findings show the CNS to be active in the roles of researcher, educator, communicator, change agent, leader, and clinical specialist, but the level of activity varies between different roles. There is variety in the activity of CNSs in the various roles and to what extent they enact the role. The findings merit further study on CNS role activity and possible variables that influence role activity.
Nurses frequently care for patients who have stomas. A common complication is sore peristomal skin (skin around the stoma). The study aim was to answer the research question: what is the current nursing practice for peristomal skin problems among UK stoma specialist nurses? The question was explored through investigation of descriptions, treatments and opinions of peristomal skin problems. Results were examined to ascertain if practice reflects the literature and if care was evidence-based. A questionnaire was posted in September 2009 to the stoma care nurses in all UK NHS hospitals (n=596). The proportion of completed or partially completed questionnaires was 15% (89 of 596). Most of the responding nurses held a stoma-related qualification (86%), a degree (55%) and had specialised in stoma care for over 5 years (67%). Respondents used erythema to describe sore skin (80%). Stoma powder (98%) and convex appliances (98%) were the most commonly used treatments. The most common cause of sore skin was appliance leakage (61%). The study population was deemed suitably qualified and experienced to answer the research question. Many responses were reflected in the literature (predominantly opinion articles), reflecting a degree of reliability and validity. It could be concluded that stoma specialist nurses can accurately assess and use stoma accessories to treat sore skin, but due to the paucity of research, the care cannot be defined as evidence-based. More research is needed to determine universally accepted definitions and treatments for sore peristomal skin.
Al-Mezaine, H.; Al-Muteb, M.; Al-Motowa, S.; Wagoner, M. D.
To quantify the number of cases and clinical courses of Acanthamoeba keratitis treated at the King Khaled Eye Specialist Hospital (KKESH) between December 1982 and May 2005, and to review their clinical course and response to medical and surgical therapy. Retrospective review of medical records of all patients with Acanthamoeba keratitis diagnosed by the KKESH Microbiology or Pathology or Pathology Laboratory since the opening of the hospital. During a period of over 22 years, only six cases of confirmed. Acanthamoeba keratitis were diagnosedand treated at KKESH. In two cases the diagnosis was made by corneal biopsy, while four cases required examination of a histopathology specimen obtained at the time of therapeutic keratoplasty to establish the diagnosis. One eye was cured by medical therapy, while five eyes required one (4eyes) or two (1 eye) therapeutic penetrating keratoplasty (PKP) to achieve a clinical cure. Three eyes achieved good visual acuity (20/40, 20/50, 20/60), one eye achieved fair visual acuity (20/160), and two eyes suffered profound visual loss (hand motions). The incidence of Acanthamoeba keratitis may be less in Saudi Arabia than reported in Western countries although the clinical is similarly complicated, with most cases requiring therapeutic keratoplasty for definitive education of the organism. (author)
Lamina, S; Hanif, S
Data on incidence of facial palsy is generally lacking in Nigeria. To assess six years' incidence of facial palsy in Murtala Muhammed Specialist Hospital (MMSH), Kano, Nigeria. The records of patients diagnosed as facial problems between January 2000 and December 2005 were scrutinized. Data on diagnosis, age, sex, side affected, occupation and causes were obtained. A total number of 698 patients with facial problems were recorded. Five hundred and ninety four (85%) were diagnosed as facial palsy. Out of the diagnosed facial palsy, males (56.2%) had a higher incidence than females; 20-34 years age group (40.3%) had a greater prevalence; the commonest cause of facial palsy was found out to be Idiopathic (39.1%) and was most common among business men (31.6%). Right sided facial palsy (52.2%) was predominant. Incidence of facial palsy was highest in 2003 (25.3%) and decreased from 2004. It was concluded that the incidence of facial palsy was high and Bell's palsy remains the most common causes of facial (nerve) paralysis.
Mahasin, Z.; Khan, B.
From 1975 to 1985, 202 patients with hypopharyngeal cancer were seen at King Faisal Specialist Hospital and Research Center (KFSHRC). The endoscopic investigation showed that 28.3% of these patients had postcricoid carcinoma; 19.85% had pyriform fossa carcinoma and 52.9% had involvement of both sites. The pathological diagnosis of all cases was squamous cell carcinoma type. The majority of the patients (62.98%) had T4 lesions, which showed a late presentation to KFSHRC. Information related to survival was available for a smaller number of patients to many lost-to-follow-up cases. The overall median survival time was 8.5 months (1-110 months). The survival rate for each site was calculated, as well as the staging of the disease and treatment modality used. It appeared that pyriform fossa (median 21 months) had the best survival rate. In addition the earlier the lesion was detected and the more aggressive the treatment applied, the better the survival rate. Fifty percent of the patients receiving radiation therapy and surgery had a five year survival arte. Factors other than smoking and/on drinking should be looked for in our community as predisposing to this disease in our population. (author)
Silicka, Inese; Ļubkina, Velta
The theoretical aspects of the concept of the professional competences of future hospitality industry specialists are examined and analysed in the paper. The study is carried out within the framework of development of the doctoral thesis “Interrelation of the professional competence theories and the practice in the hospitality industry”. The components and constituent elements of the professional competences of the hospitality industry specialists are defined in the research; the concepts “pr...
Al-Rayes, H.; Al-Sheikh, A.; Al-Dalaan, A.; Al-Saleh, S.
The aim of this study was to assess the clinical presentation, complications and serological analysis of mixed connective tissue disease (MCTD) at King Faisal Specialist Hospital and Research Centre (KFSHRC), and to determine the long-term clinical and immunologic outcomes. This was a retrospective study with prospective follow-up of 18 patients with MCTD who were followed at KFSHRC between 1982 and 1999. The age at onset of the disease ranged from 6 to 44 years, with mean age of 17.9 years. The female to male ratio was 2.5:1 and the mean follow-up time was 5 years. The most frequent presenting symptoms were arthralgia in all patients, Raynaud's phenomenon in 16 patients (88%) and swollen hands in 11 patients (61%). Arthritis was seen in 12 patients in (67%) and definite myositis in 10 patients (58%). The most common skin rashes encountered included lupus-like rash in 8 patients (44%) and cutaneous vasculitis in 5 patients (28%). Pulmonary hypertension occurred in 4 patients (22%). Other clinical manifestations encountered were esophageal hypomotility in 10 patients (56%), myocarditis in 2 patients (11%) and proteinurea in 2 patients (11%), while various neurological manifestations were present in 7 patients (39%). All patients exhibited higher titer of ANA and anti-nRNP antibodies. Five of the 18 patients (28%) had marked reduction in the anti-nRNP during remission. Following treatment, features of inflammation as well as Raynaud's phenomenon and esophageal hypomotility diminished, while pulmonary hypertension persisted. A favorable outcome was observed in 12 patients (67%), 3 patients (17%) had continued active disease, while 3 patients (17%) died, with death related to pulmonary hypertension occurring in 2 patients (11%). The studied patients demonstrated the typical clinical and serological findings of MCTD, which support the correlation between anti-nRNP antibody specificities and MCTD. Autoantibody reactivity against nRNP polypeptides tends to regress during
Mogensen, Christian Backer; Ankersen, Ejnar Skytte; Lindberg, Mats J
. CONCLUSIONS: The GP based HaH model was more effective than the hospital specialist model in avoiding hospital admissions within 7 days among elderly patients with an acute medical condition with no differences in mental or physical recovery rates or deaths between the two models. REGISTRATION: No. NCT......BACKGROUND: Hospital at home (HaH) is an alternative to acute admission for elderly patients. It is unclear if should be cared for a primarily by a hospital intern specialist or by the patient's own general practitioner (GP). The study assessed whether a GP based model was more effective than...... Denmark, including + 65 years old patients with an acute medical condition that required acute hospital in-patient care. The patients were randomly assigned to hospital specialist based model or GP model of HaH care. Five physical and cognitive performance tests were performed at inclusion and after 7...
Weigel, Paula A M; Ullrich, Fred; Ward, Marcia M
Rural bypass for elective surgical procedures is a challenge for critical access hospitals, yet there are opportunities for rural hospitals to improve local retention of surgical candidates through alternative approaches to developing surgery lines of business. In this study we examine the effect of visiting surgical specialists on the odds of rural bypass. Discharge data from the 2011 State Inpatient Databases and State Ambulatory Surgery Databases for Iowa were linked to outreach data from the Office of Statewide Clinical Education Programs and Iowa Physician Information System to model the effect of surgeon specialist supply on rural patients' decision to bypass rural critical access hospitals. Patients in rural communities with a local general surgeon were more likely to be retained in a community than to bypass. Those in communities with visiting general surgeons were more likely to bypass, as were those in communities with visiting urologists and obstetricians. Patients in communities with visiting ophthalmologists and orthopedic surgeons were at higher odds of being retained for their elective surgeries. In addition to known patient and local hospital factors that have an influence on bypass behavior among rural patients seeking elective surgery, availability of surgeon specialists also plays an important role in whether patients bypass or not. Visiting ophthalmologists and orthopedic surgeons were associated with less bypass, as was having local general surgeons. Visiting general surgeons, urologists, and obstetricians were associated with greater odds of bypass. © 2016 National Rural Health Association.
French, Fiona; Ikenwilo, Divine; Scott, Anthony
Despite their rising numbers in the National Health Service (NHS), the recruitment, retention, morale and educational needs of staff and associate specialist hospital doctors have traditionally not been the focus of attention. A postal survey of all staff grades and associate specialists in NHS Scotland was conducted to investigate the determinants of their job satisfaction. Doctors in both grades were least satisfied with their pay. They were more satisfied if they were treated as equal members of the clinical team, but less satisfied if their workload adversely affected the quality of patient care. With the exception of female associate specialists, respondents who wished to become a consultant were less satisfied with all aspects of their jobs. Associate specialists who worked more sessions also had lower job satisfaction. Non-white staff grades were less satisfied with their job compared with their white counterparts. It is important that associate specialists and staff grades are promoted to consultant posts, where this is desired. It is also important that job satisfaction is enhanced for doctors who do not desire promotion, thereby improving retention. This could be achieved through improved pay, additional clinical training, more flexible working hours and improved status.
Manawadu, Dulka; Choyi, Jithesh; Kalra, Lalit
Delays in treatment of in-hospital stroke (IHS) adversely affect patient outcomes. We hypothesised that early referral and specialist management of IHS patients will improve outcomes at 90 days. Baseline characteristics, assessment delays, thrombolysis eligibility, 90-day functional outcomes and all-cause mortality were compared between IHS patients referred for specialist stroke management within 3 hours of symptom onset (early referrals) and later referrals. Patients were identified from a prospective stroke registry between January 2009 and December 2010. Inclusion criteria were primary admission with a non-stroke diagnosis, onset of new neurological deficits after admission and early ischaemic changes on CT or MR imaging. Eighty four (4.6%) of 1836 stroke patients had IHS (mean age 74 year; 51% male, median NIHSS score 10). There were no significant differences in baseline characteristics between 53 (63%) early and 31 (37%) late referrals. Thrombolysis was performed in 29 (76%) of the 37/78 (47%) potentially eligible patients; 7 patients were excluded because specialist referral was delayed beyond 4.5 hours despite symptom recognition within 3 hours of onset. Early referral improved functional outcomes (modified Rankin Scale 0-2 at 90 days 40% v 7%, p = 0.001) and was an independent predictor of mRS 0-2 at 90 days after adjusting for age, pre-morbid function, primary cause for hospital admission and stroke severity [OR 1.13 (95% C.I. = 1.10-1.27), p = 0.002]. Early referral and specialist management of IHS patients that includes thrombolysis is associated with better functional outcomes at 90 days.
Full Text Available Excessive antibiotic consumption and misuse is one of the main factors responsible for the emergence of antibiotic-resistant bacteria and has been associated with increased health care costs. Active intervention is necessary in changing antimicrobial prescribing practices. The Infection Control Committee and the administration of our hospital decided to implement an antibiotic stewardship program beginning in January 2016 in order to reduce inappropriate antibiotic use and to combat antibiotic resistance through improved prescribing practices. The antimicrobial stewardship team includes an ID specialist, physicians, infection control nurses, a microbiologist and a pharmacist who are responsible for the implementation of the program. Preauthorization by an ID specialist and prospective review is necessary for all pharmacy orders of antibiotics under restriction. Pre-intervention, we collected Pharmacy and hospital data regarding antibiotic consumption and numbers of patient-days for the years 2013-2015. We calculated antibiotic use in Defined Daily Doses (DDDs/100 patient-days. After one year, the antibiotic stewardship program was effective in reducing consumption of most antibiotics. The result of the implementation of the program in our hospital was a reduction about 17% of antibiotic DDDs/100 patient-days and about 21% of the antibiotic cost/100 patient-days. Education is an essential element of our program in order to influence prescribing behavior. Lectures and brochures are used to supplement strategies. Antibiotic stewardship programs have been shown from many studies to improve patient outcomes, reduce antibiotic resistance and save money.
Khan, Iftikhar A R; Al-Maghrabi, Mohammad; Kassim, Mohammad Salah; Tawfeeq, Mansour; Al-Saif, Faisal; Al-Oraifi, Ibrahim; Al-Qahtani, Mohammed; Alsaghier, Mohammad
The success of a pediatric kidney transplantation program can only be judged by reviewing its results. We aim to audit our short-term outcome of pediatric kidney transplantation at the King Fahad Specialist Hospital-Dammam. A retrospective chart review was performed to collect data about recipient demographics, etiology of end-stage kidney disease, type of dialysis, type of donor and outcome. Between September 2008 and April 2012, 35 pediatric kidney trans-plantations (need to encourage preemptive transplantation and living donation in this population.
Bridges, J F; Hanson, R M
This paper inquires into the effects that Diagnosis Related Groups (DRGs) have had on the ability to explain patient-level costs in a specialist paediatrics hospital. Two hedonic models are estimated using 1996/97 New Children's Hospital (NCH) patient level cost data, one with and one without a casemix index (CMI). The results show that the inclusion of a casemix index as an explanatory variable leads to a better accounting of cost. The full hedonic model is then used to simulate a funding model for the 1997/98 NCH cost data. These costs are highly correlated with the actual costs reported for that year. In addition, univariate regression indicates that there has been inflation in costs in the order of 4.8% between the two years. In conclusion, hedonic analysis can provide valuable evidence for the design of funding models that account for casemix.
Aldridge, Cassie; Bion, Julian; Boyal, Amunpreet; Chen, Yen-Fu; Clancy, Mike; Evans, Tim; Girling, Alan; Lord, Joanne; Mannion, Russell; Rees, Peter; Roseveare, Chris; Rudge, Gavin; Sun, Jianxia; Tarrant, Carolyn; Temple, Mark; Watson, Sam; Lilford, Richard
Increased mortality rates associated with weekend hospital admission (the so-called weekend effect) have been attributed to suboptimum staffing levels of specialist consultants. However, evidence for a causal association is elusive, and the magnitude of the weekend specialist deficit remains unquantified. This uncertainty could hamper efforts by national health systems to introduce 7 day health services. We aimed to examine preliminary associations between specialist intensity and weekend admission mortality across the English National Health Service. Eligible hospital trusts were those in England receiving unselected emergency admissions. On Sunday June 15 and Wednesday June 18, 2014, we undertook a point prevalence survey of hospital specialists (consultants) to obtain data relating to the care of patients admitted as emergencies. We defined specialist intensity at each trust as the self-reported estimated number of specialist hours per ten emergency admissions between 0800 h and 2000 h on Sunday and Wednesday. With use of data for all adult emergency admissions for financial year 2013-14, we compared weekend to weekday admission risk of mortality with the Sunday to Wednesday specialist intensity ratio within each trust. We stratified trusts by size quintile. 127 of 141 eligible acute hospital trusts agreed to participate; 115 (91%) trusts contributed data to the point prevalence survey. Of 34,350 clinicians surveyed, 15,537 (45%) responded. Substantially fewer specialists were present providing care to emergency admissions on Sunday (1667 [11%]) than on Wednesday (6105 [42%]). Specialists present on Sunday spent 40% more time caring for emergency patients than did those present on Wednesday (mean 5·74 h [SD 3·39] vs 3·97 h [3·31]); however, the median specialist intensity on Sunday was only 48% (IQR 40-58) of that on Wednesday. The Sunday to Wednesday intensity ratio was less than 0·7 in 104 (90%) of the contributing trusts. Mortality risk among patients
Low, Gary K K; Papapreponis, Panayoti; Isa, Ridzuan M; Gan, Seng Chiew; Chee, Hui Yee; Te, Kian Keong; Hatta, Nadia M
Increasing numbers of dengue infection worldwide have led to a rise in deaths due to complications caused by this disease. We present here a cross-sectional study of dengue patients who attended the Emergency and Trauma Department of Ampang Hospital, one of Malaysia's leading specialist hospitals. The objective was to search for potential clustering of severe dengue, in space and/or time, among the annual admissions with the secondary objective to describe the spatio-temporal pattern of all dengue cases admitted to this hospital. The dengue status of the patients was confirmed serologically with the geographic location of the patients determined by residency, but not more specific than the street level. A total of 1165 dengue patients were included in the analysis using SaTScan software. The mean age of these patients was 27.8 years, with a standard deviation of 14.2 years and an age range from 1 to 77 years, among whom 54 (4.6%) were cases of severe dengue. A cluster of general dengue cases was identified occurring from October to December in the study year of 2015 but the inclusion of severe dengue in that cluster was not statistically significant (P=0.862). The standardized incidence ratio was 1.51. General presence of dengue cases was, however, detected to be concentrated at the end of the year, which should be useful for hospital planning and management if this pattern holds.
Full Text Available Background: This study was a cross-sectional survey of children and their mothers in specialist Hospital Gombe, Nigeria. Objective: Anthropometric assessment of nutritional status of the children (0-12 months and a survey of mothers′ opinion on malnutrition. Population: Children and mothers attending immunization sessions in specialist hospital Gombe, Nigeria. Materials and Methods: Hundred children (0-12 months attending immunization sessions were purposefully sampled and measured using sensitive anthropometric tools and techniques, while on the other arm of the study structured interviews were administered on the children′s consenting mothers (100 who turned in for their wards′ immunization. Only 97 out of 100 data collected on the children were used. Anthropometric indices used were height-for-age, weight-for-height, weight-for-age, and mid-upper arm circumference. Results: The study revealed a higher prevalence of moderate stunting in male (46.9% than in female (33.3% children (P 11 exhibited both severe and moderate forms of underweight. Among infants 3-5 months, moderate wasting was found to be less prevalent (4.2%. And despite the fact that 90% of their mothers showed a positive attitude toward exclusive breastfeeding, only 44% of them breastfed their infants exclusively from birth to the 6 th month of life. Conclusion: In order to address the various forms of nutritional derangements detected among the children, mothers should be targeted for infant nutritional education and authorities should institute poverty alleviation measures so as to address underlying causes of malnutrition.
Skelly, Rob; Brown, Lisa; Fakis, Apostolos; Kimber, Lindsey; Downes, Charlotte; Lindop, Fiona; Johnson, Clare; Bartliff, Caroline; Bajaj, Nin
Objective Suboptimal management of Parkinson's disease (PD) medication in hospital may lead to avoidable complications. We introduced an in-patient PD unit for those admitted urgently with general medical problems. We explored the effect of the unit on medication management, length of stay and patient experience. Methods We conducted a single-center prospective feasibility study. The unit's core features were defined following consultation with patients and professionals: specially trained staff, ready availability of PD drugs, guidelines, and care led by a geriatrician with specialty PD training. Mandatory staff training comprised four 1 h sessions: PD symptoms; medications; therapy; communication and swallowing. Most medication was prescribed using an electronic Prescribing and Administration system (iSOFT) which provided accurate data on time of administration. We compared patient outcomes before and after introduction of the unit. Results The general ward care (n = 20) and the Specialist Parkinson's Unit care (n = 24) groups had similar baseline characteristics. On the specialist unit: less Parkinson's medication was omitted (13% vs 20%, p < 0.001); of the medication that was given, more was given on time (64% vs 50%, p < 0.001); median length of stay was shorter (9 days vs 13 days, p = 0.043) and patients' experience of care was better (p = 0.01). Discussion If replicated and generalizable to other hospitals, reductions in length of stay would lead to significant cost savings. The apparent improved outcomes with Parkinson's unit care merit further investigation. We hope to test the hypothesis that specialized units are cost-effective and improve patient care using a randomized controlled trial design. PMID:25264022
Sabey, Abigail; Harris, Michael
Workplace-based assessment (WBPA) was introduced in 2007 as a new approach to monitoring competence of GP specialist trainees (GPSTs). It includes a raft of assessments carried out in the workplace to assess what a trainee actually does in clinical practice. The assessment tools used are adapted from other contexts of doctors' training but little is known about how they function in day-to-day practice within GP training or how valid and useful they are found to be by trainees. To establish how the new system of WPBA is working in day-to-day practice for GPSTs in hospital posts. A mixed methods design including quantitative and qualitative phases of data collection. Two training locations within Severn Deanery. A questionnaire was completed by 52 GPSTs (67% response rate) currently in hospital posts. Twenty-two took part in focus groups and semi-structured interviews to explore key findings from the questionnaire in greater depth. There is value in the face-to-face contact between trainees and senior doctors. However, quality and depth of feedback are not consistent and there is evidence of poor use of the tools, reducing the value of the assessments. The system is further undermined by a clear perception of bias and lack of honesty in judgements which limit the scope for assessment to lead to learning. Overall, these weaknesses may impair the validity and usefulness of the system and its potential to improve the performance of doctors. General practice trainees in this study have a low opinion of how WPBA assessments function in the hospital setting. Changes are needed to optimise the potential of WPBA to improve the performance of doctors in training and to increase its credibility.
Vargas Enriquez, M J; Chazarreta, B; Emilio, D G; Fernandez Sarda, E
This document aims to find relating points between the current and future Clinical Engineer professional in order to discuss about the hospital environment, its characteristics and its realities which lead to our professional development. The main aim is to depict our experience through a retrospective analysis based on the underwriting experience and consequently to arrive at conclusions that will support the inclusion and active interaction of the Clinic Engineer Specialist as part of a Hospital's Surgical Center
Full Text Available Background: An estimate of 250,000 children are born annually with sickle cell disease (SCD worldwide and 75%–85% of the affected children are born in Africa; where mortality rates for those under age 5 years range from 50% to 80%. Objective: The present study was conducted to estimate the prevalence of SCD among children in Plateau State Specialist Hospital (PSSH, Jos, Nigeria. Methodology: Ethical approval was obtained from the Health Research Ethics Committee of the Hospital. Secondary data on age, gender, and region from the case notes of infants, children and/or adolescents; who received medical care in PSSH from 2012 to 2014 were used. Data were analyzed using frequency tables and Chi-square statistics. Results: The findings revealed that the prevalence of SCD in PSSH, Jos from 2012 to 2014 was 26.9/1000 population of pediatric patients. There was a gradual increase in the prevalence rate from 25.8/1000 in 2012 to 26.8/1000 in 2013 and 28.1/1000 in 2014. However, the case fatality rate of SCD gradually decreased from 15.4% in 2012 to 11.1% in 2013 and 10.3% in 2014. Chi-square test shows that the prevalence of the disease in relation to sex, age, and residence was not statistically significant (P > 0.05. Even though the case fatality rate of the disease decreased, its prevalence increased during the study. Conclusion: Therefore, preventive measure for SCD such as premarital genetic screening and counseling should be emphasized, especially in the southern and central geopolitical zones of Plateau state, where the prevalence was found to be higher.
Al-Haj, Abdalla N; Lobriguito, Aida M; Al Anazi, Ibrahim
King Faisal Specialist Hospital & Research Centre (KFSHRC) is the largest specialized medical center in Saudi Arabia. It performs highly specialized diagnostic imaging procedures with the use of various radionuclides required by sophisticated dual imaging systems. As a leading institution in cancer research, KFSHRC uses both long-lived and short-lived radionuclides. KFSHRC established the first cyclotron facility in the Middle East, which solved the in-house high demand for radionuclides and the difficulty in importing them. As both user and producer of high standard radiopharmaceuticals, KFSHRC generates large volumes of low and high level radioactive wastes. An old and small radioactive facility that was used for storage of radioactive waste was replaced with a bigger warehouse provided with facilities that will reduce radiation exposure of the staff, members of the public, and of the environment in the framework of "as low as reasonably achievable." The experiences and the effectiveness of the radiation protection program on handling and storage of radioactive wastes are presented.
Iftikhar A. R. Khan
Full Text Available The success of a pediatric kidney transplantation program can only be judged by reviewing its results. We aim to audit our short-term outcome of pediatric kidney transplantation at the King Fahad Specialist Hospital-Dammam. A retrospective chart review was performed to collect data about recipient demographics, etiology of end-stage kidney disease, type of dialysis, type of donor and outcome. Between September 2008 and April 2012, 35 pediatric kidney trans-plantations (<16 year were performed of a total of 246 kidney transplants (14.2%. The mean age was 8.1 years, with a mean weight of 23.3 kg, and there were 21 (60% boys in the study. Kidney dysplasia/hypoplasia was the most common etiology (51.4%. Pre-emptive kidney transplantation was performed in six (17% patients. Peritoneal dialysis was the most common mode of dialysis [24 (69% children]. Living donation was the source of kidney allografts in 13 (37% cases. During a mean follow-up of 1.5 years, one patient died and one graft was lost due to kidney vein thrombosis. The one year patient and graft survival rates were 97% and 94%, respectively. Efforts should now be focused on achieving optimal long-term results. There is also a need to encourage pre-emptive transplantation and living donation in this population.
Hamid, K M; Onoja, A B; Tofa, U A; Garba, K N
Primary Cytomegalovirus (CMV) infection during pregnancy is a frequent and serious threat to the fetus. As there is no vaccine alternative measures are needed to prevent congenital CMV infection. This study determined CMV Immunoglobulin G (IgG) antibody among pregnant women in order to ascertain the immune status of mothers to guide policy makers. A semi-structured questionnaire was initially administered to obtain information on demographic details, stage of pregnancy and risk factors. Blood was collected by venipuncture from 180 women attending the antenatal clinic in Murtala Mohammed Specialist Hospital Kano, Kano State, Nigeria. Sera samples were screened using CMV IgG ELISA kit (Dialab, Austria). Out of 180 pregnant women, 164 (91.1%) were seropositive. Based on stages of pregnancy 6/6(100%), 52/60(86.7%) and 106/114(93.0%) were seropositive among women in the first, second and third trimesters respectively. Seroprevalence of pregnant women to CMV Ig G is high, hence the need for CMV - IgM screening to know the extent of active infection. There is also need for public enlightenment on the methods of transmission, effective prevention and control strategies.
Silicka, Inese; Dembovska, Iveta
According to the SWOT analysis on the Latvian Tourism Marketing Strategy 2010-2015 carried out by the Tourism Development Agency in 2010, the lack of skilled labour force in tourism and hospitality industry, as well as the low level of professional qualifications are mentioned as one of the potential threats. The aim of the research is to examine and analyse the development of professional competencies of hospitality industry specialists within the framework of completion of the interactive e...
Implementing a working together model for Aboriginal patients with acute coronary syndrome: an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse working together to improve hospital care.
Daws, Karen; Punch, Amanda; Winters, Michelle; Posenelli, Sonia; Willis, John; MacIsaac, Andrew; Rahman, Muhammad Aziz; Worrall-Carter, Linda
Acute coronary syndrome (ACS) contributes to the disparity in life expectancy between Aboriginal and non-Aboriginal Australians. Improving hospital care for Aboriginal patients has been identified as a means of addressing this disparity. This project developed and implemented a working together model of care, comprising an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse, providing care coordination specifically directed at improving attendance at cardiac rehabilitation services for Aboriginal Australians in a large metropolitan hospital in Melbourne. A quality improvement framework using a retrospective case notes audit evaluated Aboriginal patients' admissions to hospital and identified low attendance rates at cardiac rehabilitation services. A working together model of care coordination by an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse was implemented to improve cardiac rehabilitation attendance in Aboriginal patients admitted with ACS to the cardiac wards of the hospital. A retrospective medical records audit showed that there were 68 Aboriginal patients admitted to the cardiac wards with ACS from 1 July 2008 to 30 June 2011. A referral to cardiac rehabilitation was recorded for 42% of these. During the implementation of the model of care, 13 of 15 patients (86%) received a referral to cardiac rehabilitation and eight of the 13 (62%) attended. Implementation of the working together model demonstrated improved referral to and attendance at cardiac rehabilitation services, thereby, has potential to prevent complications and mortality. WHAT IS KNOWN ABOUT THE TOPIC?: Aboriginal Australians experience disparities in access to recommended care for acute coronary syndrome. This may contribute to the life expectancy gap between Aboriginal and non-Aboriginal Australians. WHAT DOES THIS PAPER ADD?: This paper describes a model of care involving an Aboriginal Hospital Liaisons Officer and a specialist cardiac nurse working
Quanjel, Tessa C C; Winkens, Anne; Spreeuwenberg, Marieke D; Struijs, Jeroen N; Winkens, Ron A G; Baan, Caroline A; Ruwaard, Dirk
Consistent evidence on the effects of specialist services in the primary care setting is lacking. Therefore, this study evaluated the effects of an in-house internist at a GP practice on the number of referrals to specialist care in the hospital setting. Additionally, the involved GPs and internist were asked to share their experiences with the intervention. A retrospective interrupted times series study. Two multidisciplinary general practitioner (GP) practices. An internist provided in-house patient consultations in two GP practices and participated in the multidisciplinary meetings. The referral data extracted from the electronic medical record system of the GP practices, including all referral letters from the GPs to specialist care in the hospital setting. The number of referrals to internal medicine in the hospital setting. This study used an autoregressive integrated moving average model to estimate the effect of the intervention taking account of a time trend and autocorrelation among the observations, comparing the pre-intervention period with the intervention period. It was found that the referrals to internal medicine did not statistically significant decrease during the intervention period. This small explorative study did not find any clues to support that an in-house internist at a primary care setting results in a decrease of referrals to internal medicine in the hospital setting. Key Points An in-house internist at a primary care setting did not result in a significant decrease of referrals to specialist care in the hospital setting. The GPs and internist experience a learning-effect, i.e. an increase of knowledge about internal medicine issues.
Gustafsson, Marcus; Wennerholm, Sara; Fridlund, Bengt
Inter-hospital patient transports are required around the clock. During these transports it is the responsibility of the accompanying nurse specialists to ensure their patient's safety, while at the same time providing optimal nursing care in an unusual and often stressful situation. The aim of this study was to explore and describe the nurse specialists' cause of worries and concerns (WaC) and how they manage these. An explorative and qualitative design based on the critical incident technique was used. Interviews were conducted with 30 nurse specialists within the fields of anaesthetic, intensive and pre-hospital care in the south of Sweden. WaC felt by the nurse specialists were based on being unable to influence their work situation, or carry out their tasks as expected. Their responses to these unusual situations were resolved by using internal (acquired knowledge and experience) and external resources (consulting colleagues having different competences). A safe working environment improves the possibility to deliver a satisfactory work performance. Shared experiences and communication between colleagues should be encouraged; teamwork should be enhanced by the implementation of local and national training courses, and unambiguous work guidelines should be given. Copyright 2010 Elsevier Ltd. All rights reserved.
Islam, Sara I.; Moore, C.
Staphyloccocus aureus is known to be a frequent pathogen in hospital settings, with its well-known and resistant forms to the anti-staphylococcal penicillins. Reports on community carriage outside hospital settings have been feared to be on the increase due to the due to the frequency of reported cases on admission to hospitals. We undertook this study to determine the prevalence of and to establish predictors for, nasal carriage of methicillin-resistant S.aureus (MRSA) at the time of admission to a specialist care eye hospital. A prospective survey was conducted at King Khaled Eye Specialist Hospital (KKESH), Riyadh during the three differing weeks randomly selected from the year 1999. The first 100 patients admitted during those three weeks were selected according to inclusion criteria. The hospital is a 220-bed tertiary ophthalmic care facility, with an average 7,500admission per year. Nasal bacterial swabs were taken within 48 hours of admission and tested for all strains of S.aureus and sensitivity to methicillin. Detailed interviews were conducted about medical history and habitual environment. Of 306 nasal cultures tested, none was isolated for MRSA and 102 (33%) were sensitive to methicillin (MSSA).We found 0% nasal carriage rate for MRSA. Respondents have difficulty with questions related to antibiotic administration. No identifiable medical or environmental risk factors could be found. Nasal swabs of patients admitted to KKESH did not reveal MRSA colonization, indicating that MRSA may not be prevalent in the community at present. (author)
Sasikumar, M; Boyer, S; Remacle-Bonnet, A; Ventelou, B; Brouqui, P
This study evaluated the impact of infectious disease (ID) specialist referrals on outcomes in a tertiary hospital in France. This study tackled methodological constraints (selection bias, endogeneity) using instrumental variables (IV) methods in order to obtain a quasi-experimental design. In addition, we investigated whether certain characteristics of patients have a bearing on the impact of the intervention. We used the payments database and ID department files to obtain data for adults admitted with an ID diagnosis in the North Hospital, Marseille from 2012 to 2014. Comparable cohorts were obtained using coarsened exact matching and analysed using IV models. Mortality, readmissions, cost (payer perspective) and length of stay (LoS) were analysed. We recorded 15,393 (85.97%) stays, of which 2,159 (14.03%) benefited from IDP consultations. The intervention was seen to significantly lower the risk of inpatient mortality (marginal effect (M.E) = -19.06%) and cost of stay (average treatment effect (ATE) = - €5,573.39). The intervention group was seen to have a longer LoS (ATE = +4.95 days). The intervention conferred a higher reduction in mortality and cost for stays that experienced ICU care (mortality: odds ratio (OR) =0.09, M.E cost = -8,328.84 €) or had a higher severity of illness (mortality: OR=0.35, M.E cost = -1,331.92 €) and for patients aged between 50 and 65 years (mortality: OR=0.28, M.E cost = -874.78 €). This study shows that ID referrals are associated with lower risk of inpatient mortality and cost of stay, especially when targeted to certain subgroups.
Fabbruzzo-Cota, Christina; Frecea, Monica; Kozell, Kathryn; Pere, Katalin; Thompson, Tamara; Tjan Thomas, Julie; Wong, Angela
The purpose of this clinical nurse specialist-led interprofessional quality improvement project was to reduce hospital-acquired pressure ulcers (HAPUs) using evidence-based practice. Hospital-acquired pressure ulcers (PUs) have been linked to morbidity, poor quality of life, and increasing costs. Pressure ulcer prevention and management remain a challenge for interprofessional teams in acute care settings. Hospital-acquired PU rate is a critical nursing quality indicator for healthcare organizations and ties directly with Mount Sinai Hospital's (MSH's) mission and vision, which mandates providing the highest quality care to patients and families. This quality improvement project, guided by the Donabedian model, was based on the Registered Nurses' Association of Ontario Best Practice Guideline Risk Assessment & Prevention of Pressure Ulcers. A working group was established to promote evidence-based practice for PU prevention. Initiatives such as documentation standardization, development of staff education and patient and family educational resources, initiation of a hospital-wide inventory for support surfaces, and procurement of equipment were implemented to improve PU prevention and management across the organization. An 80% decrease in HAPUs has been achieved since the implementation of best practices by the Best Practice Guideline Pressure Ulcer working group. The implementation of PU prevention strategies led to a reduction in HAPU rates. The working group will continue to work on building interprofessional awareness and collaboration in order to prevent HAPUs and promote an organizational culture that supports staff development, teamwork and communication. This quality improvement project is a successful example of an interprofessional clinical nurse specialist-led initiative that impacts patient/family and organization outcomes through the identification and implementation of evidence-based nursing practice.
Bonell, Simon; Ali, Afia; Hall, Ian; Chinn, Deborah; Patkas, Ioannis
Background: Little has been published regarding the views of family members of people with intellectual disabilities who are being cared for in out-of-area psychiatric hospitals. This study explores this area with specific reference to whether culturally appropriate services were being provided. Materials and Methods: Sixteen family members were…
Despite the advances made in asepsis, antimicrobial drugs, sterilization and operative techniques, surgical site infections (SSI) continue to be a major problem in all branches of surgery in the hospitals. The objective of this study was to establish the incidence of SSI, the type and frequency of various pathogens and their ...
Danny A Asogun
Full Text Available BACKGROUND: Lassa fever is a viral hemorrhagic fever endemic in West Africa. However, none of the hospitals in the endemic areas of Nigeria has the capacity to perform Lassa virus diagnostics. Case identification and management solely relies on non-specific clinical criteria. The Irrua Specialist Teaching Hospital (ISTH in the central senatorial district of Edo State struggled with this challenge for many years. METHODOLOGY/PRINCIPAL FINDINGS: A laboratory for molecular diagnosis of Lassa fever, complying with basic standards of diagnostic PCR facilities, was established at ISTH in 2008. During 2009 through 2010, samples of 1,650 suspected cases were processed, of which 198 (12% tested positive by Lassa virus RT-PCR. No remarkable demographic differences were observed between PCR-positive and negative patients. The case fatality rate for Lassa fever was 31%. Nearly two thirds of confirmed cases attended the emergency departments of ISTH. The time window for therapeutic intervention was extremely short, as 50% of the fatal cases died within 2 days of hospitalization--often before ribavirin treatment could be commenced. Fatal Lassa fever cases were older (p = 0.005, had lower body temperature (p<0.0001, and had higher creatinine (p<0.0001 and blood urea levels (p<0.0001 than survivors. Lassa fever incidence in the hospital followed a seasonal pattern with a peak between November and March. Lassa virus sequences obtained from the patients originating from Edo State formed--within lineage II--a separate clade that could be further subdivided into three clusters. CONCLUSIONS/SIGNIFICANCE: Lassa fever case management was improved at a tertiary health institution in Nigeria through establishment of a laboratory for routine diagnostics of Lassa virus. Data collected in two years of operation demonstrate that Lassa fever is a serious public health problem in Edo State and reveal new insights into the disease in hospitalized patients.
Bartle, David; Finlay, Fiona; Atherton, Fiona
To review paediatric admissions with a primary diagnosis of constipation to see whether some could have been managed in the community instead. A review of the medical notes of all patients admitted with a primary diagnosis of constipation to the children's ward of a district general hospital over a 12-month period. Of 41 admissions (19 girls and 22 boys, age range 6 weeks to 12 years), the average length of stay was less than two nights. The short duration of hospital stay implies rapid improvement. It is likely that many of these children could have been managed in the community if suitable resources, such as a community nurse specialising in constipation, were available.
Yousuf, Husam Bin; Al-Zahrani, A. A.; Al-Sobhi, S.
We describe our experiences of adrenalectomy and compare the results of open and laparoscopic approach. From March 1999 to March 2002 we performed 23 adrenalectomies. An anterior transabdominal approach was used for the open procedure (OP), and a lateral transperitoneal approach for the laparoscopic procedure (LP). There was no difference in tumor size or pathology between the two groups. The tumor size was smaller, operative time was longer and blood loss was was less in (LP). Mean length of hospital stay was shorter, mean time of resumption of oral intake was faster in the LP group. It was concluded that laparoscopic adrenalectomy is a safe procedure that can be performed for most adrenal pathology. It is associated with faster recovery, less postoperative pain, and shorter hospital stay. (author)
... Healthy Children > Family Life > Medical Home > Pediatric Specialists Pediatric Specialists Article Body Your pediatrician may refer your child to a pediatric specialist for further evaluation and treatment. Pediatric specialists ...
Mraihi, Hamza; Chevaux, Fabienne; Castoni, Julien; Aebischer, Oriane; Christou, Foetini; Jaccard, Evrim; Benmachiche, Malik; Tasheva, Plamena; Giroud, Sabine; Kraege, Vanessa; Lamy, Olivier
The year 2016 was rich in significant advances in all areas of internal medicine. Many of them have an impact on our daily practice in general internal medicine. From the treatment of NSTEMI in population older than 80, to new sepsis and septic shock criteria to antidotes of new oral anticoagulants, this selection offers to the readers a brief overview of the major advances. The chief residents in the Service of internal medicine of the Lausanne University hospital are pleased to share their readings.
Sateren, Warren B; Trimble, Edward L; Abrams, Jeffrey; Brawley, Otis; Breen, Nancy; Ford, Leslie; McCabe, Mary; Kaplan, Richard; Smith, Malcolm; Ungerleider, Richard; Christian, Michaele C
We chose to examine the impact of socioeconomic factors on accrual to National Cancer Institute (NCI)-sponsored cancer treatment trials. We estimated the geographic and demographic cancer burden in the United States and then identified 24,332 patients accrued to NCI-sponsored cancer treatment trials during a 12-month period. Next, we examined accrual by age, sex, geographic residence, health insurance status, health maintenance organization market penetration, several proxy measures of socioeconomic status, the availability of an oncologist, and the presence of a hospital with an approved multidisciplinary cancer program. Pediatric patients were accrued to clinical trials at high levels, whereas after adolescence, only a small percentage of cancer patients were enrolled onto clinical trials. There were few differences by sex. Black males as well as Asian-American and Hispanic adults were accrued to clinical trials at lower rates than white cancer patients of the same age. Overall, the highest observed accrual was in suburban counties. Compared with the United States population, patients enrolled onto clinical trials were significantly less likely to be uninsured and more like to have Medicare health insurance. Geographic areas with higher socioeconomic levels had higher levels of clinical trial accruals. The number of oncologists and the presence of approved cancer programs both were significantly associated with increased accrual to clinical trials. We must work to increase the number of adults who enroll onto trials, especially among the elderly. Ongoing partnership with professional societies may be an effective approach to strengthen accrual to clinical trials.
Al-Essa, M.; Sakati, N.; Joshi, S.; Ozand, P.T.; Nounou, R.; Le Quesne, G.; Archibald, A.
Wolman's disease is a rare autosomal recessive lysosomal storage disease. A recent review indicates that approximately 50 patients have reported in the world. Reports of patients from the Arabian Peninsula are rare due to lack of awareness among pediatricians. We retrospectively reviewed the clinical, radiological, biochemical and histopathological findings of four Saudi patients diagnosed with Wolman's disease at King Faisal Hospital and Research Centre. The diagnosis was confirmed by deficient acid lipase activity in the leukocytes and fibroblasts, which was measured using 4-methylumbelliferyl palmitate. All patients were failing to thrive with progressive heptasplenomegaly. Abdominal x-ray revealed calcifications which were confirmed on abdominal CT scan. Peripheral blood film showed foamy histiocytes. Liver biopsy in one patient showed marked steatosis and elliptical empty clefs predominantly in the Kupffer cells, indicating cholesterol storage in the reticulo-endothelial cells. The acid lipase activity was less than 6% in all patients. In all suspected cases of Wolman's disease, a plane abdominal x-ray should be obtained to check for the typical pattern of adrenal calcification characteristic of the disease, especially ant young infant with failure to thrive and progressive hepatosplenomegaly. (author)
Vargas Enriquez, M J; Chazarreta, B; Emilio, D G; Fernandez Sarda, E [Surgical Center-Neurophysiology Division of Medical Tecnology Department, Garrahan Children' s Hospital, Combate de los Pozos 1881, Buenos Aires (Argentina)
This document aims to find relating points between the current and future Clinical Engineer professional in order to discuss about the hospital environment, its characteristics and its realities which lead to our professional development. The main aim is to depict our experience through a retrospective analysis based on the underwriting experience and consequently to arrive at conclusions that will support the inclusion and active interaction of the Clinic Engineer Specialist as part of a Hospital's Surgical Center.
Alsuhaibani Adel H
To present the experience of King Khaled Eye Specialist Hospital (KKESH) with uveal melanoma over the last two decades in a fashion similar to the result of the Collaborative Ocular Melanoma Study (COMS). Retrospective, non-comparative, interventional, case series. All patients were diagnosed with uveal melanoma at the King Khaled Eye Specialist Hospital (KKESH), Riyadh, Saudi Arabia from June 1983 to July 2005 and met the inclusion criteria of the COMS. A medical record review of clinical history, imaging studies, surgical procedures and treatment outcome was performed. Forty patients (24 males and 16 females) with uveal melanoma (average age 50 years; range 24-77 years) were included in the study; 28 (70%) were of Saudi Arabian descent and the remaining 12 (30%) patients were from neighboring Arab countries. Decreased vision was the main presenting complaint of 29 (72.5%) patients; the duration of this symptom was 3 months or more in 27 (67.5%) patients. The apical height of the tumor was 10 mm or more in nine (22.5%) of the affected eyes and the largest basal dimension was more than 16 mm in nine (22.5%) of the affected eyes. The posterior border of the tumor was 1-2 mmfrom the optic disc in three (7.5%) affected eyes. Primary enucleation was performed for 33 (82.5%) eyes, episcleral radiation plaque therapy for six (15%) of the eyes and endo resection of the uveal melanoma in one (2.5%) eye. Adjunct external beam radiation therapy was performed in two (5%) orbits for extrascleral extension. The histopathological diagnosis was available for 34 (84%) eyes in which surgery had been performed (33 patients underwent primary enucleation and one patient underwent endo resection of the uveal melanoma); 24 (70.6%) eyes had spindle cell and the remaining 10 (29.4%) had epithelioid or mixed cell types. Evidence of extraocular tumor extension was found in three eyes. The average follow-up was 33.7 months with a median of 19 months (range 0.5 months to 10 years). Two (5
Obalum, D C; Ogo, C N
Osteoarthritis (OA), a chronic degenerative disease of synovial joints is characterised by pain and stiffness. Aim of treatment is pain relief. Complementary and alternative medicine (CAM) refers to practices which are not an integral part of orthodox medicine. To determine the pattern of usage of CAM among OA patients in Nigeria. Consecutive patients with OA attending orthopaedic clinic of Havana Specialist Hospital, Lagos, Nigeria were interviewed over a 6- month period st st of 1 May to 31 October 2007 on usage of CAM. Structured and open-ended questions were used. Demographic data, duration of OA and treatment as well as compliance to orthodox medications were documented. One hundred and sixty four patients were studied.120 (73.25%) were females and 44(26.89%) were males. Respondents age range between 35-74 years. 66(40.2%) patients used CAM. 35(53.0%) had done so before presenting to the hospital. The most commonly used CAM were herbal products used by 50(75.8%) of CAM users. Among herbal product users, 74.0% used non- specific local products, 30.0% used ginger, 36.0% used garlic and 28.0% used Aloe Vera. Among CAM users, 35(53.0%) used local embrocation and massage, 10(15.2%) used spiritual methods. There was no significant difference in demographics, clinical characteristics and pain control among CAM users and non-users. Many OA patients receiving orthodox therapy also use CAM. Medical doctors need to keep a wary eye on CAM usage among patients and enquire about this health-seeking behaviour in order to educate them on possible drug interactions, adverse effects and long term complications.
Trinidade, A; Yung, M W
A specialist balance clinic to effectively deal with dizzy patients is recommended by ENT-UK. We audit the patient pathway before and following the introduction of a consultant-led dedicated balance clinic. Process evaluation and audit. ENT outpatients department of a district general hospital. The journey of dizzy patients seen in the general ENT clinic was mapped from case notes and recorded retrospectively. A consultant-led, multidisciplinary balance clinic involving an otologist, a senior audiologist and a neurophysiotherapist was then set up, and the journey was prospectively recorded and compared with that before the change. Of the 44 dizzy patients seen in the general clinic, 41% had further follow-up consultations; 64% were given definitive or provisional diagnoses; 75% were discharged without a management plan. Oculomotor examination was not systematically performed. The mean interval between Visits 1 and 2 was 8.4 weeks and the mean number of visits was 3. In the consultant-led dedicated balance clinic, following Visit 1, only 8% of patients required follow-up; 97% received definitive diagnoses, which guided management; all patients left with definitive management plans in place. In all patients, oculomotor assessment was systematically performed and all patients received consultant and, where necessary, allied healthcare professional input. By standardising the management experience for dizzy patients, appropriate and timely treatment can be achieved, allowing for a more seamless and efficient patient journey from referral to treatment. A multidisciplinary balance clinic led by a consultant otologist is the ideal way to achieve this. © 2014 John Wiley & Sons Ltd.
Nisser A. Umar
Full Text Available Aiming to assess the impact of the intervention in reducing the patients’ waiting time in the clinic, two surveys were conducted before and after task shifting intervention in an anti-retroviral (ARV clinic at the Specialist Hospital, Bauchi, Nigeria in November 2008 and April 2009, respectively. Before the task shifting, six nurses from the clinic were trained on integrated management of adolescent and adult illness, as well as on the principle and guidelines for the anti-retroviral therapy, after which their schedule in the clinic was broadened to include seeing HIV patients presenting for routine refill and follow-up visits. In this study, fifty-six and sixty patients, respectively out of 186 and 202 who attended the clinic on the days of the pre- and post-intervention surveys, were randomly sampled. Data on patients’ sex, age and marital status, whether patient a first timer or follow up visitor and the time spent in the clinic on that day as well as the number and composition of staff and equipment in the clinic was collected. The difference in waiting time spent between the first group before task shifting and second group after task shifting was statistically analyzed and significance tested using unpaired t- test. There was a reduction in the average waiting time for patients attending the clinic from 6.48 h before task shifting to 4.35 h after task shifting. The difference of mean was -2.13 h, with 95% CI: -2.44:-1.82 hours and the test of significance by unpaired t-test P
Bakhai, M; Hopster, D; Wakeel, R
A retrospective study was carried out to compare the overall standard of surgical excision of malignant melanomas (MMs) between general practitioners (GPs) and hospital specialists before and after the introduction of the UK melanoma guidelines between 1989 and 2006. In total, 213 melanoma excision reports were examined and surgical excision margins recorded. The results showed a significant difference in the rate of adequate surgical excision margins (at all levels of Breslow thickness) between GPs and hospital specialists, with hospital specialists excising melanomas with safe surgical excision margins at a significantly higher rate compared with GPs. Since the introduction of the guidelines in 2002, GPs showed a significant improvement in the completeness of melanoma excision but remained poor at prehistology diagnosis and in particular at taking adequate excision margins. Implementation of the guidelines has not produced significant improvements in adequacy of excision margins in both primary and secondary care. The results show that hospital specialists maintained a high standard of prehistological diagnosis and completeness of excision throughout the time of the study, performing at a significantly higher standard compared with GPs. Our conclusions concur with the UK melanoma guidelines and the National Institute for Health and Clinical Excellence guidelines, which suggest that lesions suspicious for melanoma should be urgently referred to a dermatologist or plastic surgeon for surgical excision and should not be surgically excised in primary care, particularly if lesions have a Breslow thickness > 2 mm. We suggest that the new guidelines need to be more aggressively implemented in primary care and guidance introduced to improve the accuracy of diagnosis, with better training provided for GPs.
Lizama, Natalia; Johnson, Claire E; Ghosh, Manonita; Garg, Neeraj; Emery, Jonathan D; Saunders, Christobel
To investigate general practitioners' (GP) perceptions about communication when providing cancer care. A self-report survey, which included an open response section, was mailed to a random sample of 1969 eligible Australian GPs. Content analysis of open response comments pertaining to communication was undertaken in order to ascertain GPs' views about communication issues in the provision of cancer care. Of the 648 GPs who completed the survey, 68 (10%) included open response comments about interprofessional communication. Participants who commented on communication were a median age of 50 years and worked 33 h/week; 28% were male and 59% practiced in the metropolitan area. Comments pertaining to communication were coded using five non-mutually exclusive categories: being kept in the loop; continuity of care; relationships with specialists; positive communication experiences; and strategies for improving communication.GPs repeatedly noted the importance of receiving detailed and timely communication from specialists and hospitals, particularly in relation to patients' treatment regimes and follow-up care. Several GPs remarked that they were left out of "the information loop" and that patients were "lost" or "dumped" after referral. While many GPs are currently involved in some aspects of cancer management, detailed and timely communication between specialists and GPs is imperative to support shared care and ensure optimal patient outcomes. This research highlights the need for established channels of communication between specialist and primary care medicine to support greater involvement by GPs in cancer care. © 2015 Wiley Publishing Asia Pty Ltd.
Sieng, Sokha; Hurst, Cameron
This study compares a combination of processes of care and clinical targets among patients with type 2 diabetes mellitus (T2DM) between specialist diabetes clinics (SDCs) and general medical clinics (GMCs), and how differences between these two types of clinics differ with hospital type (community, provincial and regional). Type 2 diabetes mellitus patient medical records were collected from 595 hospitals (499 community, 70 provincial, 26 regional) in Thailand between April 1 to June 30, 2012 resulting in a cross-sectional sample of 26,860 patients. Generalized linear mixed modeling was conducted to examine associations between clinic type and quality of care. The outcome variables of interest were split into clinical targets and process of care. A subsequent subgroup analysis was conducted to examine if the nature of clinical target and process of care differences between GMCs and SDCs varied with hospital type (regional, provincial, community). Regardless of the types of hospitals (regional, provincial, or community) patients attending SDCs were considerably more likely to have eye and foot exam. In terms of larger hospitals (regional and provincial) patients attending SDCs were more likely to achieve HbA1c exam, All FACE exam, BP target, and the Num7Q. Interestingly, SDCs performed better than GMCs at only provincial hospitals for LDL-C target and the All7Q. Finally, patients with T2DM who attended community hospital-GMCs had a better chance of achieving the blood pressure target than patients who attended community hospital-SDCs. Specialized diabetes clinics outperform general medical clinics for both regional and provincial hospitals for all quality of care indicators and the number of quality of care indicators achieved was never lower. However, this better performance of SDC was not observed in community hospital. Indeed, GMCs outperformed SDCs for some quality of care indicators in the community level setting.
Bryant-Lukosius, Denise; Carter, Nancy; Reid, Kim; Donald, Faith; Martin-Misener, Ruth; Kilpatrick, Kelley; Harbman, Patricia; Kaasalainen, Sharon; Marshall, Deborah; Charbonneau-Smith, Renee; DiCenso, Alba
Clinical nurse specialists (CNSs) are major providers of transitional care. This paper describes a systematic review of randomized controlled trials (RCTs) evaluating the clinical effectiveness and cost-effectiveness of CNS transitional care. We searched 10 electronic databases, 1980 to July 2013, and hand-searched reference lists and key journals for RCTs that evaluated health system outcomes of CNS transitional care. Study quality was assessed using the Cochrane Risk of Bias and Quality of Health Economic Studies tools. The quality of evidence for individual outcomes was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. We pooled data for similar outcomes. Thirteen RCTs of CNS transitional care were identified (n = 2463 participants). The studies had low (n = 3), moderate (n = 8) and high (n = 2) risk of bias and weak economic analyses. Post-cancer surgery, CNS care was superior in reducing patient mortality. For patients with heart failure, CNS care delayed time to and reduced death or re-hospitalization, improved treatment adherence and patient satisfaction, and reduced costs and length of re-hospitalization stay. For elderly patients and caregivers, CNS care improved caregiver depression and reduced re-hospitalization, re-hospitalization length of stay and costs. For high-risk pregnant women and very low birthweight infants, CNS care improved infant immunization rates and maternal satisfaction with care and reduced maternal and infant length of hospital stay and costs. There is low-quality evidence that CNS transitional care improves patient health outcomes, delays re-hospitalization and reduces hospital length of stay, re-hospitalization rates and costs. Further research incorporating robust economic evaluation is needed. © 2015 John Wiley & Sons, Ltd.
van Herk, R.; Klazinga, N. S.; Schepers, R. M.; Casparie, A. F.
Medical audit has been introduced among hospital specialists in both the Netherlands and England. In the Netherlands following some local experiments, medical audit was promoted nationally as early as 1976 by the medical profession itself and became a mandatory activity under the Hospital Licensing
Moses A. Ojo
Full Text Available Irrational drug use is associated with adverse consequences including drug resistance and avoidable adverse drug reactions. Studies of rational drug use in psychiatric facilities are scanty. This study evaluated prescription practices and perception of health care professionals regarding causes of irrational drug use. A retrospective study conducted at the outpatient clinic of Federal Neuro- psychiatric Hospital, Yaba, Lagos. Data on drug use indicators were analyzed. A cross-sectional assessment of perception of prescribers and dispensers regarding rational drug use was conducted. A total of 600 prescriptions were analyzed. Mean number of drugs per encounter was 3.5 and percentage generic prescribed was 58.5%. Poly-pharmacy (P=0.024, 95% CI=1.082-1.315 and non-generic prescribing (P=0.032, 95% CI=1.495-1.821 were significantly associated with young prescribers. Factors associated with irrational drug use include demand from patients, patients’ beliefs about injection drugs and influence of pharmaceutical sale representatives. Certain aspect of prescribers indicators are still poor in the hospital studied. Health care professionals identified possible associated factors for irrational drug use. Concerted efforts are required to ensure rational drug use especially in psychiatric facilities in Nigeria.
Garus-Pakowska, Anna; Szatko, Franciszek; Ulrichs, Magdalena
(1) Background: An analysis of work-related accidents in paramedics in Poland by presenting the model and trend of accidents, accident rates and by identifying causes and results of accidents; (2) Methods: A retrospective analysis of medical documentation regarding work-related accidents in a multi-specialist hospital, located in central Poland, in the period 2005-2015. The study group included paramedics who had an accident while being on duty; (3) Results: According to hospital records, 88 paramedics were involved in 390 accidents and 265 injuries caused by sharp instruments. The annual accident rate was 5.34/100 employed paramedics. Most of the accidents occurred at night. The most common reason for the accident was careless behaviour of the paramedic, which resulted in joint sprains and dislocations. Injuries accounted for a huge portion of the total number of events. As many as 45% of injuries were not officially recorded; (4) Conclusion: High rates of work-related accidents and injuries caused by sharp instruments in paramedics are a serious public health problem. Further studies should be conducted in order to identify risk factors of accidents, particularly injuries, and to implement preventative programmes, aiming to minimise rates of occupational hazards for paramedics.
Szatko, Franciszek; Ulrichs, Magdalena
(1) Background: An analysis of work-related accidents in paramedics in Poland by presenting the model and trend of accidents, accident rates and by identifying causes and results of accidents; (2) Methods: A retrospective analysis of medical documentation regarding work-related accidents in a multi-specialist hospital, located in central Poland, in the period 2005–2015. The study group included paramedics who had an accident while being on duty; (3) Results: According to hospital records, 88 paramedics were involved in 390 accidents and 265 injuries caused by sharp instruments. The annual accident rate was 5.34/100 employed paramedics. Most of the accidents occurred at night. The most common reason for the accident was careless behaviour of the paramedic, which resulted in joint sprains and dislocations. Injuries accounted for a huge portion of the total number of events. As many as 45% of injuries were not officially recorded; (4) Conclusion: High rates of work-related accidents and injuries caused by sharp instruments in paramedics are a serious public health problem. Further studies should be conducted in order to identify risk factors of accidents, particularly injuries, and to implement preventative programmes, aiming to minimise rates of occupational hazards for paramedics. PMID:28796193
Aberese-Ako, M.; Agyepong, I.A.; Gerrits, T.; van Dijk, H.
Background and Objectives: This paper analyses why and how conflicts occur and their influence on doctors and nurse-anaesthetists' motivation in the provision of maternal and neonatal health care in a specialist hospital. Methodology: The study used ethnographic methods including participant
... information or questions about the NFCN, contact: HEATHER RADTKE, MS, CGC NF Clinic and Symposium Coordinator hradtke@ ... be listed in this database, please contact Heather Radtke at email@example.com . Alaska Seattle Children’s Hospital ...
Guo, Ping; Dzingina, Mendwas; Firth, Alice M; Davies, Joanna M; Douiri, Abdel; O'Brien, Suzanne M; Pinto, Cathryn; Pask, Sophie; Higginson, Irene J; Eagar, Kathy; Murtagh, Fliss E M
Provision of palliative care is inequitable with wide variations across conditions and settings in the UK. Lack of a standard way to classify by case complexity is one of the principle obstacles to addressing this. We aim to develop and validate a casemix classification to support the prediction of costs of specialist palliative care provision. Phase I: A cohort study to determine the variables and potential classes to be included in a casemix classification. Data are collected from clinicians in palliative care services across inpatient hospice, hospital and community settings on: patient demographics, potential complexity/casemix criteria and patient-level resource use. Cost predictors are derived using multivariate regression and then incorporated into a classification using classification and regression trees. Internal validation will be conducted by bootstrapping to quantify any optimism in the predictive performance (calibration and discrimination) of the developed classification. Phase II: A mixed-methods cohort study across settings for external validation of the classification developed in phase I. Patient and family caregiver data will be collected longitudinally on demographics, potential complexity/casemix criteria and patient-level resource use. This will be triangulated with data collected from clinicians on potential complexity/casemix criteria and patient-level resource use, and with qualitative interviews with patients and caregivers about care provision across difference settings. The classification will be refined on the basis of its performance in the validation data set. The study has been approved by the National Health Service Health Research Authority Research Ethics Committee. The results are expected to be disseminated in 2018 through papers for publication in major palliative care journals; policy briefs for clinicians, commissioning leads and policy makers; and lay summaries for patients and public. ISRCTN90752212. © Article author
Mohammed Abdulrahim Idris
Full Text Available In patients whom are highly sensitized immunologically, the benefit of kidney transplantation can be extended to this population through the utilization of organs from human leukocyte antigen incompatible (HLAi donors. This retrospective observational study was designed to identify the incidence and predictors of acute antibody-mediated rejection/acute cellular rejection (AMR/ACR in our kidney recipients from living kidney donors (sensitized and those with low immunologic risk. This single-center study has been conducted at King Fahad Specialist Hospital, Dammam (KFSH-D, Saudi Arabia; during the period of September 2008- August 2013. All eligible recipients of living donor kidneys during the study period were included (n = 213 in the study. Over 60% of patients in the study were females. Thirty of the 213 kidneys were from HLAi donors. During the follow-up period (median follow-up time = 16 months; 3–27 months, the incidence rate of ACR among HLA compatible (HLAc and HLAi groups was 22.2% and 16.7%, respectively (P >0.05. The incidence rate of AMR was 2.6% in HLAc group and 16.7%in the HLAi group (P<0.05. The significantly higher incidence of AMR in HLAi group can be explained by the presence of the donor-specific antibodies in weak titers. These results are consistent with studies from similar populations in published literature. However, the relatively small number and short duration of the study are considered, and longer follow-up of this population will be needed for conclusions on the sustainability of our findings.
Mårtensson, Solvej; Hansen, KH; Olsen, KR
INTRODUCTION: The primary purposes of preventive child health care in Denmark are to help ensure a healthy childhood and to create preconditions for a healthy adult life. The aim of this study is to examine whether participation in age-appropriate preventative child health care affects...... the number of contacts with a specialist in 2006 was related to participation in preventive child health care between 2002 and 2005. To control for the potential effect of difference in GP behaviour the data were analysed using a multilevel Poisson model linking each child to the GP with whom he or she...... was listed. RESULTS: If the children attended any preventive child health care visits, they had the same probability of contact with a specialist regardless of the parents' income. However, children from low-income families not participating in any preventive care had a lower probability of contact...
Zaman, Babar; Khandekar, Rajiv; Al Shahwan, Sami; Song, Jonathan; Al Jadaan, Ibrahim; Al Jiasim, Leyla; Owaydha, Ohood; Asghar, Nasira; Hijazi, Amar; Edward, Deepak P
In this brief communication, we present the steps used to establish a web-based congenital glaucoma registry at our institution. The contents of a case report form (CRF) were developed by a group of glaucoma subspecialists. Information Technology (IT) specialists used Lime Survey softwareTM to create an electronic CRF. A MY Structured Query Language (MySQL) server was used as a database with a virtual machine operating system. Two ophthalmologists and 2 IT specialists worked for 7 hours, and a biostatistician and a data registrar worked for 24 hours each to establish the electronic CRF. Using the CRF which was transferred to the Lime survey tool, and the MYSQL server application, data could be directly stored in spreadsheet programs that included Microsoft Excel, SPSS, and R-Language and queried in real-time. In a pilot test, clinical data from 80 patients with congenital glaucoma were entered into the registry and successful descriptive analysis and data entry validation was performed. A web-based disease registry was established in a short period of time in a cost-efficient manner using available resources and a team-based approach.
Krüger, C; Lewis, C
The slow discharge of long-term psychiatry patients from Weskoppies Hospital into the community has not matched the national and international drive towards deinstitutionalisation. This article investigates patient and social work factors related to successful community placement, in the context of limited community care facilities. Thirty-six long-term patients who were successfully placed outside of the hospital during a seven month period were compared to 235 unplaced long-term patients in terms of demographic and clinical variables. Social work services were analysed in terms of which patients received the most interventions, and the most common type of interventions. The most significant patient factors associated with successful placement were: female patients; medium-to-high level of functioning; having involved relatives living far away; a low frequency of behavioural problems (especially of cannabis abuse, verbal or physical aggression, uncontrolled sexual activity), and agitation or restlessness. These patient factors were mirrored in the social work services rendered to the long-term patients during the study period: The recipients were mostly female, in open wards (higher-functioning); and the social services utilised were mostly related to planning for placement and patient support. The lack of community care facilities in the Pretoria area that are able to care for the more difficult long-term psychiatry patients, limits successful placement and increases the burden of hospital based social workers. The problem cannot be resolved at a hospital level and needs to be addressed in the context of provincial and national health departments.
Eassey, Daniela; McLachlan, Andrew J; Brien, Jo-Anne; Krass, Ines; Smith, Lorraine
Research has shown that patients are most susceptible to medication-related problems (MRPs) when transitioning from hospital to home. Currently, the literature in this area focuses on interventions, which are mainly orientated around the perspective of the health-care professional and do not take into account patient perspectives and experiences. To capture the experiences and perceptions of Australian patients regarding MRPs following discharge from hospital. A cross-sectional study was conducted using a questionnaire collecting quantitative and qualitative data. Thematic analysis was conducted of the qualitative data. Survey participants were recruited through The Digital Edge, an online market research company. Five hundred and six participants completed the survey. A total of 174 participants self-reported MRPs. Two concepts and seven subthemes emerged from the analysis. The first concept was types of MRPs and patient experiences. Three themes were identified: unwanted effects from medicines, confusion about medicines and unrecognized medicines. The second concept was patient engagement in medication management, of which four themes emerged: informing patients, patient engagement, communication amongst health-care professionals and conflicting advice. This study provides an important insight into patients' experiences and perceptions of MRPs following discharge from hospital. Future direction for practice and research should look into implementing patient-centred care at the time of hospital discharge to ensure the provision of clear and consistent information, and developing ways to support and empower patients to ensure a smooth transition post-discharge from hospital. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.
Gasparyan, Armen Yuri; Yessirkepov, Marlen; Voronov, Alexander A.; Trukhachev, Vladimir I.; Kostyukova, Elena I.; Gerasimov, Alexey N.; Kitas, George D.
Specialist bibliographic databases offer essential online tools for researchers and authors who work on specific subjects and perform comprehensive and systematic syntheses of evidence. This article presents examples of the established specialist databases, which may be of interest to those engaged in multidisciplinary science communication. Access to most specialist databases is through subscription schemes and membership in professional associations. Several aggregators of information and d...
Full Text Available This paper analyses why and how conflicts occur and their influence on doctors and nurse-anaesthetists' motivation in the provision of maternal and neonatal health care in a specialist hospital.The study used ethnographic methods including participant observation, conversation and in-depth interviews over eleven months in a specialist referral hospital in Ghana. Qualitative analysis software Nvivo 8 was used for coding and analysis of data. Main themes identified in the analysis form the basis for interpreting and reporting study findings.Ethical clearance was obtained from the Ghana Health Service Ethics Review board (approval number GHS-ERC:06/01/12 and from the University of Wageningen. Written consent was obtained from interview participants, while verbal consent was obtained for conversations. To protect the identity of the hospital and research participants pseudonyms are used in the article and the part of Ghana in which the study was conducted is not mentioned.Individual characteristics, interpersonal and organisational factors contributed to conflicts. Unequal power relations and distrust relations among doctors and nurse-anaesthetists affected how they responded to conflicts. Responses to conflicts including forcing, avoiding, accommodating and compromising contributed to persistent conflicts, which frustrated and demotivated doctors and nurse-anaesthetists. Demotivated workers exhibited poor attitudes in collaborating with co-workers in the provision of maternal and neonatal care, which sometimes led to poor health worker response to client care, consequently compromising the hospital's goal of providing quality health care to clients.To improve health care delivery in health facilities in Ghana, health managers and supervisors need to identify conflicts as an important phenomenon that should be addressed whenever they occur. Effective mechanisms including training managers and health workers on conflict management should be put in
Aberese-Ako, Matilda; Agyepong, Irene Akua; Gerrits, Trudie; Van Dijk, Han
Background and Objectives This paper analyses why and how conflicts occur and their influence on doctors and nurse-anaesthetists' motivation in the provision of maternal and neonatal health care in a specialist hospital. Methodology The study used ethnographic methods including participant observation, conversation and in-depth interviews over eleven months in a specialist referral hospital in Ghana. Qualitative analysis software Nvivo 8 was used for coding and analysis of data. Main themes identified in the analysis form the basis for interpreting and reporting study findings. Ethics Statement Ethical clearance was obtained from the Ghana Health Service Ethics Review board (approval number GHS-ERC:06/01/12) and from the University of Wageningen. Written consent was obtained from interview participants, while verbal consent was obtained for conversations. To protect the identity of the hospital and research participants pseudonyms are used in the article and the part of Ghana in which the study was conducted is not mentioned. Results Individual characteristics, interpersonal and organisational factors contributed to conflicts. Unequal power relations and distrust relations among doctors and nurse-anaesthetists affected how they responded to conflicts. Responses to conflicts including forcing, avoiding, accommodating and compromising contributed to persistent conflicts, which frustrated and demotivated doctors and nurse-anaesthetists. Demotivated workers exhibited poor attitudes in collaborating with co-workers in the provision of maternal and neonatal care, which sometimes led to poor health worker response to client care, consequently compromising the hospital's goal of providing quality health care to clients. Conclusion To improve health care delivery in health facilities in Ghana, health managers and supervisors need to identify conflicts as an important phenomenon that should be addressed whenever they occur. Effective mechanisms including training managers
Aberese-Ako, Matilda; Agyepong, Irene Akua; Gerrits, Trudie; Van Dijk, Han
This paper analyses why and how conflicts occur and their influence on doctors and nurse-anaesthetists' motivation in the provision of maternal and neonatal health care in a specialist hospital. The study used ethnographic methods including participant observation, conversation and in-depth interviews over eleven months in a specialist referral hospital in Ghana. Qualitative analysis software Nvivo 8 was used for coding and analysis of data. Main themes identified in the analysis form the basis for interpreting and reporting study findings. Ethical clearance was obtained from the Ghana Health Service Ethics Review board (approval number GHS-ERC:06/01/12) and from the University of Wageningen. Written consent was obtained from interview participants, while verbal consent was obtained for conversations. To protect the identity of the hospital and research participants pseudonyms are used in the article and the part of Ghana in which the study was conducted is not mentioned. Individual characteristics, interpersonal and organisational factors contributed to conflicts. Unequal power relations and distrust relations among doctors and nurse-anaesthetists affected how they responded to conflicts. Responses to conflicts including forcing, avoiding, accommodating and compromising contributed to persistent conflicts, which frustrated and demotivated doctors and nurse-anaesthetists. Demotivated workers exhibited poor attitudes in collaborating with co-workers in the provision of maternal and neonatal care, which sometimes led to poor health worker response to client care, consequently compromising the hospital's goal of providing quality health care to clients. To improve health care delivery in health facilities in Ghana, health managers and supervisors need to identify conflicts as an important phenomenon that should be addressed whenever they occur. Effective mechanisms including training managers and health workers on conflict management should be put in place
Gaertner, Jan; Siemens, Waldemar; Antes, Gerd; Meerpohl, Joerg J; Xander, Carola; Schwarzer, Guido; Stock, Stephanie; Becker, Gerhild
Specialist palliative care (SPC) interventions aim to relieve and prevent suffering in the physical, psychological, social, and spiritual domain. Therefore, SPC is carried out by a multi-professional team with different occupations (e.g., physician, nurse, psychologist, and social worker). Remaining skepticism concerning the need for SPC may be based on the scarcity of high-quality evaluations about the external evidence for SPC. Therefore, we will conduct a systematic review according to Cochrane standards to examine the effects of SPC for adults with advanced illness. The comprehensive systematic literature search will include randomized controlled trials (RCTs) and cluster RCTs. We will search the databases MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and PsycINFO. Patients must be adults suffering from life-limiting diseases. Proxy and caregiver outcomes will not be assessed in order to ensure a clear and well-defined research question for this review. Interventions may be in an in- or outpatient setting, e.g., consulting service, palliative care ward, and palliative outpatient clinic. In line with the multi-dimensional scope of palliative care, the primary outcome is quality of life (QoL). Key secondary outcomes are patients' symptom burden, place of death and survival, and health economic aspects. Subgroup analysis will assess results according to cancer type, age, early vs not early SPC, site of care, and setting. Analysis will be performed with the current RevMan software. We will use the Cochrane Collaboration risk of bias assessment tool. The quality of evidence will be judged according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The available evidence will be summarized and discussed to provide a basis for decision-making among health care professionals and policy makers. For SPC, we believe that multi-professional care is of utmost importance. Therefore, single
Department of Homeland Security — This database contains locations of Hospitals for 50 states and Washington D.C. , Puerto Rico and US territories. The dataset only includes hospital facilities and...
Stefanati, Armando; Brosio, Federica; Kuhdari, Parvanè; Baccello, Valeria; De Paris, Paola; Nardini, Marco; Boschetto, Piera; Lupi, Silvia; Gabutti, Giovanni
The hospital as a work environment is particularly characterized by various risks for healthcare workers (HCWs). The main risk is represented by biological accidents, associated with the parenteral transmission of pathogens. Biological injuries can occur during the care service and the manipulation of biological fluids. Hepatitis B (and hepatitis D), hepatitis C and HIV are the most common infections transmitted by biological injuries. Physicians should acquire awareness of the risks associated with their professional activity during their training as medical residents (MRs). Some infectious diseases are preventable by vaccination and the "National Immunization Plan 2017-2019" (PNPV) recommends HCWs vaccination against hepatitis B, influenza, measles -mumps -rubella, chicken pox, and pertussis. Besides, not only HCWs' vaccination can prevent the disease in healthcare professionals, but it also may reduce the transmission to patients. Therefore, active immunization of HCWs by recommended vaccinations plays an important role to prevent disease cases, complications and death in patients. An increased awareness of risk behaviors is the first important point to address in order to reduce biological accidents and infectious diseases transmission, so as to reduce their frequency. Besides, HCWs' vaccination is useful to reinforce protection and to prevent the transmission of some infectious diseases in case of exposure. The aim of this five-year incidence study is to investigate the MRs' biological accidents characteristics and to analyze the MRs' immune status at the University of Ferrara in the period 2011-2015. Data on MRs' biological accidents and immune status at Azienda Ospedaliero-Universitaria of Ferrara in 2011-2015 were analyzed by Microsoft Excel 2007 Software. In this study, the percentage of MRs' biological injuries compared to the total number of MRs showed an annual variability, with a peak in 2011 (11.9%). During the analyzed period, there were 190
Houwen, L G H J Louis
The reforms in the field of medical specialist care have important implications for the professional practice of medical specialists and their working relationship with the hospital. This leads to a considerable amount of pressure placed upon the way physicians have traditionally practiced their liberal professions, which is by forming partnerships and practicing from within the hospitals based on an admission agreement. As of 2015, the tax benefits for entrepreneurs will be abolished and the formation of regional partnerships will be discouraged. These developments not only pose threats but also offer opportunities for both the entrepreneurial medical specialist and the innovative hospital. In this article, the prospect of a future business model for specialist medical care will be outlined and explored by proposing three new organizational forms. The central vision of this model is that physicians who wish to retain their status of liberal professional practitioners in the twenty-first century should be more involved in the ownership structure of hospitals. The social importance of responsible patient care remains paramount.
Health service costs and clinical gains of psychotherapy for personality disorders: a randomized controlled trial of day-hospital-based step-down treatment versus outpatient treatment at a specialist practice
Background Day-hospital-based treatment programmes have been recommended for poorly functioning patients with personality disorders (PD). However, more research is needed to confirm the cost-effectiveness of such extensive programmes over other, presumably simpler, treatment formats. Methods This study compared health service costs and psychosocial functioning for PD patients randomly allocated to either a day-hospital-based treatment programme combining individual and group psychotherapy in a step-down format, or outpatient individual psychotherapy at a specialist practice. It included 107 PD patients, 46% of whom had borderline PD, and 40% of whom had avoidant PD. Costs included the two treatment conditions and additional primary and secondary in- and outpatient services. Psychosocial functioning was assessed using measures of global (observer-rated GAF) and occupational (self-report) functioning. Repeated assessments over three years were analysed using mixed models. Results The costs of step-down treatment were higher than those of outpatient treatment, but these high costs were compensated by considerably lower costs of other health services. However, costs and clinical gains depended on the type of PD. For borderline PD patients, cost-effectiveness did not differ by treatment condition. Health service costs declined during the trial, and functioning improved to mild impairment levels (GAF > 60). For avoidant PD patients, considerable adjuvant health services expanded the outpatient format. Clinical improvements were nevertheless superior to the step-down condition. Conclusion Our results indicate that decisions on treatment format should differentiate between PD types. For borderline PD patients, the costs and gains of step-down and outpatient treatment conditions did not differ. For avoidant PD patients, the outpatient format was a better alternative, leaning, however, on costly additional health services in the early phase of treatment. Trial
Gasparyan, Armen Yuri; Yessirkepov, Marlen; Voronov, Alexander A; Trukhachev, Vladimir I; Kostyukova, Elena I; Gerasimov, Alexey N; Kitas, George D
Specialist bibliographic databases offer essential online tools for researchers and authors who work on specific subjects and perform comprehensive and systematic syntheses of evidence. This article presents examples of the established specialist databases, which may be of interest to those engaged in multidisciplinary science communication. Access to most specialist databases is through subscription schemes and membership in professional associations. Several aggregators of information and database vendors, such as EBSCOhost and ProQuest, facilitate advanced searches supported by specialist keyword thesauri. Searches of items through specialist databases are complementary to those through multidisciplinary research platforms, such as PubMed, Web of Science, and Google Scholar. Familiarizing with the functional characteristics of biomedical and nonbiomedical bibliographic search tools is mandatory for researchers, authors, editors, and publishers. The database users are offered updates of the indexed journal lists, abstracts, author profiles, and links to other metadata. Editors and publishers may find particularly useful source selection criteria and apply for coverage of their peer-reviewed journals and grey literature sources. These criteria are aimed at accepting relevant sources with established editorial policies and quality controls.
Specialist bibliographic databases offer essential online tools for researchers and authors who work on specific subjects and perform comprehensive and systematic syntheses of evidence. This article presents examples of the established specialist databases, which may be of interest to those engaged in multidisciplinary science communication. Access to most specialist databases is through subscription schemes and membership in professional associations. Several aggregators of information and database vendors, such as EBSCOhost and ProQuest, facilitate advanced searches supported by specialist keyword thesauri. Searches of items through specialist databases are complementary to those through multidisciplinary research platforms, such as PubMed, Web of Science, and Google Scholar. Familiarizing with the functional characteristics of biomedical and nonbiomedical bibliographic search tools is mandatory for researchers, authors, editors, and publishers. The database users are offered updates of the indexed journal lists, abstracts, author profiles, and links to other metadata. Editors and publishers may find particularly useful source selection criteria and apply for coverage of their peer-reviewed journals and grey literature sources. These criteria are aimed at accepting relevant sources with established editorial policies and quality controls. PMID:27134485
Morán López, Jesús Manuel; Piedra León, María; Enciso Izquierdo, Fidel Jesús; Luengo Pérez, Luis Miguel; Amado Señaris, José Antonio
Adequate nutritional support includes many different aspects, but poor understanding of clinical nutrition by health care professionales often results in an inadequate prescription. A study was conducted to compare enteral and parenteral nutritional support plans prescribed by specialist and non-specialist physicians. Non-specialist physicians recorded anthropometric data from only 13.3% of patients, and none of them performed nutritional assessments. Protein amounts provided by non-specialist physicians were lower than estimated based on ESPEN (10.29g of nitrogen vs 14.62; Pspecialist group (14.88g of nitrogen; P=.072). Calorie and glutamine provision and laboratory controls prescribed by specialists were significantly closer to those recommended by clinical guidelines. Nutritional support prescribed by specialists in endocrinology and nutrition at San Pedro de Alcántara Hospital was closer to clinical practice guideline standards and of higher quality as compared to that prescribed by non-specialists. Copyright © 2015 SEEN. Published by Elsevier España, S.L.U. All rights reserved.
Kille, Michael O.
This four-volume student text is designed for use by Air Force personnel enrolled in a self-study extension course for optometry specialists. Covered in the individual volumes are optometry clinic administration (optometry career and field training, ethical relationships and professionalism, eligibility for optometric care and appointment…
The challenge could be briefly seen in these terms: hospitals as places for treatment where there’s a technology focus and hospitals for healing where there’s a human focus. In the 60s - 70s wave of new hospital building, an emphasis on technology can be seen. It’s time to move from the technology...... focus. It is not enough to consider only the factors of function within architecture, hygiene, economy and logistics. We also need to look at aspects of aesthetics, bringing nature into the building, art, color, acoustics, volume and space as we perceive them. Contemporary methods and advances...... placed, accessible, provided with plenty of greenery, and maximize sensory impressions, providing sounds, smells, sight and the possibility to be touched. This is a very well documented area I can say. Hygiene, in terms of architecture can give attention to hand wash facilities and their positioning...
... medical professionals? When do I need an ID specialist? Many common infections can be treated by your ... diseases. Back to Top How was my ID specialist trained? Your ID Physician has 9-10 years ...
Situation of preparation of nuclear energy specialists in Lithuania is presented. Nuclear engineers are being prepared at Kaunas University of Technology. In view with decision to decommission Unit 1, the Ignalina NPP is limiting the number of new personnel to fill in vacancies. The main attention is given to the training courses for improvement skills of existing Ignalina NPP, VATESI personnel. Main topics of the training courses are listed. Comparison with previous years on personnel hired and dismissed in Ignalina NPP is made
Abuja is Nigeria's capital with a population of about 4 million residents. There are a total of fourteen public general and specialist hospitals with 6 consultant Urologists working in only three of these hospital serving the population. It is not known what proportion of the total surgical workload in Abuja is urological. Objective: ...
Stayko I. Spiridonov
Full Text Available Purpose: In the resent years the healthcare system has moved to inter-professional, cross-disciplinary, multi-person approach where the communications are very important for ensuring patient safety. Communication in health organisations needs to be studied and analysed deeply and comprehensively because the future of an organisation often depends on good communication. The purpose of this study is to investigate and analyse the reasons for ineffective communication between medical specialists in the teams they work in. Materials and Methods: A questionnaire method is used. Through a survey over a period of 12 months (from 01. 12. 2014 to 01. 12. 2015 at the Escullap Hospital in Pazardzhik, DCC 18 - Sofia, St. Mina Hospital in Plovdiv, MHAT – Plovdiv, DCC 1 in Haskovo, UMHAT in Stara Zagora, DCC 3 in Varna and MHAT – Parvomay, was studied and analyzed the opinion of medical specialists on the effectiveness of communication within the team they work in. The survey includes 477 medical specialists. Results and conclusions: According to 41.1% of the respondents, the communication in the team they work in is insufficiently effective. Most of the respondents (39.8% find their colleagues responsible for the ineffective communication, followed by those who seek the cause for poor communication in the management of the health care facility (27.6%. The leading cause of poor communication in the team according to the study participants is the inequality between the characters of the colleagues (41.9%. According to the majority of respondents (28.3%, improvements in facilities and wage increases (27.3% would be essential to improve communication within the team they work in. Recommendations have been formulated to improve communication among medical specialists.
Preparation system of nuclear energy specialists in Lithuania is presented. Nuclear engineers are being prepared at Kaunas University of Technology. Post-graduates students usually continue studies at Obninsk Nuclear Energy Institute in Russia. Many western countries like Sweden, Finland and US is providing assistance in education of Lithuanian specialists. Many of them were trained in these countries
van der Burgt, Stéphanie M E; Kusurkar, Rashmi A; Wilschut, Janneke A; Tjin A Tsoi, Sharon L N M; Croiset, Gerda; Peerdeman, Saskia M
Medical specialists face the challenge of maintaining their knowledge and skills and continuing professional development, that is, lifelong learning. Motivation may play an integral role in many of the challenges facing the physician workforce today including maintenance of a high performance. The aim of this study was to determine whether medical specialists show different motivational profiles and if these profiles predict differences in motivation for lifelong learning. An online questionnaire was sent to every medical specialist working in five hospitals in the Netherlands. The questionnaire included the validated Multidimensional Work Motivation Scale and the Jefferson Scale of Physician Lifelong Learning together with background questions like age, gender, and type of hospital. Respondents were grouped into different motivational profiles by using a two-step clustering approach. Four motivational profiles were identified: (1) HAMC profile (for High Autonomous and Moderate Controlled motivation), (2) MAMC profile (for Moderate Autonomous and Moderate Controlled motivation), (3) MALC profile (for Moderate Autonomous and Low Controlled motivation), and (4) HALC profile (for High Autonomous and Low Controlled motivation). Most of the female specialists that work in an academic hospital and specialists with a surgical specialty were represented in the HALC profile. Four motivational profiles were found among medical specialists, differing in gender, experience and type of specialization. The profiles are based on the combination of autonomous motivation (AM) and controlled motivation (CM) in the specialists. The profiles that have a high score on autonomous motivation have a positive association with lifelong learning.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work
... History Resource Center Patients Thyroid Information Find an Endocrinology – Thyroid Specialist Patient Support Links Clinical Thyroidology for ... Access Thyroid Online Access Clinical Thyroidology Online Video Endocrinology Donate Give Online Research Accomplishments Ridgway Legacy Fund ...
... Text Size Email Print Share What is a Pediatric Infectious Diseases Specialist? Page Content Article Body If ... the teen years. What Kind of Training Do Pediatric Infectious Diseases Specialists Have? Pediatric infectious diseases specialists ...
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This is a prospective study of all cases of motorcycle related accidents with involvement of the eyes seen at the Irrua Specialist Teaching Hospital from January 2005 to December 2005. The study was conducted to assess the severity of ocular trauma, ocular structures mostly affected and initial effect on visual acuity in such ...
This cross-sectional study sought to estimate the direct medical cost of Lassa fever treatment on patients in South-South Nigeria. All the 73 confirmed Lassa fever cases admitted in the isolation ward of the Institute Of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital (ISTH) Irrua, in Edo State, Nigeria, ...
Clifton, J S [University College Hospital, London (United Kingdom)
Since to most clinicians physical and computer science are two of the great mysteries of the world, the physicist in a hospital is expected by clinicians to be fully conversant with, and competent to make profound pronouncements on, all methods of computing. specific computing problems, and the suitability of computing machinery ranging from desk calculators to Atlas. This is not surprising since the proportion of the syllabus devoted to physics and mathematics in an M. B. degree is indeed meagre, and the word 'computer' has been surrounded with an aura of mysticism which suggests that it is some fantastic piece of electronic gadgetry comprehensible only to a veritable genius. The clinician consequently turns to the only scientific colleague with whom he has direct contact - the medical physicist - and expects him to be an authority. The physicist is thus thrust, however unwillingly, into the forefront of the advance of computer assistance to scientific medicine. It is therefore essential for him to acquire sufficient knowledge of computing science to enable him to provide satisfactory answers for the clinicianst queries, to proffer more detailed advice as to programming convince clinicians that the computer is really a 'simpleton' which can only add and subtract and even that only under instruction.
Cunningham, S. J.; Bateman, L. E.; Collins, J. M.
Objective: To identify factors affecting work-life balance amongst male and female orthodontists in the United Kingdom. Design: A qualitative interview-based study with a cross-sectional design. Subjects: Specialist orthodontists working in specialist practice and the hospital service in the United Kingdom were selected by purposive sampling. Methods: In-depth semi-structured interviews were conducted with eighteen orthodontic specialists. Interview transcripts were analysed using Framework A...
Gruen, Russell; Bailie, Ross
People in remote Aboriginal communities in the Northern Territory have greater morbidity and mortality than other Australians, but face considerable barriers when accessing hospital-based specialist services. The Specialist Outreach Service, which began in 1997, was a novel policy initiative to improve access by providing a regular multidisciplinary visiting specialist services to remote communities. It led to two interesting juxtapositions: that of 'state of the art' specialist services alongside under-resourced primary care in remote and relatively traditional Aboriginal communities; and that of attempts to develop an evidence base for the effectiveness of outreach, while meeting the short-term evaluative requirements of policy-makers. In this essay, first we describe the development of the service in the Northern Territory and its initial process evaluation. Through a Cochrane systematic review we then summarise the published research on the effectiveness of specialist outreach in improving access to tertiary and hospital-based care. Finally we describe the findings of an observational population-based study of the use of specialist services and the impact of outreach to three remote communities over 11 years. Specialist outreach improves access to specialist care and may lessen the demand for both outpatient and inpatient hospital care. Specialist outreach is, however, dependent on well-functioning primary care. According to the way in which outreach is conducted and the service is organised, it can either support primary care or it can hinder primary care and, as a result, reduce its own effectiveness.
Steltenkamp Carol L
Full Text Available Abstract Background Information transfer is critical in the primary care to specialist referral process and has been examined extensively in the US and other countries, yet there has been little attention to the patient's perspective of the information transfer process. This cross-sectional study examined the quality of the information received by patients with a chronic condition from the referring and specialist physician in the specialist referral process and the relationship of the quality of information received to trust in the physicians. Methods Structured telephone interviews were conducted with a random sample of 250 patients who had experienced a referral to a specialist for the first visit for a chronic condition within the prior six months. The sample was selected from the patients who visited specialist physicians at any of the 500 hospitals from the National Research Corporation client base. Results Most patients (85% received a good explanation about the reason for the specialist visit from the referring physician yet 26% felt unprepared about what to expect. Trust in the referring physician was highly associated with the preparatory information patients received. Specialists gave good explanations about diagnosis and treatment, but 26% of patients got no information about follow-up. Trust in the specialist correlated highly with good explanations of diagnosis, treatment, and self-management. Conclusion Preparatory information from referring physicians influences the quality of the referral process, the subsequent coordination of care, and trust in the physician. Changes in the health care system can improve the information transfer process and improve coordination of care for patients.
... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Specialist. 552.236-72... FORMS SOLICITATION PROVISIONS AND CONTRACT CLAUSES Text of Provisions and Clauses 552.236-72 Specialist. As prescribed in 536.570-3, insert the following clause: Specialist (APR 1984) The term “Specialist...
Air Univ., Gunter AFS, Ala. Extension Course Inst.
This eight-volume student text is designed for use by Air Force personnel enrolled in a self-study extension course for pest management specialists. Covered in the individual volumes are civil engineering; pest management (entomology, pest management planning and coordination, and safety and protective equipment); pest management chemicals and…
Rock, Samuel K., Jr.; Chagalis, George P.
The Basic Medical Specialist course has one of the largest enrollments of the U.S. Army's Academy of Health Sciences; 11,000 soldiers were trained in this course in 1977 and 1978. Training encompasses both emergency first aid (for field medics) and basic nursing skills. A task force working to improve Army training developed this course, in…
... and therapists will show you how to use pieces of equipment, like crutches, if you need them. Some hospitals have child life specialists. Their job is to make sure kids in the hospital understand what's going on around them and help them feel more ...
Within the past days of November the project teams of SAP Nuclear in Slovenske elektrarne, a. s. incorporated the specialists from PSEG from New Jersey, U.S.A. The goal of their stay here was to pass on the professional experience and good practice from the implementation of quite demanding project in the nuclear power plants. We have learned more about the company and the objectives from an interview with Clay Warren, SAP Nuclear Project Manager in SE. (author)
Hansen, Tom G
There has been a great deal of focus on specialist training in pediatric anesthesia in the last decade or so. Internationally, however, there is still no uniform agreement as to how such a training program should be arranged and organized. Since September 2003, the Scandinavian Society of Anaesth......There has been a great deal of focus on specialist training in pediatric anesthesia in the last decade or so. Internationally, however, there is still no uniform agreement as to how such a training program should be arranged and organized. Since September 2003, the Scandinavian Society...... of Anaesthesiology and Intensive Care Medicine has coordinated an advanced Inter-Nordic educational program in pediatric anesthesia and intensive care. The training program is managed by a Steering Committee. This program is intended for physicians who recently have received their specialist degree in anesthesiology...... and intensive care. The training period is 12 months of which 9 months are dedicated to pediatric anesthesia and 3 months to pediatric intensive care. During the 1-year training period, the candidates are designated a Scandinavian host clinic (at a tertiary pediatric center in Scandinavia approved...
Stoffels, Antoinette Marie-Rose Renée
This thesis investigates the cooperation among medical specialists in multidisciplinary teams as well as its antecedents and consequences. During meetings, medical specialists combine their knowledge and expertise, discuss the health problems of patients, weigh possible treatment options and decide
Magnussen, Alex; Galloway, Kate; Dinneen, Alexander
Fractures of the vertebral column are increasing in incidence. Even though spinal trauma is increasingly being managed in specialist units, these patients often still initially present to district general hospitals. Due to lack of exposure to these patients, the attending Orthopaedic Senior House Officer may not always be aware of current best practice in the acute management of these patients beyond immediate Advance Trauma Life Support measures. There is concern that initiation of managemen...
... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Specialist. 536.570-3... CATEGORIES OF CONTRACTING CONSTRUCTION AND ARCHITECT-ENGINEER CONTRACTS Contract Clauses 536.570-3 Specialist. Insert 552.236-72, Specialist, in solicitations and contracts for construction if the technical sections...
The purpose of this thesis was to implement a hospital management software which is suitable for small private hospitals in Nigeria, especially for the ones that use a file based system for storing information rather than having it stored in a more efficient and safer environment like databases or excel programming software. The software developed within this thesis project was specifically designed for the Rainbow specialist hospital which is based in Lagos, the commercial neurological cente...
Hunt, Kevin; Mitchell, Murray; Maina, Michael; Griffin, Lisa
The purpose of this study was to describe and contrast selected approaches to the supervision of student teachers between Content Specialist and Non-Content Specialist university supervisors. Content Specialist supervisors were identified as trained university supervisors with a background in physical education. Non-Content Specialist supervisors…
Biggerstaff, Mary Ellen; Short, Nancy
Transition to a value-based care system involves reducing costs improving population health and enhancing the patient experience. Many rural hospitals must rely on specialist referrals because of a lack of an internal system of specialists on staff. This evaluation of the existing specialist referrals from primary care was conducted to better understand and improve the referral process and address costs, population health, and the patient experience. A 6-month retrospective chart review was conducted to evaluate quality and outcomes of specialty referrals submitted by 10 primary care providers. During a 6-month period in 2015, there was a total of 13,601 primary care patient visits and 3814 referrals, a referral rate of approximately 27%. The most striking result of this review was that nearly 50% of referred patients were not making the prescribed specialist appointment. Rather than finding a large number of unnecessary referrals, we found overall referral rates higher than expected, and a large percentage of our patients were not completing their referrals. The data and patterns emerging from this investigation would guide the development of referral protocols for a newly formed accountable care organization and lead to further quality improvement projects: a LEAN effort, dissemination of results to clinical and executive staff, protocols for orthopedic and neurosurgical referrals, and recommendations for future process improvements. ©2017 American Association of Nurse Practitioners.
Highly professional and knowledgeable employees for chemical, and especially radiochemical, technology companies are very much sought after these days. Taking into account the advancement of nuclear power and the associated expansion of radioactive waste management facilities, the demand for staff that possesses all the necessary knowledge is set to increase multi-tenfold. In such circumstances, training of personnel is becoming a key element of the human resource management process. The author says that training of personnel at SUE SIA Radon Moscow is conducted in accordance with the Program of Training, Advanced Training and Personnel Qualification, which prescribes areas of training, categories of trainees, approximate number of trainees for each area, schedule and budget of training sessions. The cooperation of SUE SIA Radon Moscow with higher-education institutions in the field of young specialists training and advanced training of managerial, technical and administrative staff is reported [ru
Accepted: 7th December 2012. West BA. Department of Paediatrics,. University of Port Harcourt ... oping countries with perinatal asphyxia and birth inju- ries together ... age, sex, birth weight, gestational age of recruited ba- bies, parity, booking ...
For outborn babies with no Apgar score recording, a history of poor cry from birth with either poor colour, respiratory distress, floppiness or loss of primitive reflexes were used. Results: One hundred and fifty seven of 630 babies admitted had perinatal asphyxia giving a prevalence of 29.4%. Mean gestational age of affected ...
Local Purchasing of Journals is Required in Addition to a Nationally Purchased Collection to Meet the Information Needs of NHS Staff. A review of: Glover, Steven William, John Addison, Colette Gleghorn, and John Bramwell. “Journal Usage in NHS Hospitals: A Comparison Report of Total Usage at an Acute NHS Trust and a Specialist NHS Trust in the North West of England.” Health Information and Libraries Journal 24.3 (2007: 193‐9.
Full Text Available Objective ‐ To compare journal usage between an acute National Health Service (NHS Trust and a specialist NHS Trust located in North West England to provide some evidence as to how well the National Core Content Collection (provided by ProQuest meets the needs of staff in these settings.Design ‐ Comparative studySetting ‐ An acute NHS Trust, comprising four hospital sites, and a cancer specialist NHS Trust based on a single site. Both Trusts are located in North West England. The cancer specialist NHS Trust is a teaching hospital with undergraduate nurses, medical students, and student radiographers. This Trust is also closely associated with an adjoining cancer research institute. The acute NHS Trust has a large number of healthcare staff in training and was not described as a teaching hospital.Subjects ‐ Staff of the respective NHS Trusts. The staff numbers for each organisation were not provided.Methods ‐ COUNTER usage statistics of online journals, obtained from publisher administration tools, were collected for one year covering the period 1 December 2005 to 30 November 2006. Where available, the number of photocopies made from print journals during the same period by library users for their own use was also included. All full‐text downloads of journal articles were counted as part of this study, hence the possibility of double counting if a single article was requested in both HTML and PDF versions. Details of free or open access articles accessed without the need for a username and password were not included in the study. To encourage use of the electronic journals, library services at both Trusts implemented a number of initiatives to maximize publicity. These included direct e‐mails to staff, posters, and presentations to staff. Athens registration, required for access to the electronic journal collections, was promoted as part of the induction process for new library users. Staff members were encouraged to apply for the
Miller, L. Diane
Describes a professional development program to train math/science specialists for the upper elementary school grades. Using results from an interest survey, 30 teachers were chosen to participate in a 3-year program to become math/science specialists. Presents the teaching model used and the advantages for teachers and students in having subject…
STS-95 Mission Specialist Scott E. Parazynski notes the time on his watch upon his late arrival aboard a T-38 jet at the Shuttle Landing Facility. Parazynski's first plane experienced problems at the stop at Tyndall AFB and he had to wait for another jet and pilot to finish the flight to KSC. He joined other crewmembers Mission Commander Curtis L. Brown Jr., Pilot Steven W. Lindsey, Mission Specialist Stephen K. Robinson, Payload Specialist John H. Glenn Jr., senator from Ohio, Mission Specialist Pedro Duque, with the European Space Agency (ESA), and Payload Specialist Chiaki Mukai, with the National Space Development Agency of Japan (NASDA), for final pre-launch preparations. STS-95 is expected to launch at 2 p.m. EST on Oct. 29, last 8 days, 21 hours and 49 minutes, and land at 11:49 a.m. EST on Nov. 7.
Jenkins, Sarah; Chenneville, Tiffany; Salnaitis, Christina
This study was designed to examine the impact of role clarity and job training on job satisfaction among peer specialists. A 3-part survey assessing job training, job satisfaction, and role clarity was administered online to 195 peer specialists who are members of the International Association of Peer Specialists. Data was analyzed using descriptive statistics, correlational analyses to include multiple linear regressions and analysis of variance. Self-study and online training methods were negatively correlated with job satisfaction while job shadowing was positively correlated with job satisfaction. Role clarity was positively correlated with job satisfaction and job training satisfaction as well as job shadowing and one-on-one training. The use of self-study and online training for peer specialists is contraindicated by current findings, which suggest the need to utilize job shadowing or training methods that allow for personal interaction between peer specialists and their colleagues. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Planning, budgeting and performance management at Swiss hospitals – Are Swiss hospitals at a crossroads – Will these medical specialist organisations in future develop into institutions with a business orientation? [Die Krankenhäuser der Schweiz am Wendepunkt von der medizinischen Expertenorganisation hin zu betriebswirtschaftlich geführten Institutionen? – Untersuchung zu deren Performance-Management-System
Full Text Available [english] This article explores the question of how Swiss hospitals can establish a coherent performance management system with a long term orientation. With the introduction of competitive mechanisms (DRG system in the new Medical Insurance Act, a business orientation with regard to hospital management has become a key factor for market survival. The present study is based on a written survey of all Swiss hospitals in the German-speaking regions of the country. They were asked about the status quo and the targets for their performance management systems, based on a general maturity model for performance management, ed for hospitals. The descriptive evaluation of the data indicates that most hospitals are on the right road. Planning and Controlling are highly matured (in terms of processes, but the strategic importance of an effective performance management system (Reporting, IT integration is still widely underestimated. Thus most hospitals already have extensive planning mechanisms, but do not give these mechanisms priority when it comes to IT support.Bivariate analyses (correlation matrices of the results of the survey show that IT, in particular, plays a central role as a carrier medium or platform for performance management. At the same time, these detailed analyses indicate that (management oriented hospital planning is the actual driver for the establishment and extension of sound performance management systems. The study shows that well-developed IT infrastructures and clear planning figures will allow for performance management of detailed content.It should also not be forgotten that a well-functioning performance management system also has an organisational component. It is only when the tasks, skills and responsibilities of hospital management as these relate to business outlook, medical treatment and care are coordinated that hospitals can be managed in a more performance-orientated way.[german] Der Beitrag behandelt die Frage, wie
Slaets Joris PJ
Full Text Available Abstract Background Collaboration between general practitioners (GPs and specialists has been the focus of many collaborative care projects during the past decade. Unfortunately, quite a number of these projects failed. This raises the question of what motivates medical specialists to initiate and continue participating with GPs in new collaborative care models. The following question is addressed in this study: What motivates medical specialists to initiate and sustain new models for collaborating with GPs? Methods We conducted semi-structured interviews with eighteen medical specialists in the province of Groningen, in the North of The Netherlands. The sampling criteria were age, gender, type of hospital in which they were practicing, and specialty. The interviews were recorded, fully transcribed, and analysed by three researchers working independently. The resulting motivational factors were grouped into categories. Results 'Teaching GPs' and 'regulating patient flow' (referrals appeared to dominate when the motivational factors were considered. In addition, specialists want to develop relationships with the GPs on a more personal level. Most specialists believe that there is not much they can learn from GPs. 'Lack of time', 'no financial compensation', and 'no support from colleagues' were considered to be the main concerns to establishing collaborative care practices. Additionally, projects were often experienced as too complex and time consuming whereas guidelines were experienced as too restrictive. Conclusion Specialists are particularly interested in collaborating because the GP is the gatekeeper for access to secondary health care resources. Specialists feel that they are able to teach the GPs something, but they do not feel that they have anything to learn from the GPs. With respect to professional expertise, therefore, specialists do not consider GPs as equals. Once personal relationships with the GPs have been established, an
Shaw, Paul B; Delate, Thomas; Lyman, Alfred; Adams, Jody; Kreutz, Heather; Sanchez, Julia K; Dowd, Mary Beth; Gozansky, Wendolyn
This study assesses outcomes associated with the implementation of an emergency department (ED) for seniors in which a clinical pharmacy specialist, with specialized geriatric training that included medication management training, is a key member of the ED care team. This was a retrospective cohort analysis of patients aged 65 years or older who presented at an ED between November 1, 2012, and May 31, 2013. Three groups of seniors were assessed: treated by the clinical pharmacy specialist in the ED for seniors, treated in the ED for seniors but not by the clinical pharmacy specialist, and not treated in the ED for seniors. Outcomes included rates of an ED return visit, mortality and hospital admissions, and follow-up total health care costs. Multivariable regression modeling was used to adjust for any potential confounders in the associations between groups and outcomes. A total of 4,103 patients were included, with 872 (21%) treated in the ED for seniors and 342 (39%) of these treated by the clinical pharmacy specialist. Groups were well matched overall in patient characteristics. Patients who received medication review and management by the clinical pharmacy specialist did not experience a reduction in ED return visits, mortality, cost of follow-up care, or hospital admissions compared with the other groups. Of the patients treated by the clinical pharmacy specialist, 154 (45.0%) were identified as having at least 1 medication-related problem. Although at least 1 medication-related problem was identified in almost half of patients treated by the clinical pharmacy specialist in the ED for seniors, incorporation of a clinical pharmacy specialist into the ED staff did not improve clinical outcomes. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
The IT Security Specialist takes a strategic role in the delivery of Infrastructure ... on IT Security to project managers, business clients and senior management. ... as a team member or a team leader by undertaking research, investigations, ...
Minnesota Department of Natural Resources — This layer represents the areas of Minnesota that MNDNR Wildlife Private Lands Specialists cover. These boundaries are provided for support mapping and to show...
This study focuses on the need for specialist training for mountain warfare. It analyzes the special characteristics of mountain and high altitude terrain which affect conduct of military operations...
OBJECTIVES: to evaluate specialist geriatric input and medication review in patients in high-dependency continuing care. DESIGN: prospective, randomised, controlled trial. SETTING: two residential continuing care hospitals. PARTICIPANTS: two hundred and twenty-five permanent patients. INTERVENTION: patients were randomised to either specialist geriatric input or regular input. The specialist group had a medical assessment by a geriatrician and medication review by a multidisciplinary expert panel. Regular input consisted of review as required by a medical officer attached to each ward. Reassessment occurred after 6 months. RESULTS: one hundred and ten patients were randomised to specialist input and 115 to regular input. These were comparable for age, gender, dependency levels and cognition. After 6 months, the total number of medications per patient per day fell from 11.64 to 11.09 in the specialist group (P = 0.0364) and increased from 11.07 to 11.5 in the regular group (P = 0.094). There was no significant difference in mortality or frequency of acute hospital transfers (11 versus 6 in the specialist versus regular group, P = 0.213). CONCLUSION: specialist geriatric assessment and medication review in hospital continuing care resulted in a reduction in medication use, but at a significant cost. No benefits in hard clinical outcomes were demonstrated. However, qualitative benefits and lower costs may become evident over longer periods.
Lennon, Julie; Harper, Robert; Biswas, Sus; Lloyd, Chris
This article presents a survey of the demographical, educational and visual functional characteristics of children attending a specialist paediatric low-vision assessment clinic at Manchester Royal Eye Hospital. Comprehensive data were collected retrospectively from children attending the paediatric low-vision clinic between January 2003 and…
Keeping track of thousands of pieces of equipment in a busy hospital environment is a considerable challenge, but, according to RFID tagging and asset tracking specialist, Harland Simon, RFID technology can make the task considerably simpler. Here Andrew James, the company's RFID sales manager, describes the positive benefits the technology has brought the Medical Equipment Library (MEL) at Addenbrooke's Hospital, one of the world's most famous teaching hospitals.
Breast cancer is the first and main problem in oncology regarding women's cancer. In EC countries it represents about 1/4 of all women cancers both in terms of cancer morbidity and cancer mortality. Special education on breast cancer is therefore of substantial importance. The option is also that breast cancer is a typical example of a disease with various therapy possibilities and continuous efforts for further therapeutic results. Breast cancer surgeons, both in cancer hospitals and specialized departments, must have, in addition to classical training in surgery, very good training in all aspects of breast cancer as biological complex. This means that they must get good knowledge of the kinetics, biochemistry and immunology, and the whole pathophysiology of breast cancer as a potentially generalized disease, also in early stages. They also need a very good knowledge and information standard on adjuvant treatments because they are the key persons -in collaboration with medical oncologists- for planning such treatment programs. For medical oncologists and radiotherapists, treatment of breast cancer, both in the adjuvant setting and treatment of the advanced disease, is the most common daily work. They must have very detailed training on all biological and nosological aspects of breast cancer and a very good contact to the actual trials. (author). 3 refs
N.S. Klazinga (Niek)
textabstractIn January 1985, the author of this study was employed as a scientific staff member at CBO, the Dutch National Organisation for Quality Assurance in Hospitals. His main job was to support peer review committees of medical specialists in hospitals. The task proved to be challenging and
Semper, Julie; Halvorson, Betty; Hersh, Mary; Torres, Clare; Lillington, Linda
The aim of the study was to describe the clinical nurse specialist role in developing and implementing a staff nurse education program to promote practice accountability using peer review principles. Peer review is essential for professional nursing practice demanding a significant culture change. Clinical nurse specialists in a Magnet-designated community hospital were charged with developing a staff nurse peer review education program. Peer review is a recognized mechanism of professional self-regulation to ensure delivery of quality care. The American Nurses Association strongly urges incorporating peer review in professional nursing practice models. Clinical nurse specialists play a critical role in educating staff nurses about practice accountability. Clinical nurse specialists developed an education program guided by the American Nurses Association's principles of peer review. A baseline needs assessment identified potential barriers and learning needs. Content incorporated tools and strategies to build communication skills, collaboration, practice change, and peer accountability. The education program resulted in increased staff nurse knowledge about peer review and application of peer review principles in practice. Clinical nurse specialists played a critical role in helping staff nurses understand peer review and its application to practice. The clinical nurse specialist role will continue to be important in sustaining the application of peer review principles in practice.
Sharpe, G; Durham, J A; Preshaw, P M
To examine the attitudes of dental practitioners towards specialist periodontal referral in the North East of England. Semi-structured interviews were conducted with a purposive sample of 10 practitioners. Interviews continued until data saturation occurred. The data were organised using a framework and analysed by two researchers working independently. Perceptions of periodontal disease and treatment appear to be heavily influenced by the NHS remuneration system. Treatment in general practice was limited to simple scaling and there was an apparent reluctance to treat advanced periodontitis. Such cases were commonly referred to specialists, confirming the demand for a referral service in periodontics. The perceived potential for medico-legal consequences was a strong driver of referrals. Distance to the referral centre and the perceived costs of treatment were significant barriers to referral. Dentists valued the specialist's personal reputation and clinical skills more highly than academic status. Deficiencies in communication between primary and secondary care were highlighted. Increased resources are required to manage periodontal diseases within the NHS. There is a need for a periodontal referral service in the North East of England to improve accessibility to specialist care. This would appear to be most appropriately delivered by increased numbers of specialist practitioners.
McGrath, Pam; Rawson, Nicole
Vulvar cancer is a serious condition that requires a range of specialist treatments including surgery, chemotherapy, and radiation. In Australia, such treatments are only available in major metropolitan hospitals. Thus, women diagnosed with this condition in rural and remote areas must relocate to the metropolitan specialist centers for treatment. The focus of this article is on the experience of relocation for specialist care for Indigenous women diagnosed with vulvar cancer from East Arnhem Land, Northern Territory, Australia. The findings presented in this article explore a range of issues that affect the experience of relocation such as community concerns, cultural distress, loneliness, fear, worry, and physical concerns associated with the condition.
... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Payload specialist responsibilities. 1214... Payload Specialists for Space Transportation System (STS) Missions § 1214.305 Payload specialist... commander has ultimate responsibility and authority for all assigned crew duties. The payload specialist is...
... 29 Labor 1 2010-07-01 2010-07-01 true Farm Labor Specialist (ESA). 42.9 Section 42.9 Labor Office of the Secretary of Labor COORDINATED ENFORCEMENT § 42.9 Farm Labor Specialist (ESA). (a) The Assistant Secretary for ESA shall designate ESA Compliance Officers as Farm Labor Specialists (Specialists...
Stilos, Kalli; Daines, Pat
Demand for palliative care services in Canada will increase owing to an aging population and the evolving role of palliative care in non-malignant illness. Increasing healthcare demands continue to shape the clinical nurse specialist (CNS) role, especially in the area of palliative care. Clinical nurse specialists bring specialized knowledge, skills and leadership to the clinical setting to enhance patient and family care. This paper highlights the clinical leadership role of the CNS as triage leader for a hospital-based palliative care consulting team. Changes to the team's referral and triage processes are emphasized as key improvements to team efficiency and timely access to care for patients and families.
Although specialists in hospitality have worked extensively on hospitality with respect to relations between different nations or between nations and individuals of a different nationality, for instance when they seek asylum, Jacques Derrida preferred to focus instead upon the relationship between...... the guest and the host. This has provided a much-needed rethinking of how to understand hospitality as a way of relating, as an ethics and as a politics. Within this work, there have often appeared discussions of ‘spaces of hospitality’, but these spaces have remained largely abstract. This is where...... this paper comes in: It will re open discussions of spaces of hospitality with an introduction into an on-going research project that studies the performative, structural and social dynamics of cultural encounters focusing on forms of hospitality that are related to particular sites in the city, namely...
I. I. Leonovich
Full Text Available Complicated conditions, under which road enterprises of the Republic are forced to operate, put forward and reveal the necessity to innovative way of development. In order to fulfill this task it is necessary to have specialists who are capable and ready to realize this endeavour. The most acceptable variant is to train specialists who will be able to introduce innovations and who are presently involved in the production process. Such training should be carried out within the framework of post-graduate education. Authors have provide a number of reasons in favour of quick development of such education.
Groenewegen Peter P
Full Text Available Abstract Background An increasing number of medical specialists prefer to work part-time. This development can be found worldwide. Problems to be faced in the realization of part-time work in medicine include the division of night and weekend shifts, as well as communication between physicians and continuity of care. People tend to think that physicians working part-time are less devoted to their work, implying that full-time physicians complete a greater number of tasks. The central question in this article is whether part-time medical specialists allocate their time differently to their tasks than full-time medical specialists. Methods A questionnaire was sent by mail to all internists (N = 817, surgeons (N = 693 and radiologists (N = 621 working in general hospitals in the Netherlands. Questions were asked about the actual situation, such as hours worked and night and weekend shifts. The response was 53% (n = 411 for internists, 52% (n = 359 for surgeons, and 36% (n = 213 for radiologists. Due to non-response on specific questions there were 367 internists, 316 surgeons, and 71 radiologists included in the analyses. Multilevel analyses were used to analyze the data. Results Part-time medical specialists do not spend proportionally more time on direct patient care. With respect to night and weekend shifts, part-time medical specialists account for proportionally more or an equal share of these shifts. The number of hours worked per FTE is higher for part-time than for full-time medical specialists, although this difference is only significant for surgeons. Conclusion In general, part-time medical specialists do their share of the job. However, we focussed on input only. Besides input, output like the numbers of services provided deserves attention as well. The trend in medicine towards more part-time work has an important consequence: more medical specialists are needed to get the work done. Therefore, a greater number of medical specialists
Higgins, Niall S; Taraporewalla, Kersi; Edirippulige, Sisira; Ware, Robert S; Steyn, Michael; Watson, Marcus O
To measure specialist international medical graduates' (SIMGs) level of learning through participation in guided tutorials, face-to-face or through videoconferencing (VC), and the effect of tutorial attendance and quality of participation on success in specialist college examinations. Tutorials were conducted at the Royal Brisbane and Women's Hospital between 19 September 2007 and 23 August 2010, and delivered through VC to participants at other locations. Tutorials were recorded and transcribed, and speaker contributions were tagged and ranked using content analysis software. Summary examination results were obtained from the Australian and New Zealand College of Anaesthetists. Tutorial participation and attendance, and college examination pass and fail rates. Transcripts were obtained for 116 tutorials. The median participation percentage for those who subsequently failed the college examinations was 1% (interquartile range [IQR], 0%-1%), while for those who passed the exams it was 5% (IQR, 2%-8%; P technology was found to be a feasible method to assist SIMGs to become aware of the requirements of the exam and to prepare more effectively.
O'Neill, M B; Nabialek, T; Kandamany, N
In the training process, there is a tension between the work life and home life of trainees. This study explored both the personal impact and the opportunity costs of training from the Specialist Paediatric Registrar (SPR) perspective. The survey explored 1) career progression, 2) perceived functional effectiveness at work, 3) psychological impact of hospital based training, and 4) the personal and social cost of training. Fifty-three (71%) SPRs responded of whom 47 (89%)were married or in long term relationships. Seventy-five percent of trainees had a definite career plan with 86% intending to undertake fellowship training. Seventy percent believed they were efficient time managers but 53% had difficulty in making time for academic pursuits and fifty percent experienced negative feelings, which lingered after work and interfered with their relationships at home. Seventy-four percent stated training was undertaken at significant personal cost with only 21% achieving a very satisfactory work/life balance. To address these difficulties trainee wellbeing should be addressed at the Basic Specialist Training (BST) level and the career path clearly explained outlining the challenges that are likely to be encountered.
Butler, Grainne; Breatnach, Colm; Harty, Sinead; Gavin, Patrick; O'Donnell, Colm; O'Grady, Michael J
A survey of paediatric higher specialist trainees was carried out in 2002 assessing career intentions and perception of training. Fourteen years later, with increased numbers of trainees and a national model of care and a tertiary paediatric hospital on the horizon, we re-evaluated the career intentions of the current trainee workforce. To assess the career intentions of the current paediatric higher specialist trainees. A 28-item questionnaire was developed based on a previously validated instrument and distributed online using the Royal College of Physicians of Ireland trainee database. We distributed the questionnaire to 118 eligible trainees and received responses from 92 (78%). Seventy-nine (86%) respondents desire a consultant post in Ireland. Seventy-five (82%) indicated that their preferred consultant post location was in a tertiary paediatric centre. Sixty-two trainees (67%) intend to become subspecialists with 25 (27%) planning a career in general paediatrics. This contrasts with the 2002 survey when 76% wished to work in urban centres and 61% of trainees planned a career in general paediatrics. There appears to be a mismatch between the career goals of the future paediatric consultant workforce and the requirements for staffing paediatric units nationally. This has the potential to complicate the proposed expansion of general paediatricians in regional centres and result in a significant proportion of current trainees failing to secure a post in their desired location.
In the training process, there is a tension between the work life and home life of trainees. This study explored both the personal impact and the opportunity costs of training from the Specialist Paediatric Registrar (SPR) perspective. The survey explored 1) career progression2) perceived functional effectiveness at work 3) psychological impact of hospital based training and 4) the personal and social cost of training. Fifty-three (71%) SPRs responded of whom 47 (89%)were married or in long term relationships. Seventy-five percent of trainees had a definite career plan with 86% intending to undertake fellowship training. Seventy percent believed they were efficient time managers but 53% had difficulty in making time for academic pursuits and fifty percent experienced negative feelings, which lingered after work and interfered with their relationships at home. Seventy-four percent stated training was undertaken at significant personal cost with only 21% achieving a very satisfactory work\\/life balance. To address these difficulties trainee wellbeing should be addressed at the Basic Specialist Training (BST) level and the career path clearly explained outlining the challenges that are likely to be encountered.
... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Specialists. 62.26 Section 62.26 Foreign Relations DEPARTMENT OF STATE PUBLIC DIPLOMACY AND EXCHANGES EXCHANGE VISITOR PROGRAM Specific Program... such areas, for example, as mass media communication, environmental science, youth leadership...
Due to content-based analysis of marketing specialists' professional training and approaches to development of their educational trajectory, it has been revealed that curricula and their content are given much attention by employers whose demands are focused on meeting current labour market conditions. It has been justified that despite the…
Peleška, Jan; Anger, Z.; Buchtela, David; Tomečková, Marie; Veselý, Arnošt; Zvárová, Jana
Roč. 25, Suppl. 2 (2007), S 383-S 383 ISSN 0952-1178. [European Meeting on Hypertension /17./. 15.06.2007-19.06.2007, Milan] R&D Projects: GA AV ČR 1ET200300413 Institutional research plan: CEZ:AV0Z10300504 Keywords : treatment algorithm for hypertension * hypertension specialist Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery
Cicmanec, Karen B. Mauck
For over 30 years, educators have recommended that mathematics specialists be placed in schools to provide teachers with the resources they need to assist their students. To assess whether these recommendations have been realized, a survey was used to gather data from large school districts, the 50 states, and District of Columbia. The outcome of…
Mellin, Laurel M.
Presents seven reasons why it is important for health specialist teams to take action supporting the prevention and treatment of childhood obesity. The article offers guidelines to help parents assist their children in maintaining positive eating, exercise, and self-esteem patterns, noting sensitive intervention is preferable to imposed diets. (SM)
Schneller, S; Hoeppner, M
Preceptor orientation is a well identified need. Less often identified is the critical role the staff development specialist plays in the ongoing support and development of preceptors. In this article, the authors explain activities of coaching, facilitating, mentoring, and consulting. These role components are essential in the ongoing development of preceptors. This support also may help retain preceptors.
Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.
This document contains teacher's materials for a course on becoming an automotive brakes specialist, based on the National Institute of Automotive Service Excellence task lists. The course consists of three instructional units: service brake hydraulic system and wheel bearings, service drum brakes, and service disc brakes. Depending on the…
ASTRO-2 payload specialist Ronald A. Parise reminisces on his inspace amateur radio experience of five years ago in the ASTRO-1 mission. Using the Shuttle Amateur Radio Experiment (SAREX), Parise talks to students on Earth from the flight deck of the Earth orbiting Space Shuttle Endeavour.
Full Text Available As we all know, libraries are these years rapidly undergoing change on unparalleled scale. Evidently, this applies to librarians, too, and not the least to that important category of library staff, the subject specialist. As recruiting and education of library workers differ from country to country it is difficult to give a detailed, generally valid description of the subject librarian in libraries, but I believe that you can describe an ideal model of subject librarianship as follows: Within each of the major subject disciplines covered by the library, the library should have a subject specialist preferably with a master degree or at least a bachelor degree in the particular subject discipline. The role of the subject specialist is to perform four basic functions where extensive subject knowledge is considered to be necessary: selecting and classifying books, assisting users with advanced subject inquiries, giving subject-specific courses in information retrieval, and maintaining liaison with relevant academic departments and centres. Personally, I know this system very well since I got employment in the Royal Library in Copenhagen as a subject specialist in psychology in the very month I finished my degree in psychology from the University of Copenhagen, back in 1973. The subject librarian system at the Royal Library in Copenhagen was patterned on the ideal model, as I just described it, and it was closely paralleled in the other academic libraries in Denmark, also the new university libraries which were founded in the seventies.
The XIIth national conference of Czechoslovak power specialists was held in Bratislava from October 5 to 7, 1983. Of the total number of 32 papers 12 were incorporated in the INIS system, i.e., such which dealt with the development of the nuclear power complex and the rationalization of sources and the use of heat in the Czechoslovak energy balance. (E.S.)
Buerkel, Elaine; Rehling, Joseph H.
The general purpose of the occupational analysis is to provide workable, basic information dealing with the many and varied duties performed in the textile service occupation. The industry needs properly trained alteration specialists, bushelmen and dressmakers, in the repairing, remodeling, altering or renovating of garments. Their personal…
Litsios, Glenn; Kostikova, Anna; Salamin, Nicolas
Why generalist and specialist species coexist in nature is a question that has interested evolutionary biologists for a long time. While the coexistence of specialists and generalists exploiting resources on a single ecological dimension has been theoretically and empirically explored, biological systems with multiple resource dimensions (e.g. trophic, ecological) are less well understood. Yet, such systems may provide an alternative to the classical theory of stable evolutionary coexistence of generalist and specialist species on a single resource dimension. We explore such systems and the potential trade-offs between different resource dimensions in clownfishes. All species of this iconic clade are obligate mutualists with sea anemones yet show interspecific variation in anemone host specificity. Moreover, clownfishes developed variable environmental specialization across their distribution. In this study, we test for the existence of a relationship between host-specificity (number of anemones associated with a clownfish species) and environmental-specificity (expressed as the size of the ecological niche breadth across climatic gradients). We find a negative correlation between host range and environmental specificities in temperature, salinity and pH, probably indicating a trade-off between both types of specialization forcing species to specialize only in a single direction. Trade-offs in a multi-dimensional resource space could be a novel way of explaining the coexistence of generalist and specialists. PMID:25274370
Balsdon, Helen; Wilkinson, Susan
The contribution made by clinical nurse specialists (CNSs) to patient care needs to be understood fully to provide assurance of effective use of resources. However, CNS roles are often poorly understood and not easily articulated. Due to the diversity of these roles, robust reviews of performance and economic benefits can be regarded as time consuming and resource intense, and many organisations enlist external agencies to clarify the contribution to care made by their CNSs. This article gives an overview of a Cambridge University Hospitals NHS Foundation Trust internal review of CNS roles without the support of an external agency. The review provided assurance that this group of nurses is being used effectively and identified opportunities to use the role in different ways to increase effectiveness.
Vladimir A. Romanov
Full Text Available The aim of the investigation is development of innovative strategy of quality control training of engineers and skilled workers (hereinafter – future specialists in educational professional organizations on the principles of social partnership.Methods. Theoretic: theoretic and methodological analysis, polytheoretic synthesis, modeling. Empirical: research and generalization of the system, process and competence – based approaches experience, experiment, observation, surveys, expert evaluation, SWOT-analysis as a method of strategic planning which is to identify the internal and external factors (socio-cultural of the organization surrounding.Results. The strategy of the development of the process of quality control training in educational professional organizations and a predictive model of the system of quality control training for future engineers and workers have been created on the analysis and synthesis of a quantitative specification of the quality, the obtained experience and success in control training of future specialists in educational professional organizations in recent economic and educational conditions.Scientific novelty. There has been built a predicative model of quality control training of future specialists to meet modern standards and the principles of social partnership; the control algorithm of the learning process, developed in accordance with the standards (international of quality ISO in the implementation of the quality control systems of the process approach (matrix-based responsibility, competence and remit of those responsible for the education process in the educational organization, the «problem» terms and diagnostic tools for assessing the quality of professional training of future specialists. The perspective directions of innovation in the control of the quality of future professionals training have been determined; the parameters of a comprehensive analysis of the state of the system to ensure the
Jacobi, Judith; Ray, Shaunta'; Danelich, Ilya; Dodds Ashley, Elizabeth; Eckel, Stephen; Guharoy, Roy; Militello, Michael; O'Donnell, Paul; Sam, Teena; Crist, Stephanie M; Smidt, Danielle
This paper describes the goals of the American Society of Health-System Pharmacists' Pharmacy Practice Model Initiative (PPMI) and its recommendations for health-system pharmacy practice transformation to meet future patient care needs and elevate the role of pharmacists as patient care providers. PPMI envisions a future in which pharmacists have greater responsibility for medication-related outcomes and technicians assume greater responsibility for product-related activities. Although the PPMI recommendations have elevated the level of practice in many settings, they also potentially affect existing clinical pharmacists, in general, and clinical pharmacy specialists, in particular. Moreover, although more consistent patient care can be achieved with an expanded team of pharmacist providers, the role of clinical pharmacy specialists must not be diminished, especially in the care of complex patients and populations. Specialist practitioners with advanced training and credentials must be available to model and train pharmacists in generalist positions, residents, and students. Indeed, specialist practitioners are often the innovators and practice leaders. Negotiation between hospitals and pharmacy schools is needed to ensure a continuing role for academic clinical pharmacists and their contributions as educators and researchers. Lessons can be applied from disciplines such as nursing and medicine, which have developed new models of care involving effective collaboration between generalists and specialists. Several different pharmacy practice models have been described to meet the PPMI goals, based on available personnel and local goals. Studies measuring the impact of these new practice models are needed. © 2016 Pharmacotherapy Publications, Inc.
textabstractThis study analyses the nature and organisation of specialists' day to day work in general hospitals in the Netherlands and the claims for jurisdiction specialists make in their work. It is of interest because it presents a picture of specialist work from within. Most
van den Berg, Tilja I J; Vrijhoef, Hubertus J M; Tummers, Gladys; Landeweerd, Jan A; van Merode, Godefridus G
The aim of this study is to explore whether the work organisation of diabetes specialist nurses (DSNs) differs significantly from nurses working in hospital and nursing home and if so, does this difference result in positive or negative consequences regarding work and health. In traditional health care settings, nurses exhibit a high level of environmental uncertainty and low decision-making authority, which has a negative effect on psychological reactions towards work. In professional nursing, specialisation, e.g. diabetic nursing, is a current trend in many countries. Therefore, insight into the determinants of the work situation of nursing specialists is becoming increasingly relevant. Comparisons were made between 3 different samples: 1204 nurses employed by 15 hospitals, 1058 nurses employed by 14 nursing homes, and 350 diabetes nurses working in other health care settings throughout the Netherlands. Data concerning organisation, work aspects, and psychological reactions were measured via questionnaires. Variances between the groups were analysed with ANCOVA, besides hierarchical multiple regression analysis was applied. Environmental uncertainty scored lower amongst diabetes nurses when compared to nurses working in the other two types of health care settings. Social support and role conflict scored low for diabetes nursing specialists who simultaneously perceived autonomy and role ambiguity highest. Diabetes nursing specialists also scored highest on intrinsic work motivation and job satisfaction and lowest for psychosomatic health. Except for social support and role ambiguity, diabetic nurses rate their [work] organisation, [work] aspects and psychological [work] reactions more positively than nurses employed in other health care settings.
Bateman, Lindsey E; Collins, Joanne M; Cunningham, Susan J
To identify factors affecting work-life balance amongst male and female orthodontists in the UK. A qualitative interview-based study with a cross-sectional design. Specialist orthodontists working in specialist practice and the hospital service in the UK were selected by purposive sampling. In-depth semi-structured interviews were conducted with 18 orthodontic specialists. Interview transcripts were analyzed using Framework Analysis. Four main themes pertaining to work-life balance in orthodontics were identified: work factors affecting work-life balance, life factors affecting work-life balance, perception and effects of work-life balance and suggestions for managing work-life balance within the profession. There was substantial variation in the work-life balance of the orthodontists interviewed in this study; however the majority reported high levels of career satisfaction despite difficulties maintaining a good work-life balance. Whilst there were some clear distinctions in the factors affecting work-life balance between the hospital environment and specialist practice (including additional professional commitments and teaching/training-related issues), there were also a number of similarities. These included, the lack of flexibility in the working day, managing patient expectations, taking time off work at short notice and the ability to work part-time.
Woolley, S M; Hingston, E J; Shah, J; Chadwick, B L
The objectives were three-fold: to investigate the level of conscious sedation training received prior to and during specialist training in paediatric dentistry; to establish the use of conscious sedation during and following specialisation; and to determine the attitudes of specialists in paediatric dentistry to conscious sedation. A self-administered postal questionnaire was sent to all specialists in paediatric dentistry registered with the General Dental Council in January 2008. Non-responders were contacted again after a four-week period. A response rate of 60% was achieved. Of the 122 respondents, 67 (55%) had received sedation training as an undergraduate; 89 (75%) had been trained during specialisation. All respondents performed dental treatment under sedation as a trainee and the majority used nitrous oxide inhalation sedation (NOIS). Over 90% of respondents felt that NOIS should be available to all children, both in appropriate primary care settings and in hospitals. One hundred and twenty-one (99%) respondents thought that all trainees in paediatric dentistry should have sedation training. The most popular form of sedation amongst specialists in paediatric dentistry was NOIS. However, some of the respondents felt that children should have access to other forms of sedation in both the primary care and hospital settings. Additional research on other forms of sedation is required to evaluate their effectiveness and safety.
Fuel Safety Research Specialists' Meeting, which was organized by Japan Atomic Energy Research Institute, was held on March 4-5, 2002 at JAERI in Tokai Establishment. Purposes of the Meeting are to exchange information and views on LWR fuel safety topics among the specialist participants from domestic and foreign organizations, and to discuss the recent and future fuel research activities in JAERI. In the Meeting, presentations were given and discussions were made on general report of fuel safety research activities, fuel behaviors in normal operation and accident conditions, FP release behaviors in severe accident conditions, and JAERI's ''Advanced LWR Fuel Performance and Safety Research Program''. A poster exhibition was also carried out. The Meeting significantly contributed to planning future program and cooperation in fuel research. This proceeding integrates all the pictures and papers presented in the Meeting. The 10 of the presented papers are indexed individually. (J.P.N.)
This thesis is dealing with burnout syndrome among leisure time specialists. Theoretical part describes burnout syndrome, its historical basis, symptoms and causes, protective factors and preventive techniques, which prevent from burnout syndrome risk. Next part deals with common stress, its causes and symptoms, and psychosocial stress, which is closely related with burnout syndrome. Ending of the theoretical part is focused on understanding the differences between jobs of common teacher and ...
Full Text Available The difficulties specialized phytophagous insects face in finding habitats with an appropriate host should constrain their dispersal. Within the concept of metacommunities, this leads to the prediction that host-plant specialists should sort into local assemblages according to the local environmental conditions, i.e. habitat conditions, whereas assemblages of host-plant generalists should depend also on regional processes. Our study aimed at ranking the importance of local environmental factors and species composition of the vegetation for predicting the species composition of phytophagous moth assemblages with either a narrow or a broad host range. Our database consists of 351,506 specimens representing 820 species of nocturnal Macrolepidoptera sampled between 1980 and 2006 using light traps in 96 strict forest reserves in southern Germany. Species were grouped as specialists or generalists according to the food plants of the larvae; specialists use host plants belonging to one genus. We used predictive canonical correspondence and co-correspondence analyses to rank the importance of local environmental factors, the species composition of the vegetation and the role of host plants for predicting the species composition of host-plant specialists and generalists. The cross-validatory fit for predicting the species composition of phytophagous moths was higher for host-plant specialists than for host-plant generalists using environmental factors as well as the composition of the vegetation. As expected for host-plant specialists, the species composition of the vegetation was a better predictor of the composition of these assemblages than the environmental variables. But surprisingly, this difference for specialized insects was not due to the occurrence of their host plants. Overall, our study supports the idea that owing to evolutionary constraints in finding a host, host-plant specialists and host-plant generalists follow two different models of
Payload specialist Reinhard Furrer shows evidence of previous blood sampling while Wubbo J. Ockels, Dutch payload specialist (only partially visible), extends his right arm after a sample has been taken. Both men show bruises on their arms.
Thompson, Jo; Brown, Jayne; Davies, Andrew
Introduction: This report describes a service evaluation of the 'added value' of routine specialist palliative care team (SPCT) involvement with patients on the Liverpool Care Pathway for the Dying Patient (LCP). Methods: In the authors' hospital, patients that are commenced on the LCP are routinely referred to the SPCT. They are reviewed on the day of referral and then at least every other day, depending on the clinical situation. The data for this report was obtained by reviewing the S...
Cooper, O. P.; Bray, Marty
The most successful school library media specialists are those who collaborate with teachers as full partners in the instructional process. Without assertive action by the school library media specialist, however, school administrators and teachers are likely to be more aware of the media specialist's administrative role than the roles of teacher,…
McCann-Stone, Nancy; Robinson, Sherry B.; Rull, Gary; Rosher, Richard B.
This paper describes an Elder Specialist Program developed by one school of medicine to sensitize medical students to geriatric psychosocial issues. Elder Specialists participate in panel discussions as part of each geriatric session. As an alternative to traditional senior mentoring programs, the Elder Specialist Program provides all students a…
Freed, Gary L; Turbitt, Erin; Allen, Amy
Objectives The aim of the present study was to provide data to help clarify the public-private division of clinical care provision by doctors in Australia. Methods A secondary analysis was performed of data from the workforce survey administered by the Australian Health Practitioner Regulation Agency. The questionnaire included demographic and employment questions. Analysis included frequency distributions of demographic variables and mean and median calculations of employment data. Data were analysed from those currently employed in eight adult specialities chosen to provide a mix of surgical and medical fields. The specialties were orthopaedic surgery, otolaryngology, ophthalmology, cardiology, neurology, nephrology, gastroenterology and rheumatology. Results For the specialities analysed in the present study, a large majority of the time spent in patient care was provided in the private sector. For the surgical specialties studied, on average less than 30% of clinical time was spent in the public sector. There was considerable variation among specialties in whether a greater proportion of time was spent in out-patient versus in-patient care and how that was divided between the public and private sectors. Conclusions Ensuring Australians have a medical workforce that meets the needs of the population will require assessments of the public and private medical markets, the needs of each market and the adequacy with which current physician clinical time allocation meets those requirements. By appreciating this nuance, Australia can develop policies and strategies for the current and future speciality workforce to meet the nation's needs. What is known about the topic? Australian medical specialists can split their clinical practice time between the public (e.g. public hospitals, public clinics) and private (e.g. private hospitals, private consulting rooms) sectors. For all medical specialists combined, working hours have been reported to be similar in the public and
Full Text Available Ori Segal,1,2 Yael Segal-Trivitz,1,3 Arie Y Nemet,1,2 Noa Geffen,1,2 Ronit Nesher,1,2 Michael Mimouni4 1Department of Ophthalmology, Meir Medical Center, Kfar Saba, 2The Sackler School of Medicine, Tel Aviv University, Tel Aviv, 3Department of Psychiatry, Geha Psychiatric Hospital, Petah Tikva, 4Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel Purpose: The purpose of this study was to describe antivascular endothelial growth factor intravitreal injection techniques of retinal specialists in order to establish a cornerstone for future practice guidelines. Methods: All members of the Israeli Retina Society were contacted by email to complete an anonymous, 19-question, Internet-based survey regarding their intravitreal injection techniques. Results: Overall, 66% (52/79 completed the survey. Most (98% do not instruct patients to discontinue anticoagulant therapy and 92% prescribe treatment for patients in the waiting room. Three quarters wear sterile gloves and prepare the patient in the supine position. A majority (71% use sterile surgical draping. All respondents apply topical analgesics and a majority (69% measure the distance from the limbus to the injection site. A minority (21% displace the conjunctiva prior to injection. A majority of the survey participants use a 30-gauge needle and the most common quadrant for injection is superotemporal (33%. Less than half routinely assess postinjection optic nerve perfusion (44%. A majority (92% apply prophylactic antibiotics immediately after the injection. Conclusion: The majority of retina specialists perform intravitreal injections similarly. However, a relatively large minority performs this procedure differently. Due to the extremely low percentage of complications, it seems as though such differences do not increase the risk. However, more evidence-based medicine, a cornerstone for practice guidelines, is required in order to identify the intravitreal injection techniques
Full Text Available The article presents the results of a study of psychological factors of decision making amongforensic psychiatric specialists. Given the survey data of10 medical psychologists and 10 psychiatrists carrying out compulsory treatment in the psychiatric hospital №5, Moscow Department of Public Health, in comparison with the control group, consisting of professionals working in the field of education, manufacturing, services and technology. Methodical complex included: 1. The Epstein questionnaire of the intuitive style (adaptation Kornilova T. V., Kornilov S. A.; A new questionnaire of tolerance/intolerance to uncertainty (Kornilova T. V.; Melbourne questionnaire of decision making (adaptation T. V.Kornilova; The questionnaire «Personal factors of decision making»(T.V. Kornilova; TheV. Smecalo and V. M. Kucher method; The Tsvetkova Method; 7. The questionnaire «Styles of thinking» by R. Bramsonand Harrison (adaptation of A. A. Alekseev; 8.The questionnaire «Scale of base convictions» (R.Yanov-Boulemane, adaptation M.A. Padun, A.V. Kotelnikov; 9. The check-list aimed to identify the type of decisions taken by the expert in professional activity, their frequency, importance, subjective evaluation is necessary for decision making qualities and to evaluate the most significant opinions of other persons in the decision-making process. There were defined the characteristics of decision making depending on gender. The relationships between type of activity and frequency of occurrence of different types of decisions in professional activities of specialists were revealed. Analyzed the relationship between consideration of the views of others when making decisions and activity.
Dadkhah, Mehdi; Lagzian, Mohammad; Borchardt, Glenn
In this opinion piece, we present a synopsis of our findings from the last 2 years concerning cyber-attacks on web-based academia. We also present some of problems that we have faced and try to resolve any misunderstandings about our work. We are academic information security specialists, not hackers. Finally, we present a brief overview of our methods for detecting cyber fraud in an attempt to present general guidelines for researchers who would like to continue our work. We believe that our work is necessary for protecting the integrity of scholarly publishing against emerging cybercrime.
Flexer, S M; Durham-Hall, A C; Steward, M A; Robinson, J M
Transanal endoscopic microsurgery (TEMS) is becoming more widespread due to the increasing body of evidence to support its role. Previous published data has reported recurrence rates in excess of 10% for benign polyps after TEMS. Bradford Royal Infirmary is a tertiary referral centre for TEMS and early rectal cancer in the UK. Data for all TEMS operations were entered into a prospective database over a 7-year period. Demographic data, complications and recurrence rates were recorded. Both benign adenomas and malignant lesions were included. A total of 164 patients (65% male), with a mean age of 68 years were included; 114 (70%) of the lesions resected were benign adenomas, and 50 (30%) were malignant lesions. Median polyp size was 4 (range 0.6-14.5) cm. Mean length of operation was 55 (range 10-120) min. There were no recurrences in any patients with a benign adenoma resected; two patients with malignant lesions developed recurrences. Three intra-operative complications were recorded, two rectal perforations (repaired primarily, one requiring defunctioning stoma), and a further patient suffered a blood loss of >300 ml requiring transfusion. Six patients developed strictures requiring dilation either endoscopically or under anaesthetic in the post-operative period. We have demonstrated that TEMS procedures performed in a specialist centre provide low rates of both recurrence and complication. Within a specialist centre, TEMS surgery should be offered to all patients for rectal lesions, both benign and malignant, that are amenable to TEMS.
Heiliger, P J; Hingstman, L
In this article career preferences of medical specialists in the Netherlands are analysed, based on a survey among the members of medical associations of five specialties. Four different career preferences were offered, each of which implied a possible variation in working hours. A questionnaire was sent to a random selected group of working specialists in general practice, internal medicine, anaesthesiology, ophthalmology and psychiatry. Logistic regressions were used to predict career preferences. Besides individual characteristics, work and home domain characteristics were taken into the analysis. Not surprisingly, the preference for career change in respect of working hours is higher among full-time MDs, especially women, than among part-time workers. In contradiction to what was expected, home domain characteristics did not predict a part-time preference for female, but for male MDs. One home domain characteristic, children's age, did predict the male part-time preference. Further gender differences were found in respect of the fit between actual and preferred working hours (A/P-fit). The majority of male MDs with a full-time preference had achieved an A/P-fit, whereas significantly less female MDs achieved their preferences. It was found that hospital-bound specialists are less positive towards part-time careers than other specialists. Furthermore, the change of working hours would imply a reduction in FTE for all specialties, if all preferences were met. Especially in hospital-bound specialisms it was not confirmed that the reduction in FTE would be low; this was found only in respect of interns. It may be concluded that individual preferences in career paths are very diverse. Personnel policy in medical specialties, especially in hospitals, will have to cope with changes in traditional vertical and age-related career paths. Flexible careers related to home domain determinants or other activities will reinforce a life cycle approach, in which the centrality
Müller, J.; Stadler, J.; Jarzabek-Müller, A.; Hacker, H.; Braak, ter C.J.F.; Brandl, R.
The difficulties specialized phytophagous insects face in finding habitats with an appropriate host should constrain their dispersal. Within the concept of metacommunities, this leads to the prediction that host-plant specialists should sort into local assemblages according to the local
Haslerud, Torjan; Tulipan, Andreas Julius; Gray, Robert M; Biermann, Martin
While e-learning has become an important tool in teaching medical students, the training of specialists in medical imaging is still dominated by lecture-based courses. To assess the potential of e-learning in specialist education in medical imaging. An existing lecture-based five-day course in Clinical Nuclear Medicine (NM) was enhanced by e-learning resources and activities, including practical exercises. An anonymized survey was conducted after participants had completed and passed the multiple choice electronic course examination. Twelve out of 15 course participants (80%) responded. Overall satisfaction with the new course format was high, but 25% of the respondents wanted more interactive elements such as discussions and practical exercises. The importance of lecture handouts and supplementary online material such as selected original articles and professional guidelines was affirmed by all the respondents (92% fully, 8% partially), while 75% fully and 25% partially agreed that the lectures had been interesting and relevant. E-learning represents a hitherto unrealized potential in the education of medical specialists. It may expedite training of medical specialists while at the same time containing costs.
Shin, Hyunsook; Kim, Bog-Ja; Kang, Hee Sun
The study was done to investigate physical assessment skills used by, and educational needs of, advanced practice nurses (APNs) and nurse specialists in Korea. A total of 123 APNs and nurse specialists working in five major hospitals in Seoul were surveyed from July 15 to August 20, 2007. Fourteen skills out of 126 items were reported as being performed on a regular basis by participants. The majority of these skills involved general observation. Forty-six skills were rarely used. Some participants showed a lack of confidence in certain assessment skills, such as in doing a rectal or pelvic exam, and the use of some assessment equipment. Over 90% of participants required in-depth education on health assessment provided by specialists or nursing professional organizations. More educational opportunities in physical assessment should be provided including education programs based on the nurses' skill levels and needs. This effort will help to increase confidence of APNs and nurse specialists in physical assessment skills, ultimately resulting in better nursing outcomes.
Full Text Available Introduction: Emergency department (ED as the fundamental part of hospital has a specific importance due to admitting the most various and sensitive group of patients. The aim of the ED is presenting services with highest quality in the least time. To reach this goal establishment of an emergency medicine specialist who performs assessment, resuscitation, stabilization, detection, and maintenance of emergency patients is noteworthy. The aim of this study was evaluating the effect of establishing the emergency medicine specialists on the performance of ED in Poursina Hospital, Rasht, Iran. Methods: In this cross-sectional study files of all patients hospitalized in the ED of Poursina, Rasht, Iran, through 2005-2012 were evaluated. Variables such as age, gender, cause of refer and number of hospitalization, number of discharging from department, percentage of bed occupation and daily bed occupation, time of hospitalization, number of discharging under six hours, number of transportation to other wards or hospitals, and the rate of bed circulation in the ED were assessed, too. Data was gathered through hospital information system and analyzed using SPSS 20. Results: Through 2005 to 2012 number of admitted patients in the ED has increased so that the most admitted number was related to 2012 (p=0.0001. The present of discharged patients under six hours and the rate of direct discharging before the presence of emergency medicine specialists have increased from 15.5% and 58.9% to 23.4% and 61.2% in after their presence, respectively(p=0.001. Transporting to other wards and hospitals were also decreased from 41.1% to 38.8% (p=0.0001. The occupied beds percentage after presenting of emergency medicine specialists has noticeably decreased compared to the past, while bed turnover rate increased. In other words, the bed turnover mean has increased from 354.5±108.4 during 2005-2008 to 637.7±30.8 through 2009-2012 (p=0.002. Also, during 2005-2008 the
There is a highly inequitable distribution of health workers between public and private sectors in South Africa, partly due to within-country migration trends. This article elaborates what South African medical specialists find satisfying about working in the public and private sectors, at present, and how to better incentivize retention in the public sector. Seventy-four qualitative interviews were conducted - among specialists and key informants - based in one public and one private urban hospital in South Africa. Interviews were coded to determine common job satisfaction factors, both financial and non-financial in nature. This served as background to a broader study on the impacts of specialist 'dual practice', that is, moonlighting. All qualitative specialist respondents were engaged in dual practice, generally working in both public and private sectors. Respondents were thus able to compare what was satisfying about these sectors, having experience of both. Results demonstrate that although there are strong financial incentives for specialists to migrate from the public to the private sector, public work can be attractive in some ways. For example, the public hospital sector generally provides more of a team environment, more academic opportunities, and greater opportunities to feel 'needed' and 'relevant'. However, public specialists suffer under poor resource availability, lack of trust for the Department of Health, and poor perceived career opportunities. These non-financial issues of public sector dissatisfaction appeared just as important, if not more important, than wage disparities. The results are useful for understanding both what brings specialists to migrate to the private sector, and what keeps some working in the public sector. Policy recommendations center around boosting public sector resources and building trust of the public sector through including health workers more in decision-making, inter alia. These interventions may be more cost
Foreman, L.R.; Stark, J.C. [comp.
This tenth meeting of specialists in target fabrication for inertial confinement is unique in that it is the first meeting that was completely unclassified. As a result of the new classification, we were able to invite more foreign participation. In addition to participants from the US, UK, and Canada, representatives from France, Japan, and two Russian laboratories attended, about 115 in all. This booklet presents full papers and poster sessions. Indirect and direct drive laser implosions are considered. Typical topics include: polymer or aluminium or resorcinol/formaldehyde shells, laser technology, photon tunneling microscopy as a characterization tool, foams, coatings, hohlraums, and beryllium capsules. Hydrogen, deuterium, tritium, and beryllium are all considered as fuels.
Full Text Available BACKGROUND The neurosurgical patient is often a real challenge for the physicians, because of a frequent multimorbidity and a higher risk for severe complications. Cooperation between internal medicine specialist and neurosurgeon is essential to prevent the fatal effects of cranial and spinal injuries. The topic issues of medical interest in neurosurgery are the disorders of sodium balance, the glycemic control, the thromboembolic risk, the intracerebral bleeding management and the infective problems. The neurosurgeons could be worried by treating these complications that are mostly of internal medicine interest and that could unfortunately rise the risk of death or irreversible insults. AIM OF THE REVIEW This review summarizes the modality of diagnosis and therapy of the foremost concerns in neurosurgical field.
District nurse (DN) care delivery has undergone substantial change in recent years due to changing demographics and service delivery demands that have called for a move of care delivery from secondary to primary care. The title District Nurse is recorded with the Nursing and Midwifery Council (NMC) on completion of the Specialist Practice Qualification in District Nursing (SPQ DN), which purports to be a 'transformational' course that prepares future caseload holders to manage their team and prioritise care delivery effectively. This article explores the need for assertiveness skills in this role in response to Australian research, and outlines the pedagogic interventions implemented during the SPQ DN course to enhance this skill. Assertiveness scores were monitored for the duration of the course and demonstrated a significant increase-a topic that is now the subject of a future, funded study.
In the business world 'CNN REVOLUTION' is prevailing. 'CNN REVOLUTION' means the information system organized mostly by the Computer and the Communication Network through which they can make a vital business judgment. They try to give customers better service, enjoy a higher share and be more competitive through the information system, which enables them to control various information inside their firm completely and use it most usefully. They are also trying to hard to make the information system effective enough to gather information outside their firm. In making use of information for business, it is vital to get 'intelligence' which analized and processed information and to expand information distribution inside their company freely. As a new field of activity information specialist are expected to take a more important role in developing how to get 'good intelligence' and making useful information accessible through the information system.
Foreman, L.R.; Stark, J.C.
This tenth meeting of specialists in target fabrication for inertial confinement is unique in that it is the first meeting that was completely unclassified. As a result of the new classification, we were able to invite more foreign participation. In addition to participants from the US, UK, and Canada, representatives from France, Japan, and two Russian laboratories attended, about 115 in all. This booklet presents full papers and poster sessions. Indirect and direct drive laser implosions are considered. Typical topics include: polymer or aluminium or resorcinol/formaldehyde shells, laser technology, photon tunneling microscopy as a characterization tool, foams, coatings, hohlraums, and beryllium capsules. Hydrogen, deuterium, tritium, and beryllium are all considered as fuels
Parab, Chitra S; Cooper, Carolyn; Woolfenden, Susan; Piper, Susan M
Specialist paediatric home-based nursing services have been proposed as a cost-effective means of reducing distress resulting from hospital admissions, while enhancing primary care and reducing length of hospital stay. This review is an update of our original review, which was published in 2006. To evaluate specialist home-based nursing services for children with acute and chronic illnesses. We searched the following databases in February 2012: the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library 2012 Issue 2, Ovid MEDLINE, EMBASE, PsycINFO, CINAHL and Sociological Abstracts. We also searched ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform. No language restrictions were applied. Randomised controlled trials (RCTs) of children from birth to age 18 years with acute or chronic illnesses allocated to specialist home-based nursing services compared with conventional health care. Outcomes included utilisation of health care, physical and mental health, satisfaction, adverse health outcomes and costs. Two review authors extracted data from the studies independently and resolved any discrepancies by recourse to a third author. Meta-analysis was not appropriate because of the clinical diversity of the studies and the lack of common outcome measures. We screened 4226 titles to yield seven RCTs with a total of 840 participants. Participants, interventions and outcomes were diverse. No significant differences were reported in health outcomes; two studies reported a reduction in the hospital stay with no difference in the hospital readmission rates. Three studies reported a reduction in parental anxiety and improvement in child behaviours was reported in three studies. Overall increased parental satisfaction was reported in three studies. Also, better parental coping and family functioning was reported in one study. By contrast, one study each reported no impact on parental burden of care or on functional status of
Marshall, Z; Luffingham, N
Much conflict and confusion surrounds the title and role of the specialist nurse, leading in some instances to disharmony between general and specialist nurses. It has been suggested that too many highly specialized nurses in a general area may lead to a deskilled workforce and fragmented care. Attempts to define the key concepts of specialist practice as described by the UKCC has resulted in elitism, conflict and abuse of the title. One suggestion to eliminate this conflict is for specialist nurses to achieve key competencies that encompass the role of the clinical expert. These key competencies should be devised by specialist nurses, in the absence of national guidelines, and be agreed by employers. They should incorporate the key roles of: change agent, expert clinician, educator, researcher and coordinator. It is contended that if all concerned have a clearer definition of the title, role and what is expected from the specialist nurse then this will result in reduced conflict and improved quality of care.
University of Rhode Island Geospatial Extension Program — Hospital Facilities information was compiled from several various sources. Main source was the RI Department of Health Facilities Regulation database, License 2000....
Chang, Angela T; Gavaghan, Belinda; O'Leary, Shaun; McBride, Liza-Jane; Raymer, Maree
Objective The aim of the present study was to determine the rates of re-referral to specialist out-patient clinics for patients previously managed and discharged from an advanced practice physiotherapy-led service in three metropolitan hospitals. Methods A retrospective audit was undertaken of 462 patient cases with non-urgent musculoskeletal conditions discharged between 1 April 2014 and 30 March 2015 from three metropolitan hospitals. These patients had been discharged from the physiotherapy-led service without requiring specialist medical review. Rates and patterns of re-referral to specialist orthopaedic, neurosurgical, chronic pain, or rheumatology services within 12 months of discharge were investigated. Results Forty-six of the 462 patients (10.0%) who were managed by the physiotherapy-led service were re-referred to specialist medical orthopaedic, neurosurgical, chronic pain or rheumatology departments within 12 months of discharge. Only 22 of these patients (4.8%) were re-referred for the same condition as managed previously and discharged. Conclusions Ninety-five per cent of patients with non-urgent musculoskeletal conditions managed by an advanced practice physiotherapy-led service at three metropolitan hospitals did not re-present to access public specialist medical services for the same condition within 12 months of discharge. This is the first time that re-presentation rates have been reported for patients managed in advanced practice physiotherapy services and the findings support the effectiveness of these models of care in managing demand for speciality out-patient services. What is known about the topic? Advanced practice physiotherapy-led services have been implemented to address the needs of patients referred with non-urgent musculoskeletal conditions to hospital specialist out-patient services. Although this model is widely used in Australia, there has been very little information about whether patients managed in these services subsequently re
Schoevers, Johan; Jenkins, Louis
Access to health care often depends on where one lives. Rural populations have significantly poorer health outcomes than their urban counterparts. Specialist outreach to rural communities is one way of improving access to care. A multifaceted style of outreach improves access and health outcomes, whilst a shifted outpatients style only improves access. In principle, stakeholders agree that specialist outreach and support (O&S) to rural populations is necessary. In practice, however, factors influence whether or not O&S reaches its goals, affecting sustainability.Aim and setting: Our aim was to better understand factors associated with the success or failure of specialist O&S to rural populations in the Eden and Central Karoo districts in the Western Cape. An anonymous parallel three-stage Delphi process was followed to obtain consensus in a specialist and district hospital panel. Twenty eight specialist and 31 district hospital experts were invited, with response rates of 60.7%-71.4% and 58.1%-74.2% respectively across the three rounds. Relationships, communication and planning were found to be factors feeding into a service delivery versus capacity building tension, which affects the efficiency of O&S. The success of the O&S programme is dependent on a site-specific model that is acceptable to both the outreaching specialists and the hosting district hospital. Good communication, constructive feedback and improved planning may improve relationships and efficiency, which might lead to a more sustainable and mutually beneficial O&S system.
Cassenote, Alex Jones Flores; Scheffer, Mario César; Segurado, Aluísio Augusto Cotrim
The infectious diseases specialist is a medical doctor dedicated to the management of infectious diseases in their individual and collective dimensions. The aim of this paper was to evaluate the current profile and distribution of infectious diseases specialists in Brazil. This is a cross-sectional study using secondary data obtained from institutions that register medical specialists in Brazil. Variables of interest included gender, age, type of medical school (public or private) the specialist graduated from, time since finishing residency training in infectious diseases, and the interval between M.D. graduation and residency completion. Maps are used to study the geographical distribution of infectious diseases specialists. A total of 3229 infectious diseases specialist registries were counted, with 94.3% (3045) of individual counts (heads) represented by primary registries. The mean age was 43.3 years (SD 10.5), and a higher proportion of females was observed (57%; 95% CI 55.3-58.8). Most Brazilian infectious diseases specialists (58.5%) practice in the Southeastern region. However, when distribution rates were calculated, several states exhibited high concentration of infectious diseases specialists, when compared to the national rate (16.06). Interestingly, among specialists working in the Northeastern region, those trained locally had completed their residency programs more recently (8.7yrs; 95% CI 7.9-9.5) than physicians trained elsewhere in the country (13.6yrs: 95% CI 11.8-15.5). Our study shows that Brazilian infectious diseases specialists are predominantly young and female doctors. Most have concluded a medical residency training program. The absolute majority practice in the Southeastern region. However, some states from the Northern, Northeastern and Southeastern regions exhibit specialist rates above the national average. In these areas, nonetheless, there is a strong concentration of infectious diseases specialists in state capitals and in
Alex Jones Flores Cassenote
Conclusion: Our study shows that Brazilian infectious diseases specialists are predominantly young and female doctors. Most have concluded a medical residency training program. The absolute majority practice in the Southeastern region. However, some states from the Northern, Northeastern and Southeastern regions exhibit specialist rates above the national average. In these areas, nonetheless, there is a strong concentration of infectious diseases specialists in state capitals and in metropolitan areas.
Djuric, G.; Popovic, D.
The education of radiation protection for veterinary medicine specialists on the University of Belgrade is integrated both in regular graduate studies and in postgraduate studies. Within the graduate studies, students attend courses in physics and biophysics and in radiation hygiene. During postgraduate or specialistic veterinary medicine studies, veterinary medicine specialists expand their knowledge in radiation protection through a number of courses on radiation biophysics, radioecology, nuclear instrumentation and environmental protection. (author)
M. L. Gruzdeva
Full Text Available In the article discussed the question of formation of professional mobility specialist through the formation of professional competencies within the educational process in high school.
Higgins, T.J.; Diaz, M.R.
This paper provides a nontechnical discussion of the use of Technical Specialists in quality assurance audits by the Office of Civilian Radioactive Waste Management's Office of Quality Assurance. The purpose is to describe one successful solution to the problem that arises when a quality assurance organization is responsible for conducting audits of many, diverse, highly technical activities. The solution is the conduct of audits that combine both horizontal and vertical sample selection strategies and which employ Technical Specialists in the vertical portion of the audit. The Technical Specialist is paired with a programmatic auditor who perform as a dedicated team in their conduct of the audit. This paper focuses on the Technical Specialist
FIGOVSKY Oleg Lvovich
Full Text Available The performance of innovative training system aimed at highly intellectual specialists in the area of nanotechnologies for Kazakhstan’s economy demands establishment and development of nanotechnological market in the country, teaching of innovative engineering combined with consistent research, integration of trained specialists with latest technologies and sciences at the international level. Methodological aspects of training competitive specialists for nanotechnological field are specific. The paper presents methodological principles of innovative training of specialists for science-intensive industry that were realized according to grant given by the Ministry of Education and Science of the Republic of Kazakhstan.
Maguire, Martin C
The EU EuroClim project developed a system to monitor and record climate change indicator data based on satellite observations of snow cover, sea ice and glaciers in Northern Europe and the Arctic. It also contained projection data for temperature, rainfall and average wind speed for Europe. These were all stored as data sets in a GIS database for users to download. The process of gathering requirements for a user population including scientists, researchers, policy makers, educationalists and the general public is described. Using an iterative design methodology, a user survey was administered to obtain initial feedback on the system concept followed by panel sessions where users were presented with the system concept and a demonstrator to interact with it. The requirements of both specialist and non-specialist users is summarised together with strategies for the effective communication of geographic climate change information. Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.
Schneiderhahn, Mary Elizabeth; Fish, Anne Folta
The purpose of this article was to describe the history and leadership dimensions of the role of resuscitation process manager and provide specific examples of how this role is implemented at a Midwest medical center. In 1992, a medical center in the Midwest needed a nurse to manage resuscitation care. This role designation meant that this nurse became central to all quality improvement efforts in resuscitation care. The role expanded as clinical resuscitation guidelines were updated and as the medical center grew. The role became known as the critical care clinical nurse specialist as resuscitation process manager. This clinical care nurse specialist was called a manager, but she had no direct line authority, so she accomplished her objectives by forming a multitude of collaborative networks. Based on a framework by Finkelman, the manager role incorporated specific leadership abilities in quality improvement: (1) coordination of medical center-wide resuscitation, (2) use of interprofessional teams, (3) integration of evidence into practice, and (4) staff coaching to develop leadership. The manager coordinates resuscitation care with the goals of prevention of arrests if possible, efficient and effective implementation of resuscitation protocols, high quality of patient and family support during and after the resuscitation event, and creation or revision of resuscitation policies for in-hospital and for ambulatory care areas. The manager designs a comprehensive set of meaningful and measurable process and outcome indicators with input from interprofessional teams. The manager engages staff in learning, reflecting on care given, and using the evidence base for resuscitation care. Finally, the manager role is a balance between leading quality improvement efforts and coaching staff to implement and sustain these quality improvement initiatives. Revisions to clinical guidelines for resuscitation care since the 1990s have resulted in medical centers developing improved
Urbonas, Gvidas; Jakušovaitė, Irayda; Savickas, Arūnas
The main objective of this study was to analyze pharmacy specialists' attitudes toward the quality of pharmaceutical services at Lithuanian community pharmacies. Between April and June 2009, a total of 471 Lithuanian community pharmacy specialists completed a questionnaire designed to evaluate their attitudes toward the quality of pharmaceutical services at community pharmacies. The main dimensions of pharmaceutical service quality were extracted by principal component analysis. Two main dimensions of pharmaceutical service quality were extracted: pharmacotherapeutic aspects (provision of information about drug therapy, possible side effects, health promotion, the amount of time spent with a patient, and the ascertainment that a patient understood the provided information) and socioeconomic aspects (considering patient's needs and financial capabilities, making a patient confident with the services provided). Pharmacy specialists evaluated the quality of both dimensions positively, but the quality of the first dimension was rated significantly worse than that of the second dimension. The attitudes of pharmacy specialists working at independent pharmacies were more positive toward pharmacotherapeutic aspects as compared to the specialists working at chain or state pharmacies. Pharmacotherapeutic aspects were rated better by pharmacy specialists, aged ≥ 55 years, than those younger than 45 years. Moreover, the attitudes of 45-54-year-old pharmacy specialists toward the socioeconomic aspects were more positive as compared with those of 35-44-year olds. Pharmacists rated the socioeconomic aspects of pharmaceutical service quality worse as compared with pharmacy technicians. The attitudes of pharmacy specialists working at pharmacies with 6-9 specialists were more negative toward pharmacotherapeutic aspects than those of the pharmacies with 1-2 specialists. Pharmacy specialists working at pharmacies with ≥ 10 specialists reported lower scores of socioeconomic
Girlanda, Francesca; Fiedler, Ines; Ay, Esra; Barbui, Corrado; Koesters, Markus
Clinical practice guidelines in mental healthcare are viewed as an essential asset if appropriately developed and implemented. The purpose of this article was to review the existing literature on how guidelines should be implemented to optimize their impact on provider performance and patient outcomes in specialist mental healthcare settings. Findings from recent studies suggest a trend toward an improvement in process and patient outcomes following guideline implementation. However, studies are heterogeneous in terms of design, implementation strategies and outcome measures, making it very difficult to draw firm conclusions about which implementation strategy is effective in different healthcare contexts. Current knowledge about how guidelines should be implemented is still sparse and inconclusive in mental healthcare. Future studies should attempt to employ more rigorous designs, including random allocation of patients or clusters of patients, to shed further light on this compelling issue. Research on guideline implementation strategies should additionally take into account potential barriers to knowledge translation, which can heavily influence the implementability of treatment recommendations.
National Council on Foreign Language and International Studies, New York, NY.
The South Asia Panel of the National Council on Foreign Languages and International Studies reports on the need for specialists in the languages and cultures of Afghanistan, Bangladesh, India, Nepal, Pakistan, Sri Lanka, Bhutan, and the Maldives. Two categories of specialists are discussed: (1) individuals in government, mission, etc., in…
Södergren, Ulrika; Benjaminson, Carin; Mattsson, Janet
Background: Specialist nurse students are upon graduation certified to have increased their professional competence to an advanced level. But how do specialist nurse students themselves experience and understand their professional competence and its development upon graduation? This is what this study aims at describing. Method: This study has a…
Young, M Cherilyn; Drayton, Vonna L C; Menon, Ramdas; Walker, Lesa R; Parker, Colleen M; Cooper, Sam B; Bultman, Linda L
Assuring the sufficiency and suitability of systems of care and services for children with special health care needs (CSHCN) presents a challenge to Texas providers, agencies, and state Title V programs. To meet the need for specialist care, referrals from primary care doctors are often necessary. The objective of this study was to describe the factors associated with the need for specialist care and problems associated with obtaining referrals in Texas. Bivariate and multivariate analyses were performed using the National Survey of Children with Special Health Care Needs (NS-CSHCN) weighted sample for Texas (n = 719,014) to identify variables associated with the need for specialist care and problems obtaining referrals for specialist care. Medical need of the CSHCN and sensitivity to family values/customs was associated with greater need for specialist care, and Hispanic ethnicity and lower maternal education were associated with less need. Medical need, amount of time spent with doctors and sensitivity to values/customs, living in a large metropolitan statistical area, and lack of medical information were associated with problems obtaining a specialist care referral. Findings revealed some similarities and differences with meeting the need for specialist care when comparing Texas results to other studies. In Texas, aspects of customer satisfaction variables, especially doctors' sensitivity to family values/customs and parents' not receiving enough information on medical problems, were significantly associated with problems obtaining specialist referrals. Findings indicate a need to further research relationships and communication among doctors, CSHCN, and their families.
The Perception of Teachers and School Library Media Specialist on the Role of School Library Media Specialists in Selected Secondary Schools in Ogun State. ... Journal Home > Vol 9, No 1 (2012) >. Log in or Register to get access to full text ...
Pappas, Marjorie L.
Library media specialists need tools to help them manage the school library media program. The Internet includes a vast array of tools that a library media specialist might find useful. The websites and electronic resources included in this article are only a representative sample and future columns may explore additional tools. All the tools are…
Two Spacelab 1 payload specialists and a backup for that flight prepare for a training session in the JSC mockup and integration laboratory. Fully decked out in the Shuttle constant wear garments (foreground) are Ulf Merbold, left, and Byron K. Licktenberg, prime crewmembers on the STS-9 team. In civilian clothes is payload specialist backup Michael L. Lampton.
Millberg, Lena German; Berg, Linda; Brämberg, Elisabeth Björk; Nordström, Gun; Ohlén, Joakim
The aim was to explore the major concerns of specialist nurses pertaining to academic learning during their education and initial professional career. Specialist nursing education changed in tandem with the European educational reform in 2007. At the same time, greater demands were made on the healthcare services to provide evidence-based and safe patient-care. These changes have influenced specialist nursing programmes and consequently the profession. Grounded Theory guided the study. Data were collected by means of a questionnaire with open-ended questions distributed at the end of specialist nursing programmes in 2009 and 2010. Five universities were included. Further, individual, pair and group interviews were used to collect data from 12 specialist nurses, 5-14 months after graduation. A major concern for specialist nurses was that academic learning should be "meaningful" for their professional future. The specialist nurses' "meaningful academic learning process" was characterised by an ambivalence of partly believing in and partly being hesitant about the significance of academic learning and partly receiving but also lacking support. Specialist nurses were influenced by factors in two areas: curriculum and healthcare context. They felt that the outcome of contribution to professional confidence was critical in making academic learning meaningful. Copyright © 2014 Elsevier Ltd. All rights reserved.
Visser, Mechteld R. M.; Smets, Ellen M. A.; Oort, Frans J.; de Haes, Hanneke C. J. M.
Background: Stress and stress-related illnesses are increasing among medical specialists. This threatens the quality of patient care. in this study we investigated (a) levels of job stress and job satisfaction among medical specialists, (b) factors contributing to stress and satisfaction and (c) the
Harris, Frances Jacobson
In this article, the author talks about the school librarian as information specialist. She stresses that the school librarian's information specialist role is more important than ever. She offers her personal toolkit that consists of four strategies in helping and teaching students to use content responsibly.
Ginsburg, Victoria Elaine
This descriptive qualitative case study explored the changing role of the reading specialist through various perceptions of professionals in the Neon Shadow School District. The purpose of the study was to explore what, how, and why the duties and responsibilities of the reading specialist have changed since first employed as an…
Seow, Hsien; Dhaliwal, Gagan; Fassbender, Konrad; Rangrej, Jagadish; Brazil, Kevin; Fainsinger, Robin
Prior research on community-based specialist palliative care teams used outcome measures of place of death and/or dichotomous outcome measures of acute care use in the last two weeks of life. However, existing research seldom measured the diverse places of care used and their timing prior to death. The study objective was to examine the place of care in the last 30 days of life. In this retrospective cohort study, patients who received care from a specialist palliative care team (exposed) were matched by propensity score to patients who received usual care in the community (unexposed) in Ontario, Canada. Measured was the percentage of patients in each place of care in the last month of life as a proportion of the total cohort. After matching, 3109 patients were identified in each group, where 79% had cancer and 77% received end-of-life home care. At 30 days compared to 7 days before death, the exposed group's proportions rose from 33% to 41% receiving home care and 14% to 15% in hospital, whereas the unexposed group's proportions rose from 28% to 32% receiving home care and 16% to 22% in hospital. Linear trend analysis (proportion over time) showed that the exposed group used significantly more home care services and fewer hospital days (p care. Examining place of care in the last month can effectively illustrate the service use trajectory over time.
Cabral, Linda; Strother, Heather; Muhr, Kathy; Sefton, Laura; Savageau, Judith
Mental health peer specialists develop peer-to-peer relationships of trust with clients to improve their health and well-being, functioning in ways similar to community health workers. Although the number of peer specialists in use has been increasing, their role in care teams is less defined than that of the community health worker. This qualitative study explored how the peer specialist role is defined across different stakeholder groups, the expectations for this role and how the peer specialist is utilised and integrated across different types of mental health services. Data were collected through interviews and focus groups conducted in Massachusetts with peer specialists (N = 44), their supervisors (N = 14) and clients (N = 10) between September 2009 and January 2011. A consensus coding approach was used and all data outputs were reviewed by the entire team to identify themes. Peer specialists reported that their most important role is to develop relationships with clients and that having lived mental health experience is a key element in creating that bond. They also indicated that educating staff about the recovery model and peer role is another important function. However, they often felt a lack of clarity about their role within their organisation and care team. Supervisors valued the unique experience that peer specialists bring to an organisation. However, without a defined set of expectations for this role, they struggled with training, guiding and evaluating their peer specialist staff. Clients reported that the shared lived experience is important for the relationship and that working with a peer specialist has improved their mental health. With increasing support for person-centred integrated healthcare delivery models, the demand for mental health peer specialist services will probably increase. Therefore, clearer role definition, as well as workforce development focused on team orientation, is necessary for peer specialists to be fully integrated
The T-38 jet aircraft arrives at the Shuttle Landing Facility carrying STS-95 Mission Specialist Scott E. Parazynski (second seat). The pilot is astronaut Kent Rominger. Parazynski's first plane experienced problems at the stop at Tyndall AFB and he had to wait for another jet and pilot to finish the flight to KSC. He joined other crewmembers Mission Commander Curtis L. Brown Jr., Pilot Steven W. Lindsey, Mission Specialist Stephen K. Robinson, Payload Specialist John H. Glenn Jr., senator from Ohio, Mission Specialist Pedro Duque, with the European Space Agency (ESA), and Payload Specialist Chiaki Mukai, with the National Space Development Agency of Japan (NASDA), for final pre-launch preparations. STS-95 is expected to launch at 2 p.m. EST on Oct. 29, last 8 days, 21 hours and 49 minutes, and land at 11:49 a.m. EST on Nov. 7.
Ragucci, Kelly R; O'Bryant, Cindy L; Campbell, Kristin Bova; Buck, Marcia L; Dager, William E; Donovan, Jennifer L; Emerson, Kayleigh; Gubbins, Paul O; Haight, Robert J; Jackevicius, Cynthia; Murphy, John E; Prohaska, Emily
The American College of Clinical Pharmacy and other stakeholder organizations seek to advance clinical pharmacist practitioners, educators, and researchers. Unfortunately, there remains an inadequate supply of residency-trained clinical specialists to meet the needs of our health care system, and nonspecialists often are called on to fill open specialist positions. The impact of clinical pharmacy specialists on pharmacotherapy outcomes in both acute care and primary care settings demonstrates the value of these specialists. This commentary articulates the need for postgraduate year two (PGY2)-trained clinical specialists within the health care system by discussing various clinical and policy rationales, interprofessional support, economic justifications, and their impact on quality of care and drug safety. The integrated practice model that has grown out of the American Society of Health-System Pharmacists Pharmacy Practice Model Initiative (PPMI) could threaten the growth and development of future clinical specialists. Therefore, the ways in which PGY2-trained clinical pharmacist specialists are deployed in the PPMI require further consideration. PGY2 residencies provide education and training opportunities that cannot be achieved in traditional professional degree programs or postgraduate year one residencies. These specialists are needed to provide direct patient care to complex patient populations and to educate and train pharmacy students and postgraduate residents. Limitations to training and hiring PGY2-trained clinical pharmacy specialists include site capacity limitations and lack of funding. A gap analysis is needed to define the extent of the mismatch between the demand for specialists by health care systems and educational institutions versus the capacity to train clinical pharmacists at the specialty level. © 2014 Pharmacotherapy Publications, Inc.
U.S. Department of Health & Human Services — Hospital Compare has information about the quality of care at over 4,000 Medicare-certified hospitals across the country. You can use Hospital Compare to find...
U.S. Department of Health & Human Services — A list of hospital ratings for the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). HCAHPS is a national, standardized survey of hospital...
Eneroth, Mari; Gustafsson Sendén, Marie; Løvseth, Lise T; Schenck-Gustafsson, Karin; Fridner, Ann
Physicians have an elevated risk of experiencing suicidal thoughts, which might be due to work-related factors. However, the hierarchical work positions as well as work-related health differ among resident and specialist physicians. As such, the correlates of suicide ideation may also vary between these two groups. In the present study, work- and health-related factors and their association with suicidal thoughts among residents (n=234) and specialists (n=813) working at a university hospital were examined using cross-sectional data. Logistic regression analysis showed that having supportive meetings was associated with a lower level of suicide ideation among specialists (OR=0.68, 95% CI: 0.50-0.94), while an empowering leadership was related to a lower level of suicide ideation among residents (OR=0.55, 95% CI: 0.32-0.94). Having been harassed at work was associated with suicidal ideation among specialists (OR=2.26, 95% CI: 1.31-3.91). In addition, sickness presenteeism and work disengagement were associated with suicide ideation in both groups of physicians. These findings suggest that different workplace interventions are needed to prevent suicide ideation in residents and specialists.
Hobson, Esther V; Baird, Wendy O; Cooper, Cindy L; Mawson, Sue; Shaw, Pamela J; Mcdermott, Christopher J
Our objective was to review the evidence for using technology to improve access to specialist care for patients with amyotrophic lateral sclerosis (ALS) and their carers. Medline, Google Scholar and the Cochrane library were searched for articles describing technology that enabled clinical care of patients with ALS or their carers where the patient/carer and clinician were not in the same location. Two applications were identified: telemedicine to facilitate video conferencing as an alternative to outpatient consultations and telehealth monitoring for patients with respiratory failure. One randomized controlled trial using telehealth in patients with respiratory failure including 22 patients with ALS was identified. While rates of hospitalization were reduced, overall mortality was unchanged and there were too few patients with ALS in the study to detect significant benefit. In conclusion, there is limited evidence to support the use of telemedicine or telehealth in the care of patients with ALS. Future research needs to develop an understanding of the key beneficial aspects of the traditional specialist ALS service and how these factors could be delivered using technology. Successful evaluation and implementation of technologies to facilitate access to specialist care will only be possible if all the relevant impacts of an intervention are understood and measured.
Contla-Hosking, Jorge Eduardo; Ceballos-Martínez, Zoila Inés; Peralta-Bahena, Mónica Esther
Our aim was to identify the level of knowledge of surgical health-area specialists in Cancún, Quintana Roo, Mexico, from the personal productivity database. We carried out an investigation of 37 surgical specialists: 24 belonged to the Mexican Social Security Institute (IMSS), while 13 belonged to the Mexican Health Secretariat (SSA). In our research, we found that 61% of surgical health-area specialist physicians were familiar with some aspects of the institutional surgical registry, including the following: 54% knew of the existence of a personal registry of surgeries carried out, and 43% keep a record of their personal activities. From the latter percentage, 69% of surgical health-area specialist physicians mentioned keeping their records manually, while 44% used the computer. Results of the research suggest that these physicians would like to have some kind of record of the surgeries carried out by each. An important percentage of these specialists do not keep a personal record on a database; due to this lack of knowledge, we obtain incorrect information in institutional records of the reality of what is actually done. We consider it important to inform surgical specialists concerning the existence of personal institutional records in database form or even of record done manually, as well as correct terminology for the International Codification (CIE-9 & 10). We inform here of the need to encourage a culture in records and databases in the formative stage of surgeon specialists.
van der Burgt, Stéphanie M E; Kusurkar, Rashmi A; Croiset, Gerda; Peerdeman, Saskia M
The aim was to obtain insight into the factors in the work environment that motivate or demotivate a medical specialist during his/her working day. A qualitative ethnographic design was used, and a constructivist approach was adopted with the Self-Determination theory of motivation as a framework. Six medical specialists from VU University Medical Center in the Netherlands, recruited through convenience, snowball, and purposive sampling, were shadowed for one day each. Data were transcribed and open-coded. Themes were finalized through discussion and consensus. Sixty hours of observation data identified motivating and demotivating factors categorized into four themes that are important for specialists' motivation. Informational technology issues are demotivating factors. Working with colleagues can be both a motivating and demotivating factor, e.g., filling in for each other through feelings of relatedness was motivating. Being in control of one's planning through feelings of autonomy was motivating. Furthermore, patient care and teaching, especially in combination, stimulated specialists' motivation. Regarding the design of the study, we found that situational motivation is indeed observable. The basic psychological needs autonomy, competence, and relatedness are important for specialists' motivation. Investing in a more motivating, open, transparent, and basic-needs- supportive work environment for medical specialists is necessary. Keywords: Continuing professional development, motivation, medical specialists, self-determination theory, qualitative research.
Dhiliwal, Sunil R; Muckaden, Maryann
Home-based specialist palliative care services are developed to meet the needs of the patients in advanced stage of cancer at home with physical symptoms and distress. Specialist home care services are intended to improve symptom control and quality of life, enable patients to stay at home, and avoid unnecessary hospital admission. Total 690 new cases registered under home-based palliative care service in the year 2012 were prospectively studied to assess the impact of specialist home-based services using Edmonton symptom assessment scale (ESAS) and other parameters. Out of the 690 registered cases, 506 patients received home-based palliative care. 50.98% patients were cared for at home, 28.85% patients needed hospice referral and 20.15% patients needed brief period of hospitalization. All patients receiving specialist home care had good relief of physical symptoms (P care (OOH) through liaising with local general practitioners; 42.68% received home based bereavement care and 91.66% had good bereavement outcomes. Specialist home-based palliative care improved symptom control, health-related communication and psychosocial support. It promoted increased number of home-based death, appropriate and early hospice referral, and averted needless hospitalization. It improved bereavement outcomes, and caregiver satisfaction.
Full Text Available Functioning patterns of postgraduate education of tourism sphere specialists in Switzerland have been established. The competences of tourism sphere specialist, the formation of which programs of postgraduate education are focused on have been considered. The benefits of educational qualification of Masters in Business Administration with a major specialization in tourism have been outlined. The characteristics of the core curriculum of the Doctor of Management of leading universities in the field of tourism education have been determined. The performance criteria of postgraduate education system functioning of tourism sphere specialists in Switzerland have been revealed.
Utilisation of Antenatal Services at the Provincial Hospital, Mongomo, Guinea Equatoria. AAG Jimoh. Abstract. This prospective study was carried out to evaluate the utilisation of antenatal care at the Provincial Specialist Hospital, Mongomo, Guinea Equatoria, paying close attention to the confounding factors affecting ...
Meliala, Andreasta; Hort, Krishna; Trisnantoro, Laksono
As in many countries, the geographic distribution of the health workforce in Indonesia is unequal, with a concentration in urban and more developed areas, and a scarcity in rural and remote areas. There is less information on the distribution of specialist doctors, yet inequalities in their distribution could compromise efforts to achieve universal coverage by 2014. This paper uses data from 2007 and 2008 to describe the geographic distribution of specialist doctors in Indonesia, and to examine two key factors that influence the distribution and are targets of current policies: sources of income for specialist doctors, and specialist doctor engagement in private practice. The data demonstrates large differences in the ratio of specialist doctors to population among the provinces of Indonesia, with higher ratios on the provinces of the islands of Java, and much lower ratios on the more remote provinces in eastern Indonesia. Between 65% and 80% of specialist doctors' income derives from private practice in non-state hospitals or private clinics. Despite regulations limiting practice locations to three, most specialists studied in a provincial capital city were working in more than three locations, with some working in up to 7 locations, and spending only a few hours per week in their government hospital practice. Our study demonstrates that the current regulatory policies and financial incentives have not been effective in addressing the maldistribution of specialist doctors in a context of a growing private sector and predominance of doctors' income from private sources. A broader and more integrated policy approach, including more innovative service delivery strategies for rural and remote areas, is recommended. Copyright © 2013 Elsevier Ltd. All rights reserved.
methods of economic evaluation are relevant for a societal evaluation of the usefulness of an intervention. Sticking to DRG subtleties, only, the guidance serves private hospital profit instead of societal benefit. In all, these are serious weaknesses for a book aiming to guide the collaboration between......Book review Successful collaboration in healthcare-a guide for physicians, nurses and clinical documentation specialists Colleen Stukenberg New York: CRC Press, Taylor & Francis Group, 2010, pp. 136 ISBN 978 1 4389 1292 1 This book addresses an important topic, especially for health professionals...... engaged in integrated care (IC). Also, the book is easy to read with about 120 pages in a fluent language that you feel is based on first hand personal job experiences. Colleen Stukenberg is a certified nurse with more than 20 years' experience from a variety of hospital areas, a master's of science...
Child life programming is predominantly developed in inpatient areas throughout major pediatric hospitals. However, the trend toward outpatient services has increased the need for facilities to develop child life positions to assist in the teaching demands of patients and families coming in for routine hospital visits. Since radiology is often the first experience for families, but not the last, it is essential to involve them in a positive experience. Imaging facilities serving pediatric patients are currently developing or considering child life programs. A certified child life specialist (CCLS) is committed to developing programming that enhances the child's understanding and involvement in their medical experience. This paper provides an outline of the responsibilities and areas of expertise of the CCLS in a pediatric radiology department. The reviewed program is based on, but not limited, to fluoroscopy. (orig.)
Heinrichs, Audrey S.
Discusses the contradictions found in recommendations for direction instruction or informal math language development, and some suggestions for practical resolution of disagreements, to enable school reading specialists to provide both background and practical help to classroom instructors teaching math. (HTH)
Training the non-specialist music teacher: insights from a Zimbabwean case study. ... music education in primary schools is taught by general classroom teachers, who ... JOURNAL OF THE MUSICAL ARTS IN AFRICA VOLUME 7 2010, 1–15 ...
Cole, Lisa M; Walker, Theodore J; Nader, Kelly C; Glover, Dennis E; Newkirk, Laura E
A clearly defined role of the Perioperative Clinical Nurse Specialist (PONS) is not identified. The purpose of this study was to provide recommendations for a delineated role of the PONS that will provide role clarity and practice guidance...
Tacconelli, Evelina; Poljak, Mario; Cacace, Marina; Caiati, Giovanni; Benzonana, Nur; Nagy, Elisabeth; Kortbeek, Titia
In 2009, in a European survey, around a quarter of Europeans reported witnessing discrimination or harassment at their workplace. The parity committee from the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) designed a questionnaire survey to investigate forms of discrimination with respect to country, gender and ethnicity among medical professionals in hospitals and universities carrying out activities in the clinical microbiology (CM) and infectious diseases (ID) fields. The survey consisted of 61 questions divided into five areas (sociodemographic, professional census and environment, leadership and generic) and ran anonymously for nearly 3 months on the ESCMID website. European specialists in CM/ID. Overall, we included 1274 professionals. The majority of respondents (68%) stated that discrimination is present in medical science. A quarter of them reported personal experience with discrimination, mainly associated with gender and geographic region. Specialists from South-Western Europe experienced events at a much higher rate (37%) than other European regions. The proportion of women among full professor was on average 46% in CM and 26% in ID. Participation in high-level decision-making committees was significantly (>10 percentage points) different by gender and geographic origin. Yearly gross salary among CM/ID professionals was significantly different among European countries and by gender, within the same country. More than one-third of respondents (38%) stated that international societies in CM/ID have an imbalance as for committee member distribution and speakers at international conferences. A quarter of CM/ID specialists experienced career and research discrimination in European hospitals and universities, mainly related to gender and geographic origin. Implementing proactive policies to tackle discrimination and improve representativeness and balance in career among CM/ID professionals in Europe is urgently needed.
Mitchell, Stephanie J; Bilderback, Andrew L; Okelo, Sande O
To elucidate whether there may be a higher morbidity threshold for African American versus white children to be referred to or seek asthma specialist care. Secondary analysis of registry data captured from children presenting for an initial routine outpatient asthma consultation. Parents completed standard survey instruments, and spirometry was conducted when deemed appropriate by the provider. Wilcoxon rank sum tests revealed that African American patients had been hospitalized twice as often and admitted to the intensive care unit or intubated significantly more than 1½ times more frequently than their white patient counterparts. t tests indicated African American patients' forced expiratory volume in 1 second (FEV1) percentage predicted was significantly worse than that of whites, but there was no significant difference for FEV1/forced vital capacity ratio. t tests suggested that African American patients had statistically worse asthma control than did white patients at the time of initial presentation to the pulmonologist, but there was no difference in the distribution of asthma severity categories. Multivariate regression models indicated that racial differences in parent education did not explain the disparities in asthma morbidity. African American patients had significantly worse asthma morbidity than their white counterparts, including higher rates of hospitalization and intensive care unit admission and poorer lung functioning. Given that receipt of asthma specialist care can improve those outcomes that are disparately experienced by African American children, methods of increasing their access to and use of asthma specialist care need to be developed. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
Thackwell, Nicola; Swartz, Leslie; Dlamini, Sipho; Phahladira, Lebogang; Muloiwa, Rudzani; Chiliza, Bonginkosi
This research aimed to identify and explore the experiences of Black registrars in their training in the Western Cape's academic hospitals in order to identify structures, practices, attitudes and ideologies that may promote or impede the advancement of Black doctors into specialist medicine. This is justified by the requirement for universities to work towards monitoring and evaluating efforts to create non-discriminatory and inclusive training environments. This study employed qualitative research methods. Ten Black African medical specialists were interviewed about their training experiences in two university training hospitals in the Western Cape Province, South Africa. Interview data was collected using open-ended questions and coded and analysed using thematic and critical discursive analysis techniques. Four experiential themes emerged from the interview data, they included: 1) experiences of everyday racism during work hours, 2) the physical and psychological effects of tokenism and an increased need to perform, 3) institutional racism as a result of inconsistent and unclear methods of promotion and clinical competence building, and 4) an organisational culture that was experienced as having a race and gender bias. This is a pilot study and there are limits on the generalizability of the data due to the small sample. What is clear from our participants, though, is the strong experiential component of finding it challenging to be a Black trainee in a White-dominated profession. We are undertaking further research to explore the issues raised in more detail.
Wilkinson, Jill; Carryer, Jenny; Adams, Jeffery
To evaluate the diabetes nurse specialist prescribing project with the aim of determining whether diabetes nurse specialist prescribing is safe and effective and to inform the implementation and extension of registered nurse prescribing. Registered nurses in many countries are able to prescribe medicines, but in New Zealand, prior to the diabetes nurse specialist project, nurse practitioners were the only nurses who could prescribe medicines. New regulations allowed the nurses to prescribe a limited number of prescription medicines. The study was a process and outcome clinical programme evaluation. The project took place between April-September 2011 and involved 12 diabetes nurse specialist in four localities. Quantitative data were collected from clinical records maintained by the diabetes nurse specialist for the project (1274 patients and 3402 prescribing events), from surveys with stakeholders (general practitioners, n = 30; team members, n = 19; and patients, n = 89) and audits from patient notes (n = 117) and prescriptions (n = 227), and qualitative data from interviews with project participants (n = 18) and patients (n = 19). All data were analysed descriptively. Diabetes nurse specialist prescribing was determined to be safe, of high quality and appropriate. It brought important benefits to the effectiveness of specialist diabetes services, was acceptable to patients and was supported by the wider healthcare team. These findings are consistent with the findings reported in the international literature about nurse prescribing in a range of different practice areas. Clarification of the education and competence requirements and resourcing for the ongoing supervision of nurses is recommended if the prescribing model is to be extended. Diabetes nurse specialist prescribing improved access to medicines by providing a more timely service. Nurses felt more satisfied with their work because they could independently provide a complete episode of care
Thomas, R.; Huntley, A.; Mann, M.; Huws, D.; Paranjothy, S.; Elwyn, G.; Purdy, S.
Unplanned admissions for heart failure are common and some are considered preventable. OBJECTIVE: Undertake a systematic literature review and meta-analysis to evaluate the effectiveness of specialist clinics in reducing unplanned hospital admissions in people with heart failure. DATA SOURCES: 18
Conclusion: These findings indicate that the diagnostic accuracy of emergency medicine specialists is significantly higher than those of general physicians. The diagnostic accuracy of both physician groups was higher than the values in similar studies that signifies the role of relevant training given in the emergency departments of the Hospital.
... have aligned the definition of ``clinical nurse specialist'' that is in the rule with the definition... staffing and management decisions that individual hospitals and CAHs choose to make. 2. Section-by-Section... Association AOA American Osteopathic Association APRN Advanced Practice Registered Nurse BBA Balanced Budget...
Xuzhou Center Hospital is in a competing medical market in Xuzhou city. This hospital has been dedicating to improve the medical skills and provide professional and individualized service to the patients in order to improve the patient's experience and increase the patient's satisfaction. On the other side, this hospital has provided an all-round marketing campaign to build up the social influence and public reputation through public-praise marketing, web marketing, media marketing, and scholar marketing. Besides, this hospital has been cooperating with foreign medical institutions and inviting foreign medical specialists to academic communication. With the combined effects of improving medical service and all-round marketing, the hospital's economic performance has been enhanced significantly and laid a solid foundation for its ambition to become the first-class hospital in Huaihai Economic Zone.
Nikhil S. Choudhari
Full Text Available AIM: To obtain information on the prevailing practice patterns of glaucoma specialists in India. METHODS: Glaucoma specialists attending the Annual Conference of the Glaucoma Society of India (GSI were surveyed. This survey, conducted in 2013, was based on an interactive audience response system. RESULTS: The information was obtained from 146 glaucoma specialists. Approximately half (n=83; 57% had ≥10y of experience in managing glaucoma and were in institutional practice (n=74, 51%. Goldmann applanation tonometry was preferred by 103 (72% specialists whilst n=25 (17.4% used non-contact tonometer. Indentation gonioscopy was favoured by two-thirds (n=90, 66% whereas stereoscopic optic disc examination and visual fields using Humphrey perimeter was performed by a majority of the specialists surveyed (n=115, 86% and n=114; 83% respectively. Nearly three quarter specialists (n=96; 72% preferred optical coherence tomography for imaging. The primary choice for treatment of angle closure disease and primary open angle glaucoma was laser (iridotomy, n=117; 93% and medical management (prostaglandin analogue, n=104; 78%, respectively. Approximately only a third of the specialists surveyed (n=37; 28% were performing both trabeculectomy and implantation of a glaucoma drainage device and about half (n=64; 47% were not operating on congenital glaucoma at all. CONCLUSION: This survey has found conformance with preferred practice patterns in several areas of diagnosis and management of glaucoma, but there was diversity in a few areas. The information is a significant step towards improvement of glaucoma care in India, including planning for future strategies.
Full Text Available Thomas Glaab1,2, Claus Vogelmeier3, Andreas Hellmann4, Roland Buhl11Department of Respiratory Diseases III, Medical Center of the Johannes Gutenberg-University, Mainz, 2Medical Affairs Germany, Respiratory Medicine, Boehringer Ingelheim Pharma GmbH and Co, KG, Ingelheim, 3Department of Respiratory Diseases, University Hospitals of Giessen and Marburg, Marburg, 4Federal Association of Pneumologists, Augsburg, GermanyBackground: Little is known about the role of guidelines for the practical management of chronic obstructive pulmonary disease (COPD by office-based pulmonary specialists. The aim of this study was to assess their outpatient management in relation to current guideline recommendations for COPD.Methods: A nationwide prospective cross-sectional COPD questionnaire survey in the form of a multiple-choice questionnaire was sent to 1000 office-based respiratory specialists in Germany. The product-neutral questions focused on routine COPD management and were based on current national and international COPD guideline recommendations being consistent in severity classification and treatment recommendations.Results: A total of 590 pulmonary specialists (59% participated in the survey. Body plethysmography was considered the standard for diagnosis (65.9%, followed by spirometry (32%. Most respondents were able to cite the correct spirometric criteria for classifying moderate (87% to very severe COPD (77%. A quarter of the respondents equated the World Health Organization (WHO definition of chronic bronchitis with COPD. Notably, most participants preferred the updated national COPD guidelines (51.4% to the Global Initiative for Chronic Obstructive Lung Disease (GOLD guidelines (40.2%. Improvement of functional exercise capacity and quality of life were considered the two most relevant treatment goals; whereas impact on mortality was secondary. Treatment of COPD largely complied with the guidelines. However, a significant percentage of the
Collin, Simon M; Crawley, Esther
NHS specialist chronic fatigue syndrome (CFS/ME) services in England treat approximately 8000 adult patients each year. Variation in therapy programmes and treatment outcomes across services has not been described. We described treatments provided by 11 CFS/ME specialist services and we measured changes in patient-reported fatigue (Chalder, Checklist Individual Strength), function (SF-36 physical subscale, Work & Social Adjustment Scale), anxiety and depression (Hospital Anxiety & Depression Scale), pain (visual analogue rating), sleep (Epworth, Jenkins), and overall health (Clinical Global Impression) 1 year after the start of treatment, plus questions about impact of CFS/ME on employment, education/training and domestic tasks/unpaid work. A subset of these outcome measures was collected from former patients 2-5 years after assessment at 7 of the 11 specialist services. Baseline data at clinical assessment were available for 952 patients, of whom 440 (46.2%) provided 1-year follow-up data. Treatment data were available for 435/440 (98.9%) of these patients, of whom 175 (40.2%) had been discharged at time of follow-up. Therapy programmes varied substantially in mode of delivery (individual or group) and number of sessions. Overall change in health 1 year after first attending specialist services was 'very much' or 'much better' for 27.5% (115/418) of patients, 'a little better' for 36.6% (153/418), 'no change' for 15.8% (66/418), 'a little worse' for 12.2% (51/418), and 'worse' or 'very much worse' for 7.9% (33/418). Among former patients who provided 2- to 5-year follow-up (30.4% (385/1265)), these proportions were 30.4% (117/385), 27.5% (106/385), 11.4% (44/385), 13.5% (52/385), and 17.1% (66/385), respectively. 85.4% (327/383) of former patients responded "Yes" to "Do you think that you are still suffering from CFS/ME?" 8.9% (34/383) were "Uncertain", and 5.7% (22/383) responded "No". This multi-centre NHS study has shown that, although one third of patients
Abellán Alemán, José; Leal Hernández, Mariano; Martínez Pastor, Antonio; Hernández Menárguez, Fernando; García-Galbis Marín, José Antonio; Jara Gómez, Purificación
To find the level of knowledge, the guidelines for action and the monitoring of lipaemia by Spanish primary care and specialist doctors. A self-defined questionnaire of 12 items was designed. Data on the population treated and the subjective evaluation of objectives, and on the management and monitoring of lipid parameters were filled in. A total of 1998 doctors from the whole of Spain took part; 68.8% of the doctors interviewed worked in primary health care and 30.2% in specialist centres or hospitals. A 91% of the doctors said they followed international consensus on monitoring lipaemia. The most commonly used objective therapeutic parameter for treating lipaemia was LDL-cholesterol (83%), followed by total cholesterol (62%), HDL-cholesterol (56%) and triglycerides (51%). If the patient's lipaemia was well controlled, then 21.8% of doctors reduced the doses of lipid-lowerers. In general terms, no great differences were appreciated between the criteria followed by PC and by specialist doctors. The criteria for action on lipaemia could be improved. There are no important differences of view or action in clinical and therapeutic criteria for Lipaemia cases between PC and specialist doctors.
Lögde, Ann; Rudolfsson, Gudrun; Broberg, Roma Runesson; Rask-Andersen, Anna; Wålinder, Robert; Arakelian, Erebouni
The lack of specialist nurses in operating theatres is a serious problem. The aim of this study was to describe reasons why specialist nurses in perioperative care chose to leave their workplaces and to describe the process from the thought to the decision. Twenty specialist nurses (i.e. anaesthesia, NA, and operating room nurses) from seven university- and county hospitals in Sweden participated in qualitative individual in-depth interviews. Data were analysed by systematic text condensation. We identified four themes of reasons why specialist nurses quitted their jobs: the head nurses' betrayal and dismissive attitude, and not feeling needed; inhumane working conditions leading to the negative health effects; not being free to decide about one's life and family life being more important than work; and, colleagues' diminishing behaviour. Leaving one's job was described as a process and specialist nurses had thought about it for some time. Two main reasons were described; the head nurse manager's dismissive attitude and treatment of their employees and colleagues' mistreatment and colleagues' diminishing behaviour. Increasing knowledge on the role of the head nurse managers in specialist nurses' decision making for leaving their workplace, and creating a friendly, non-violent workplace, may give the opportunity for them to take action before it is too late.
STS-95 Mission Specialist Pedro Duque of Spain, representing the European Space Agency, suits up in the Operations and Checkout Building prior to his trip to Launch Pad 39-B. Duque and the rest of the STS-95 crew are at KSC to participate in the Terminal Countdown Demonstration Test (TCDT) which includes mission familiarization activities, emergency egress training, and a simulated main engine cutoff. The other crew members are Payload Specialist Chiaki Mukai (M.D., Ph.D.), representing the National Space Development Agency of Japan (NASDA), Pilot Steven W. Lindsey, Mission Specialist Scott E. Parazynski, Mission Specialist Stephen K. Robinson, Payload Specialist John H. Glenn Jr., senator from Ohio, and Mission Commander Curtis L. Brown. The STS-95 mission, targeted for liftoff on Oct. 29, includes research payloads such as the Spartan solar-observing deployable spacecraft, the Hubble Space Telescope Orbital Systems Test Platform, the International Extreme Ultraviolet Hitchhiker, as well as the SPACEHAB single module with experiments on space flight and the aging process. Following the TCDT, the crew will be returning to Houston for final flight preparations.
Umene-Nakano, Wakako; Uchida, Naoki; Kato, Takahiro; Tateno, Masaru; Matsumoto, Ryohei; Nakamura, Jun
The psychiatric specialist certification system of the Japanese Society of Psychiatry and Neurology was established in 2005, with a transitional period that ran until 2008. A three-year postgraduate training scheme was started in connection with the new psychiatric specialist certification system, and the first formal examination under the new system was held in 2010. A resident desiring certification as a psychiatric specialist must purchase a psychiatric specialist certification handbook and present it when taking the examination. There are many differences between the new examination and the transitional period examination, in terms of both the handbook and the number of case reports to be submitted. Results of a survey conducted on 360 psychiatrists belonging to either university or national hospitals, all of whom had undergone psychiatric training within the past eight years, revealed that there was currently a lack of knowledge, and low rate of utilization, of the handbook. The primary author was in the first cohort of those who began postgraduate psychiatric training in a university hospital and subsequently took the first examination administered after the transition period. The author has maintained that, based on personal experience, a number of issues need improvement, such as the large number of grading items to be signed off on by supervising psychiatrists, and complications involving the outline of cases to be experienced. Additionally, it was thought to be difficult for supervisors who had obtained their specialist certification via the transitional period examination to have an adequate understanding of the outline of the new examination. Therefore, it is important that residents themselves take a more assertive attitude to becoming specialists. In the future, in order to establish a sound specialist certification system, the results of this survey of physicians who took the new examination should be taken into account.
Mulder, Chris Jacob Johan; Puri, Amarender Singh; Reddy, Duvvur Nageshwar
In South Africa, nurses and doctors are emigrating in significant numbers. Job satisfaction, safety and ensuring career progression are important in retaining doctors to make a career in Republic of South Africa (RSA). Due to budgetary constraints many hospitals have not been upgraded. Coming home after overseas training seems difficult. In RSA it takes a minimum of 13 years for a young specialist to become registered and 15 years for subspecialists. Career progression, creating more specialist trainees in public and private hospitals and shortening the period of professional training are potential solutions to the problem. India, which has a population of more than 1 billion people, is struggling with similar problems. For the past 10-15 years, private hospitals have assisted in manpower development for medical specialist and subspecialist careers. Currently their private sector trains 60% of their recognised (sub)specialities fellows. A national task force for specialist training in RSA should be instituted. It should discuss, based on the current status and projected specialist and subspecialist personnel requirements, the future structure and logistics of training needs. This is required in all subspecialities including gastroenterology, as has been done in India. It is hoped that as a consequence well-trained doctors, similar to those in India, might move to provincial hospitals in rural areas, upgrading the medical services and keeping medical power in South Africa. South Africa should become a model for Sub-Saharan Africa, as India already is for South-East Asia. PMID:20180232
Hedberg, Henrik; Iivari, Netta
Typical open source software (OSS) development projects are organized around technically talented developers, whose communication is based on technical aspects and source code. Decision-making power is gained through proven competence and activity in the project, and non-technical end-user opinions are too many times neglected. In addition, also human-computer interaction (HCI) specialists have encountered difficulties in trying to participate in OSS projects, because there seems to be no clear authority and responsibility for them. In this paper, based on HCI and OSS literature, we introduce an extended OSS development project organization model that adds a new level of communication and roles for attending human aspects of software. The proposed model makes the existence of HCI specialists visible in the projects, and promotes interaction between developers and the HCI specialists in the course of a project.
Garcia, Mayra G; Watt, Jennifer L; Falder-Saeed, Karie; Lewis, Brennan; Patton, Lindsey
Clinical nurse specialists (CNSs) have a unique advanced practice role. This article describes a process useful in establishing a comprehensive orientation and onboarding program for a newly hired CNS. The project team used the National Association of Clinical Nurse Specialists core competencies as a guide to construct a process for effectively onboarding and orienting newly hired CNSs. Standardized documents were created for the orientation process including a competency checklist, needs assessment template, and professional evaluation goals. In addition, other documents were revised to streamline the orientation process. Standardizing the onboarding and orientation process has demonstrated favorable results. As of 2016, 3 CNSs have successfully been oriented and onboarded using the new process. Unique healthcare roles require special focus when onboarding and orienting into a healthcare system. The use of the National Association of Clinical Nurse Specialists core competencies guided the project in establishing a successful orientation and onboarding process for newly hired CNSs.
O'Neill, Lotte; Norberg, Karen; Thomsen, Maria
), or transferred (i.e. had unplanned changes in place of training/ward due to failure to thrive or due to inadequate development of competences), or dropped out (i.e. were dismissed from, had resigned from, or changed their speciality). Controls were a random sample of doctors in the source population, who were......Abstract summary The aim of this cummulative incidence case-control study was to examine: if struggling trainees in medical specialist training (cases) tended to struggle already in medical school or not compared to non-struggling controls, and which performance indicators during medical school...... seemed to predict struggling in postgraduate education if any. The study design is rooted in epidemiological methodology. Struggling doctors in specialist training: a case-control study. It has been reported in the international literature, that around 3-10% of doctors in post-garduate specialist...
Chazdon, Robin L; Chao, Anne; Colwell, Robert K
in second-growth (SG) and old-growth (OG) rain forests in the Caribbean lowlands of northeastern Costa Rica. We evaluate the multinomial model in detail for the tree data set. Our results for birds were highly concordant with a previous nonstatistical classification, but our method classified a higher......: (1) generalist; (2) habitat A specialist; (3) habitat B specialist; and (4) too rare to classify with confidence. We illustrate our multinomial classification method using two contrasting data sets: (1) bird abundance in woodland and heath habitats in southeastern Australia and (2) tree abundance...... fraction (57.7%) of bird species with statistical confidence. Based on a conservative specialization threshold and adjustment for multiple comparisons, 64.4% of tree species in the full sample were too rare to classify with confidence. Among the species classified, OG specialists constituted the largest...
Full Text Available This paper describes partial results of surveys realized amongCzech universities and business units which aim has been to analyzecurrent situation in demand and supply side of ICT (Informationand Communication Technologies specialists at the labor marketin the Czech Republic. The demand and supply side are comparedthrough their requirements on knowledge of ICT specialists. Theresults present typical “product” of Czech education system inICT competencies. General conclusions show that majority ofundergraduates do not have appropriate knowledge profile to enterICT corporate business as qualified employees - ICT specialist -without further additional training. The same fact is valid for a littleless than a half of graduates at master level. During quantitativeanalysis, we have identified that at about 60 per cent of ICTspecialists did not pass a formal ICT education. These facts showlacks in ICT oriented study programs and provoke requirementon further development of ICT oriented curricula in accordance tobusiness requirements and needs.
Bester, Frederik C J; Bosch, Fredricka J; van Rensburg, Barend J Jansen
Rheumatoid arthritis (RA) is expected to increase in Africa and South Africa. Due to the low numbers of rheumatologists in South Africa, specialist physicians also have to care for patients with RA. Furthermore several new developments have taken place in recent years which improved the management and outcome of RA. Classification criteria were updated, assessment follow-up tools were refined and above all, several new biological disease-modifying anti-rheumatic drugs were developed. Therefore it is imperative for specialist physicians to update themselves with the newest developments in the management of RA. This article provides an overview of the newest developments in the management of RA in the South African context. This approach may well apply to countries with similar specialist to patient ratios and disease profiles.
Since the beginning of the Nuclear Criticality Safety Division of the American Nuclear Society (ANS) in 1967, the nuclear criticality safety (NCS) community has sought to provide an exchange of information at a national level to facilitate the education and development of NCS specialists. In addition, individual criticality safety organizations within government contractor and licensed commercial nonreactor facilities have developed training and qualification programs for their NCS specialists. However, there has been substantial variability in the content and quality of these program requirements and personnel qualifications, at least as measured within the government contractor community. The purpose of this paper is to provide a brief, general history of staff training and to describe the current direction and focus of US DOE guidance for the content of training and qualification programs designed to develop NCS specialists
Elżbieta, Puacz; Waldemar, Glusiec; Barbara, Madej-Czerwonka
Along with the development of medicine, increasingly significant role has been played by the laboratory diagnostics. For over ten years the profession of the medical laboratory specialist has been regarded in Poland as the autonomous medical profession and has enjoyed a status of one of public trust. The process of education of medical laboratory specialists consists of a five-year degree in laboratory medicine, offered at Medical Universities, and of a five-year Vocational Specialization in one of the fields of laboratory medicine such as clinical biochemistry, medical microbiology, medical laboratory toxicology, medical laboratory cytomorphology and medical laboratory transfusiology. An important component of medical laboratory specialists' identity is awareness of inherited ethos obtained from bygone generations of workers in this particular profession and the need to continue its further development. An expression of this awareness is among others Polish Code of Ethics of a Medical Laboratory Specialist (CEMLS) containing a set of values and a moral standpoint characteristic of this type of professional environment. Presenting the ethos of the medical laboratory specialist is a purpose of this article. Authors focus on the role CEMLS plays in areas of professional ethics and law. Next, they reconstruct the Polish model of ethos of medical diagnostic laboratory personnel. An overall picture consists of a presentation of the general moral principles concerning execution of this profession and rules of conduct in relations with the patient, own professional environment and the rest of the society. Polish model of ethical conduct, which is rooted in Hippocratic medical tradition, harmonizes with the ethos of medical laboratory specialists of other European countries and the world.
Nattres, E.; Barrett, J. A.
HSE's mission is to ensure that risks to people's health and safety from work activities are properly controlled. Radiation Specialist Inspectors make an essential contribution to HSE's objectives through the application of their professional skills and knowledge. The role of the Radiation Specialist Inspector includes inspection work in the field to ensure compliance by employers with the Health and Safety at Work etc Act 1974, Ionising Radiations Regulations 1999 and associated legislation. They also contribute to research, and the development of technical policy, legislation, standards, and guidance on protection against the possible harm from exposure to electromagnetic fields, optical or ionizing radiation. This paper explains how Radiation Specialist Inspectors are trained. It starts with the recruitment process, with an emphasis on recruiting people who have already gained relevant experience from radiation work practices in previous employments. The interview process is explored, which includes both technical and behavioural interviews, making a presentation and completing a personality questionnaire. The initial twelve months training is then discussed in detail, including the six months as a general Health and Safety Inspector where inspector' skills and techniques' are developed by practical involvement in inspection, followed by a challenging six months with a Radiation Specialist group. The programme for this period is designed to broaden and develop skills and knowledge within the radiation protection specialist. After the initial twelve months probationary period, new Inspectors are expected to confirm and establish themselves in their role of Radiation Specialist Inspectors. However, it does not end there, continuing professional development to ensure that Inspectors have cutting edge knowledge of the latest advances within the radiation field and health and safety as a whole is essential and will be discussed in more detail. (Author) 6 refs
Jennifer A. MATHER, Tatiana S. LEITE, Allan T. BATISTA
Full Text Available Prey choice is often evaluated at the species or population level. Here, we analyzed the diet of octopuses of different populations with the aim to assess the importance of individual feeding habits as a factor affecting prey choice. Two methods were used, an assessment of the extent to which an individual octopus made choices of species representative of those population (PSi and IS and 25% cutoff values for number of choices and percentage intake of individual on their prey. In one population of Octopus cf vulgaris in Bermuda individuals were generalist by IS=0.77, but most chose many prey of the same species, and were specialists on it by >75% intake. Another population had a wider prey selection, still generalist with PSi=0.66, but two individuals specialized by choices. In Bonaire, there was a wide range of prey species chosen, and the population was specialists by IS= 0.42. Individual choices revealed seven specialists and four generalists. A population of Octopus cyanea in Hawaii all had similar choices of crustaceans, so the population was generalist by IS with 0.74. But by individual choices, three were considered a specialist. A population of Enteroctopus dofleini from Puget Sound had a wide range of preferences, in which seven were also specialists, IS=0.53. By individual choices, thirteen were also specialists. Given the octopus specialty of learning during foraging, we hypothesize that both localized prey availability and individual personality differences could influence the exploration for prey and this translates into different prey choices across individuals and populations showed in this study [Current Zoology 58 (4: 597-603, 2012].
Wallace, Jack; Smith, Elizabeth; Hajarizadeh, Behzad; Richmond, Jacqueline; Lucke, Jayne
Hepatitis B is a viral infection primarily affecting people from culturally diverse communities in Australia. While vaccination prevents infection, there is increasing mortality resulting from liver damage associated with chronic infection. Deficits in the national policy and clinical response to hepatitis B result in a low diagnosis rate, inadequate testing and diagnosis processes, and poor access to hepatitis B treatment services. While research identifies inadequate hepatitis B knowledge among people with the virus and primary health care workers, this project sought to identify how specialist clinicians in Australia negotiate cultural diversity, and provide often complex clinical information to people with hepatitis B. A vignette was developed and presented to thirteen viral hepatitis specialist clinicians prior to an electronically recorded interview. Recruitment continued until saturation of themes was reached. Data were thematically coded into themes outlined in the interview schedule. Ethical approval for the research was provided by the La Trobe University Human Research Ethics Committee. Key messages provided to patients with hepatitis B by clinical specialists were identified. These messages were not consistently provided to all patients with hepatitis B, but were determined on perceptions of patient knowledge, age and highest educational level. While the vignette stated that English was not an issue for the patient, most specialists identified the need for an interpreter. Combating stigma related to hepatitis B was seen as important by the specialists and this was done through normalising the virus. Having an awareness of different cultural understandings about hepatitis B specifically, and health and well-being generally, was noted as a communication strategy. Key core competencies need to be developed to deliver educational messages to people with hepatitis B within clinical encounters. The provision of adequate resources to specialist clinics will
This study was designed to identify the qualification requirements and the means to assess the unique knowledge and skills necessary to perform the instructional activities needed by nuclear training specialist at Fort Saint Vrain Nuclear Generating Station. A survey questionnaire with 233 task statements categorized into eleven duty areas was distributed to twenty-three nuclear training specialists at Fort Saint Vrain Nuclear Generating Station. On the basis of the data accumulated for this study, the researcher identified the following findings. A list of 158 task statements were identified as being relevant; this list was considered a core knowledge, skills, and abilities needed as a nuclear training specialist. The list consisted of ten duty areas which were relevant to the effective performance of a nuclear training specialist. Thirty-three task statements were identified as being relevant for the duty area Conductive Training. These were considered the core of knowledge, skills, and abilities needed in the development of the initial test instrument and the instructor classroom skills observation checklist. The significant correlation between the results of these two instruments, using a rank-order correlation coefficient, was interpreted by the researcher as indicating that the initial test instrument possessed concurrent validity. The researcher interpreted the reliability value as a positive indicator that the initial test instrument demonstrated internal consistency. It was concluded that it could be determined whether personnel possessed the level of competence needed to perform the instructional duties of a nuclear training specialist by using a written test. Data from this research supported the use of the initial test developed for this study as a valid means to certify nuclear training specialists for the duty area Conducting Training
... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Payload specialist relationship with... ADMINISTRATION SPACE FLIGHT Payload Specialists for Space Transportation System (STS) Missions § 1214.306 Payload specialist relationship with sponsoring institutions. Specialists who are not U.S. Government employees must...
Andrew, R R
A comparative study of costs per bed per day in teaching hospitals affiliated with Monash University compared with large non-teaching metropolitan hospitals (1964 to 1974) shows they are much higher in teaching hospitals. There is no evidence that this is due to the additional costs arising from the clinical schools. Research in the teaching hospitals and the accompanying high professional standards and demands on services are major factors accounting for the difference. Over the decade studied, the resident staff have increased by 77% and other salaried staff by 24%. The index of expenditure for the three teaching hospitals in the decade has increased by 386%.
Full Text Available This paper reports on the results of surveys carried out in Lithuania and Estonia in 1995 and 1996, the main aim of which was to provide a basis for planning the development of information management courses in the Baltic States. In the course of the project it was necessary to resolve certain methodological difficulties in the identification of the concept 'information specialist' and in the process of data collection. The results show the recruitment rates needed over the next three years and the qualities and skills needed by information specialists.
STS-87 Mission Specialist Winston Scott dons his launch and entry suit with the assistance of a suit technician in the Operations and Checkout Building. This is Scotts second space flight. He and the five other crew members will depart shortly for Launch Pad 39B, where the Space Shuttle Columbia awaits liftoff on a 16-day mission to perform microgravity and solar research. Scott is scheduled to perform an extravehicular activity spacewalk with Mission Specialist Takao Doi, Ph.D., of the National Space Development Agency of Japan, during STS-87. He also performed a spacewalk on STS-72.
Full Text Available Special features of professional training of future specialists in extraordinary (emergency situations, increasing its quality with the use of interactive technologies have been considered in this article. The paper presents a research of modern interactive educational technologies, most widely used at higher educational institutions, promoting modernization of education as well as training of competitive future specialists. The article grounds possibility of formation and development of the culture of professional communication by interactive methods of learning, and business games, in particular. The research deals with kinds of business games as active methods of learning, their structural levels and features of use.
Do specialists exit the firm increasingly outsourcing its research and development (R&D) work? Although this question is critical in understanding how R&D outsourcing links to innovation performance, the answer is not yet clear. This paper proposes that the optimal level of firm's internal...... employment of R&D specialists decreases with the deepening of R&D outsourcing but increases with the broadening of R&D outsourcing. These relations can be inferred from previous empirical studies as well as our theoretical analysis, and are supported by the empirical evidence from estimations of correlated...
In addition to medical expertise, competence-based medical training comprises communication and collaboration skills, professionalism, and leadership skills. Continuous feedback is essential for learning and development, and feedback only from the medical specialist examination taken in the end of training does not ensure thorough specialist training. Entrustable professional activity (EPA) is a unit of professional practice, defined as tasks or responsibilities typical of the specialty. EPA translates competence-based training into manageable and meaningful entities and provides tools for the evaluation of medical competence.
Schwill, Simon; Magez, Julia; Jäger, Cornelia; von Meißner, Wolfgang Cg; Szecsenyi, Joachim; Flum, Elisabeth
In 2011, the national German Medical Association (Bundesärztekammer) published guidelines for a slim-lined training program in general practice (Quereinstieg) for qualified medical specialists in other fields (e. g., surgeons, internists or anesthesiologists). This step is part of a strategy to prevent further shortages of general practitioners in Germany. In the state of Baden-Wuerttemberg, qualified medical specialists are allowed to complete their general practice training in approximately two years instead of five. The aim of this study was to understand the reasons of specialists for changing to a career in general practice. The postgraduate training program Verbundweiterbildung plus Baden-Württemberg had 597 trainees at the time of the study in December 2015. Previously qualified specialists in another medical discipline were identified and invited to participate in this study. Qualitative data was gathered using semi-structured interviews with content analysis of the interviews performed by three independent members of the research team. In total, 36 out of 597 trainees were identified as previously qualified specialists in another medical discipline. All 36 were invited to take part and 15 agreed to participate in this study. Overall, 15 interviews were performed, with a mean time of 24.19minutes. Participants with a median age of 40 years (33-59 years) - mainly anesthesiologists (n=7), surgeons (n=3) and internists (n=3) - presented with an average of 6.5 years of professional experience in their specialty. First, the participants' motivation to switch career arose from the wish to intensify the quality of patient contacts with a holistic approach including family and social background and from the infinite variety of general practice. Another reason given for a career change was self-employment opportunities. Finally, feelings of frustration over poor working conditions in hospitals resulted in a job search elsewhere in medicine, taking account of
Full Text Available Abstract Background The assessment of the impact of healthcare interventions may help commissioners of healthcare services to make optimal decisions. This can be particularly the case if the impact assessment relates to specific patient populations and uses timely local data. We examined the potential impact on readmissions and mortality of specialist heart failure services capable of delivering treatments such as b-blockers and Nurse-Led Educational Intervention (N-LEI. Methods Statistical modelling of prevented or postponed events among previously hospitalised patients, using estimates of: treatment uptake and contraindications (based on local audit data; treatment effectiveness and intolerance (based on literature; and annual number of hospitalization per patient and annual risk of death (based on routine data. Results Optimal treatment uptake among eligible but untreated patients would over one year prevent or postpone 11% of all expected readmissions and 18% of all expected deaths for spironolactone, 13% of all expected readmisisons and 22% of all expected deaths for b-blockers (carvedilol and 20% of all expected readmissions and an uncertain number of deaths for N-LEI. Optimal combined treatment uptake for all three interventions during one year among all eligible but untreated patients would prevent or postpone 37% of all expected readmissions and a minimum of 36% of all expected deaths. Conclusion In a population of previously hospitalised patients with low previous uptake of b-blockers and no uptake of N-LEI, optimal combined uptake of interventions through specialist heart failure services can potentially help prevent or postpone approximately four times as many readmissions and a minimum of twice as many deaths compared with simply optimising uptake of spironolactone (not necessarily requiring specialist services. Examination of the impact of different heart failure interventions can inform rational planning of relevant healthcare
Lyratzopoulos, Georgios; Cook, Gary A; McElduff, Patrick; Havely, Daniel; Edwards, Richard; Heller, Richard F
The assessment of the impact of healthcare interventions may help commissioners of healthcare services to make optimal decisions. This can be particularly the case if the impact assessment relates to specific patient populations and uses timely local data. We examined the potential impact on readmissions and mortality of specialist heart failure services capable of delivering treatments such as b-blockers and Nurse-Led Educational Intervention (N-LEI). Statistical modelling of prevented or postponed events among previously hospitalised patients, using estimates of: treatment uptake and contraindications (based on local audit data); treatment effectiveness and intolerance (based on literature); and annual number of hospitalization per patient and annual risk of death (based on routine data). Optimal treatment uptake among eligible but untreated patients would over one year prevent or postpone 11% of all expected readmissions and 18% of all expected deaths for spironolactone, 13% of all expected readmisisons and 22% of all expected deaths for b-blockers (carvedilol) and 20% of all expected readmissions and an uncertain number of deaths for N-LEI. Optimal combined treatment uptake for all three interventions during one year among all eligible but untreated patients would prevent or postpone 37% of all expected readmissions and a minimum of 36% of all expected deaths. In a population of previously hospitalised patients with low previous uptake of b-blockers and no uptake of N-LEI, optimal combined uptake of interventions through specialist heart failure services can potentially help prevent or postpone approximately four times as many readmissions and a minimum of twice as many deaths compared with simply optimising uptake of spironolactone (not necessarily requiring specialist services). Examination of the impact of different heart failure interventions can inform rational planning of relevant healthcare services.
Full Text Available This short article explores whether using a mentoring model supports our Subject Specialist Mentors (SSMs with their role of mentoring trainees on Initial Teacher Training (ITT courses. Although there are many mentoring models to choose from, our model is based around mentoring within the Lifelong Learning Sector (LLS where trainees need support for their subject specialism as well as their generic teaching skills. The main focus is the use of coaching and mentoring skills taking into consideration guiding, supporting and challenging the trainee during the lifetime of the mentor/trainee relationship. The SSMs found that using our model as a tool helped to structure meetings and to ensure that the trainee had the necessary support to enable them to become proficient, competent subject specialist teachers. In conclusion, it was found that there is a need for the use of a model or a framework to help the Subject Specialist Mentor (SSM with such an important role.
The article discusses the hospital laws of several land governments enacted subsequent to the hospital financing law of the Federal Government, in respect of the influence exercised by these laws on the internal structure of the hospital. The fact that the laws apply to all kinds of hospitals, and hence also to big psychiatric hospitals, is considered a disadvantage for psychiatric care. Such care is obviously hampered, on the one hand, by the legislative demand for departmentalization of the individual fields according to specialist subjects, representing a setup which is opposed to the realization of patient care in accordance with the requirements of the communities and citizens who expect to be cared for on an individual and not on a schematic basis, whereas, on the other hand, the new structures of management stipulated by the law do not provide for the inclusion of representatives of the new groups of professions now engaged in psychiatric activities. The model of regrouping the hospital structure into sectors instead of medical specialist departments, is presented and contrasted with the proposed model. It is recommended to arrange for representation of the non-medical and non-nursing professions in the managing boards, as well as to take into account the sociotherapeutico-rehabilitative interests as forming part of the conceptual approach to care in psychiatric hospitals, via special hospital committees.
Ashmore, John; Gilson, Lucy
'Dual practice', or multiple job holding, generally involves public sector-based health workers taking additional work in the private sector. This form of the practice is purported to help retain public health care workers in low and middle-income countries' public sectors through additional wage incentives. There has been little conceptual or empirical development of the relationship between dual practice and retention. This article helps begin to fill this gap, drawing on empirical evidence from a qualitative study focusing on South African specialists. Fifty-one repeat, in-depth interviews were carried out with 28 doctors (predominantly specialists) with more than one job, in one public and one private urban hospital. Findings suggest dual practice can impact both positively and negatively on specialists' intention to stay in the public sector. This is through multiple conceptual channels including those previously identified in the literature such as dual practice acting as a 'stepping stone' to private practice by reducing migration costs. Dual practice can also lead specialists to re-evaluate how they compare public and private jobs, and to overworking which can expedite decisions on whether to stay in the public sector or leave. Numerous respondents undertook dual practice without official permission. The idea that dual practice helps retain public specialists in South Africa may be overstated. Yet banning the practice may be ineffective, given many undertake it without permission in any case. Regulation should be better enforced to ensure dual practice is not abused. The conceptual framework developed in this article could form a basis for further qualitative and quantitative inquiry.
Shin, Dong-Seong; Yeo, Dong-Kyu; Hwang, Sun-Chul; Park, Sukh-Que
Objective Transfemoral catheter angiography (TFCA) is a basic procedure in neurovascular surgery with increasing importance in surgical and non-invasive treatments. Unfortunately, resident neurosurgeons have relatively few opportunities to perform TFCA in most institutions. We report a method developed in our hospital for training resident neurosurgeons to perform TFCA and evaluate the efficacy of this training. Methods From May 2011 to September 2011, a total of 112 consecutive patients underwent TFCA by one resident neurosurgeon supervised by two neuroendovascular specialists. Patients who underwent elective diagnostic procedures were included in this study. Patients who underwent endovascular treatment were excluded. Demographic data, indications for TFCA, side of approach, number of selected arteries, and complications were analyzed. Results This study included 64 males and 48 females with a mean age of 51.6 (12-81) years. All procedures were performed in the angiography suite. Common indications for procedures were as follows: stroke-induced symptoms in 61 patients (54.5%), Moyamoya disease and arteriovenous malformation in 13 patients (11.6%), and unruptured intracranial aneurysm in eight patients (7.1%). Right and left femoral puncture was performed in 98.2% and 1.8% of patients, respectively. A total of 465 selective angiographies were performed without complications. Angiographic examination was performed on 4.15 vessels per patient. Conclusion TFCA can be performed safely by resident neurosurgeons based on anatomical study and a meticulous protocol under the careful supervision of neuroendovascular specialists. PMID:24175020
Vincenzo Della Mea
Full Text Available Persons with disability from spinal cord injury (SCI are subject to high risk of pathological events and need a regular followup even after discharge from the rehabilitation hospital. To help in followup, we developed a web portal for providing online specialist as well as GP support to SCI persons. After a feasibility study with 13 subjects, the portal has been introduced in the regional healthcare network in order to make it compliant with current legal regulations on data protection, including smartcard authentication. Although a number of training courses have been made to introduce SCI persons to portal use (up to 50 users, the number of accesses remained very low. Reasons for that have been investigated by means of a questionnaire submitted to the initial feasibility study subjects and included the still easier use of telephone versus our web-based smartcard-authenticated portal, in particular, because online communications are still perceived as an unusual way of interacting with the doctor. To summarize, the overall project has been appreciated by the users, but when it is time to ask for help to, the specialist, it is still much easier to make a phone call.
Mohan, S; Wilkes, L M; Ogunsiji, O; Walker, A
This study aims to describe the experiences of nurses caring for cancer patients in non-specialist wards. The study was conducted in a large (420 beds) and small (32 beds) hospital in an area health service with urban and rural populations in the west of Sydney. A qualitative descriptive approach was utilized to collect data from the nurses. Data were collected using a survey and in-depth interviews of nurses working in non-specialist cancer wards. Transcribed data were managed with Nudist Vivo software and analysed for common themes using process of constant comparison and contrast. Twenty-five surveys were returned and five nurses volunteered to be interviewed. The six major themes that emerged from analysis of data were: emotional nature of care, lack of time, lack of knowledge of cancer treatment, family support, environment not conducive to proper care and dealing with patient's non-acceptance of cancer diagnosis. The nurses in this study wished to provide quality supportive care for cancer patients and their families but the inconducive environment and inadequate relevant training hindered the nurses' efforts. This then presents further need of relevant training for nurses in cancer care and time management, to meet up with these challenges.
Modic, Mary Beth; Canfield, Christina; Kaser, Nancy; Sauvey, Rebecca; Kukla, Aniko
The purpose of this project was to enhance the knowledge of the bedside nurse in diabetes management. A forum for ongoing support and exploration of clinical problems, along with the distribution of educational tools were the components of this program. Diabetes accounts for 30% of patients admitted to the hospital. It has become more challenging to manage as the treatment choices have increased. There are a number of researchers who have identified nurse and physician knowledge of diabetes management principles as suboptimal. DESCRIPTION OF THE INNOVATION: Staff nurses are educated for a role as a Diabetes Management Mentor and are expected to educate/dialogue with peers monthly, model advocacy and diabetes patient education skills, facilitate referrals for diabetes education, and direct staff to resources for diabetes management. Diabetes Management Mentors feel more confident in their knowledge of diabetes and their ability to resolve clinical issues as they arise. The Diabetes Management Mentor role is another avenue for nurses to refine their clinical knowledge base and acquire skills to share with colleagues while remaining at the bedside. The clinical nurse specialist is expertly prepared to foster the professional development of bedside nurses while simultaneously making a positive impact on disease management. Opportunity for future investigation includes efficacy of teaching tools on diabetes mastery, the effect of clinical nurse specialist mentoring on a select group of bedside nurses, and the Diabetes Management Mentor's impact on prevention of near-miss events.
Rabiu, Ayyuba; Abubakar, Idris Sulaiman; Garba, Ibrahim; Haruna, Iman Usman
Grand multiparity is known to be associated with pregnancy complications. Nigeria with a contraceptive prevalence of women get to grand multiparity early in their obstetric carriers. These women contribute significantly to the bad obstetric performance indices in the country. The present study was to explore the contraceptive choices among grand multiparous women. This study was a descriptive cross-sectional study among grand multiparous women attending an antenatal clinic. Data were collected on sociodemographic characteristics, contraceptive choices, and factors that influence such choices. The data were analyzed using Statistical Package for the Social Sciences version 18. There were 219 respondents. The mean age was 33.05 ± 3.17, and the mean parity was 6.48 ± 1.83. Most of the respondents (208, 95.50%) were aware of modern contraceptive methods, and oral contraceptive was the method of most of the respondents (197, 90.00%). Only 92 (42.00%) were currently using a modern contraceptive method. Being convenient for the lifestyle was the reason for the choice of a contraceptive method by many of the respondents (42, 19.10%). There was high awareness of modern contraceptive methods; however, there was low use prevalence among respondents, and the desire for more pregnancy was the reason for the nonuse.
Background: Review of causes of morbidity and mortality in health care facilities is an important exercise which gives a picture of the prevailing disease pattern in the particular community and at the same time looks out for any change in the disease pattern over time. This exercise is a necessary component for planning of ...
Olalekan Olugbenga Awolola
Full Text Available Background: Teenage pregnancies are pregnancies between the age group of 13 and 19 years. Such pregnancies are categorized as high-risk pregnancies worldwide. This makes monitoring during the antenatal, intrapartum, and puerperal periods highly important. Objectives: The aim of this study is to determine the incidence, the mode of presentation, and the materno-fetal outcome in teenage parturients and compare with a control group. Materials and Methods: this prospective case–control study, recruited 63 teenage parturients who presented in labor ward in active phase labour between February 2013 and January 2015. These teenage parturients were matched with a control group in terms of parity and cervical dilatation of not less than or more than 1 cm (+1 cm, but are of age, 22–30 years. Thus, a total number of 126 parturients were studied. The mothers and their babies were followed up until the first 7th day postpartum. Results: In this study, 39 (61.90% and 24 (38.10% were married and unmarried, respectively, among the teenage parturients, whereas 60 (95.24% and 3 (4.7% were married and unmarried among the control group. Majority of the teenage parturients, 57 (90.47% had only primary and secondary education, while 59 (93.47% among the controls had secondary and tertiary levels of education. There were statistically significant differences in the incidences of genital lacerations (9 [14.28%] and 2 [3.18%]: P < 0.05, and the incidences of anemia in pregnancy (9 [14.28%] vs. 2 [3.18%]: P < 0.05 in the teenage and the older parturients. The other outcome measures in the two groups were similar. Conclusion: This study showed that teenage pregnancies with good antenatal, intrapartum, and neonatal care, gives almost the same materno-fetal outcomes as the control group. The determining factors for poor maternal and fetal outcomes are poor socioeconomic status and lack or poor quality of antenatal, intrapartum, and puerperal care.
The organisational responsibility in a hospital lies with the individual who is actually (co-) responsible for the error (for example, the senior consultant, medical director, nursing manager, administrative director or manager of a hospital). According to the Federal Court of Justice (BGH), staff shortages are no excuse for the failure to adhere to the standard of care. According to a judgement of the Labour Court in Wilhelmshaven the Senior Consultant of a hospital is entitled to be provided with the necessary number of staff by the hospital owner who is obliged to provide a round-the-clock specialist care standard. Care should be taken that no employees be deployed who are overtired from working the previous night shift. Timely information of the follow-up physician about therapeutic issues resulting from the hospital treatment is demanded. Risk prevention strategies developed by an expert group as a form of risk management are reasonable and also requested by some liability insurances.
Pharmaceutical expenditure growth has outpaced GDP and healthcare expenditure growth rates in Denmark as in most OECD countries for the last decade. A major part of this increase was due to high growth rates in specialist areas that are typically located in hospital settings. Yet the market...... for hospital medicines and their procurement are still poorly understood. The present paper characterises the market for hospital medicines in Denmark in terms of its organisation and developments between 2005 and 2009. In Denmark hospital medicines are publicly financed and procurement is centrally organised....... 98% of all medicines administered at Danish public hospitals are purchased through a public procurement agency by means of public tenders. Using data on actual contract prices we decompose pharmaceutical expenditure growth into the contributions from newly introduced medicines, price and volume...
... FREE FLOW OF AUDIO-VISUAL MATERIALS § 61.6 Consultation with subject matter specialists. (a) The... assisting the Department in its determination of whether materials for which export certification or import authentication is sought contain widespread and gross misstatements of fact. (b) As necessary, the Department may...
Banks, Karen Vlahos; Nolen, Patricia
In light of criticisms that teacher preparation programs do not adequately prepare prospective reading teachers and specialists for actual classroom problems, a study was conducted to determine the accuracy of teacher diagnoses and planning for reading difficulties and to examine differences in coursework preparation and classroom experience.…
Schippers, G. M.
Although smoking cessation reduces the cardiovascular risk of smoking, why this is so is still uncertain. Nevertheless, because they are strongly and authoritatively involved in much of the serious health damage caused by smoking, medical specialists should do all they can to support their patients
Barron, Daniel D.
Discusses emotional intelligence and its importance for school library media specialists, based on a book by Daniel Goleman called "Emotional Intelligence." Highlights include managing emotions and relationships; self-motivation; and how emotional intelligence fits in with Standards for Information Literacy. (LRW)
Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.
This publication provides instructors with materials for an export management specialist (EMS) training program. The objective of the training program is to assist companies in reaching their export goals by educating current and potential managers about the basics of exporting. It provides a foundation for considering international trade and for…
Coast Guard Inst., Oklahoma City, OK.
This self-paced course is designed to present a basic, general overview of the duties of a Coast Guard Third Class Subsistence Specialist. The course provides basic information necessary to perform food preparation and food service tasks using various types of food service equipment and utensils. The course contains 16 illustrated reading…
More and more, health education specialists are integrating technology into their work. Whereas most are familiar with social media sites like Facebook, Twitter and LinkedIn, one relatively new form of social media, location based services (LBS), may be less familiar. Developed in 2000, LBS are software applications that are accessible from a…
McGatha, Maggie B.
This paper provides a historical overview of the role and impact of elementary mathematics specialists as well as current implications and opportunities for the field. Furthermore, suggestions are offered for the mathematics education field for ensuring the intersection of practice and research. [For complete proceedings, see ED581294.
Healthcare delivery is in a crisis, requiring improvement. How to improve and who should assume more leadership are not clear. At the same time, the nursing profession struggles with a weak education system, graduating students who require major support for an extended time. There is also confusion related to nursing roles, particularly with nurses who have a graduate degree. The Institute of Medicine has published a series of reports about the healthcare system and need for improvement and describes a structure for improvement. The clinical nurse specialist is particularly suited to assume a major role in nursing leadership to guide staff and the healthcare system to better ensure improved care. There is great need to communicate that the clinical nurse specialist can and should assume this role. This will require a review and development of more quality improvement content and experiences in clinical nurse specialist educational programs, but much of the content is already in programs. The clinical nurse specialist works in systems, impacts systems, works with staff, and can thus reach more patients with improvement approaches.
Schools Network, 2010
The aim of the Government's Science, Technology, Engineering and Mathematics (STEM) programme is to ensure Britain's future success as a major centre for science, engineering and innovation. Specialist science, technology, engineering and maths & computing colleges help to drive this programme by becoming centres of excellence in STEM…
Smets, E. M. A.; Visser, M. R. M.; Oort, F. J.; Schaufeli, W. B.; de Haes, H. J. C. J. M.
This study investigated, among medical specialists (N = 2,400), the association between perceived inequity in relationships at work (patients, colleagues, organization) and burn-out, and the moderating role of communal orientation. Intrapersonal inequity, involving an internal standard of reference,
Skeele, Rosemary W.; Schall, Patricia L.
Offers a definition of and a rationale for multicultural education based on changing demographics and suggests ways for school library media specialists to bring a multicultural perspective to collection development, evaluation of multicultural materials, library services, curriculum integration, and curriculum activities. (Contains 21…
Bregnballe, Vibeke; Erwander, Inger
/CF comprises one CF nurse from each of the centers. The board meets twice a year to plan workshops and courses. SNSG/CF is part of the International Nurse Specialist Group/Cystic Fibrosis (INSG/CF). Results: Within the framework of SNSG/CF a 2-day workshop is held every second year for approximately 40...
Polish experience in training specialists in international marketing in the context of globalization and integration processes has been studied. A range of theoretical resources, namely Market Entry Strategy for Poland; the articles dedicated to international marketing and economy development (W. Grzegorczyk, M. Viachevskyi, M. Urbanetst); program…
Payload specialist Ronald A. Parise, a senior scientist in the Space Observatories Department of Computer Sciences Corporation (CSC), checks on the ASTRO-2 payload (out of frame in the cargo bay of the Space Shuttle Endeavour). Parise is on the aft flight deck of the Earth orbiting Endeavour during STS-67.
care plans for psychosocial nursing diagnoses. Ostomy Wound Manage, 40(3), 18-22, 24-16. Heath, J., Andrews, J., & Balkstra, C. R. Potential reduction...the clinical nurse specialist. Clin Nurse Spec, 17(2), 83-85. O’Malley, P. (2004). New hope for patients with pulmonary hypertension: endothelin
Levy, Abigail Jurist; Jia, Yueming; Marco-Bujosa, Lisa; Gess-Newsome, Julie; Pasquale, Marian
This study examined science programs, instruction, and student outcomes at 30 elementary schools in a large, urban district in the northeast United States in an effort to understand whether there were meaningful differences in the quality, quantity and cost of science education when provided by a science specialist or a classroom teacher. Student…
Booz Allen and Hamilton, Inc., Washington, DC.
These second and third volumes of a four-volume study of manpower in state highway safety programs over the next decade estimate manpower resources by state and in national aggregate and describe present and planned training programs for safety specialists. For each educational level, both total manpower and manpower actually available for…
Wald, Judy L.; Repetto, Jeanne B.
Quality Implementation in Transition is a framework designed to guide transition specialists and administrators in the implementation of total quality management. The framework uses the tenets set forth by W. Edwards Deming and is intended to help professionals facilitate change within transition programs. (Author/JOW)
Lundh, Andreas; Skjelsager, Karen; Wildgaard, Kim
The seven roles of the CanMEDS system have been implemented in Danish postgraduate medical training. For each medical specialty, a professional profile describes which elements of the seven roles the specialty deems important for applicants for a specialist training position. We investigated use...
de Vries, Peter A.
This case study focuses on generalist primary (elementary) school teachers teaching music in an Australian school. With the onus for teaching music moving away from the specialist music teacher to the generalist classroom teacher, this case study adds to a growing body of literature focusing on generalist primary school teachers and music…
Lazcano-Gomez, Gabriel; Alvarez-Ascencio, Daniela; Haro-Zuno, Cindy; Turati-Acosta, Mauricio; Garcia-Huerta, Magdalena; Jimenez-Arroyo, Jesus; Castañeda-Diez, Rafael; Castillejos-Chevez, Armando; Gonzalez-Salinas, Roberto; Dominguez-Dueñas, Francisca; Jimenez-Roman, Jesus
To determine the glaucoma specialists' preferences for the different brands of topical glaucoma medications available in Mexico. A web-based survey was sent to 150 board-certified glaucoma specialists in Mexico, with 14 questions related to brand preferences for all glaucoma medications available in Mexico. Participants were asked to select each glaucoma medication class by brand and to state the factors leading to their choice. Data from 111 (74%) glaucoma specialists were collected. Imot (timolol 0.5%; Sophia, Mexico) was the preferred brand for the beta-blockers (BB) class by 71% (n = 79) of the participants. Azopt (brinzolamide 1%; Alcon Lab, US) was the preferred carbonic anhydrase inhibitor (CAI) by 54% (n = 60) of the glaucoma specialists. Lumigan (bimatoprost 0.01% and 0.03%; Allergan Inc., U.S.) was the first choice for the prostaglandin analogues (PGAs) in 62% (n = 70) of the answers. The most frequently prescribed alpha-agonist (AA) was Agglad (brimonidine 0.2%; Sophia Lab, Mexico) in 44% (n = 49) of the answers. Medication accessibility (31%), cost (29%), and recommended dose (23%) were the three main factors influencing the glaucoma specialists' preferences. Medication cost and accessibility, as well as posology, remain the main factors influencing brand preferences among glaucoma doctors. In our professional opinion, the therapeutic effect must be the leading factor when prescribing topical medications in the daily practice, so that patients receive the best treatment option. This survey provides an understanding of the decision-making process when prescribing glaucoma medications by glaucoma specialists in a Latin American developing country. Ideally, patient treatment should be individualized and aimed to achieve the best results possible for their specific condition. How to cite this article: Lazcano-Gomez G, Alvarez-Ascencio D, Haro-Zuno C, Turati-Acosta M, Garcia-Huerta M, Jimenez-Arroyo J, Castañeda-Diez R, Castillejos-Chevez A, Gonzalez
Osborn, M; Day, R; Westbrook, J
Nationally health systems are making increasing investments in the use of clinical information systems. Little is known about current computer use by specialist physicians, particularly outside the hospital setting. To identify the extent and reasons physician Fellows of the Royal Australasian College of Physicians (RACP) use computers in their work. A self-administered survey was emailed from the RACP to all practising physicians in 2007 that were living in Australia and New Zealand who had consented to email contact with the College. The survey was sent to a total of 7445 eligible physicians, 2328 physicians responded (31.3% response rate), but only 1266 responses (21.0%) were able to be analysed. Most 97.5% had access to computers at work and 96.5% used home computers for work purposes. Physicians in public hospitals (72.6%) were more likely to use computers for work (65.6%) than those in private hospitals (12.6%) or consulting rooms (27.3%). Overall physicians working in public hospitals used a wider range of applications with 70.5% using their computers for searching the internet, 53.7% for receiving results and 52.7% used their computers to engage in specific educational activities. Physicians working from their consulting rooms (33.6%) were more likely to use electronic prescribing (11%) compared with physicians working in public hospitals (5.7%). Fellows have not incorporated computers into their consulting rooms over which they have control. This is in contrast to general practitioners who have embraced computers after the provision of various incentives. The rate of use of computers by physicians for electronic prescribing in consulting rooms (11%) is very low in comparison with general practitioners (98%). One reason may be that physicians work in multiple locations whereas general practitioners are more likely to work from one location.
Kristiansen, I S; Førde, O H
The relation between current place of work (area of the country) and factors that might possibly represent doctors geographical attachments was studied in a sample of 322 Norwegian medical specialists. Location of hospital residency, age and geographical origin of spouse were associated with current location. Geographical attachment seems to influence doctors' locational choices from start of medical school until the end of their residency. The probability that a doctor shall locate in peripheral areas may increase from less than 10% to more than 50% if the doctor has the residency training in the periphery. Hence, favoring entrance to medical schools of students from the underserved areas, and location of graduate and postgraduate medical training in the underserved areas, as far as it is feasible while still maintaining medical standards, is suggested by the study.
Argüelles-Arias, Federico; Carpio, Daniel; Calvet, Xavier; Romero, Cristina; Cea-Calvo, Luis; Juliá, Berta; López-Sanromán, Antonio
Education of patients with ulcerative colitis (UC) about their disease and access to a specialist are important to improve health outcomes. Our objective was to determine, by collecting information directly from the patients, their information sources and knowledge of the disease, and the options for access to the gastroenterologist. The information was collected using a printed survey handed out by 39 gastroenterologists to 15 consecutive adult patients with UC. Patients answered anonymously from their home. The responses were stratified by hospital size (> 900; 500-900; < 500 beds). A total of 585 patients received the survey and 436 responded (74.5%; mean age of 46 years [13.5], 53% men). The main information source was the specialist physician (89.2%). Between 32% and 80% of patients had areas of improvement regarding knowledge of their disease. Knowledge of the disease was better in patients from small hospitals (< 500 beds). The frequency of routine visits was also higher in small hospitals. In case of a flare-up, 60% stated they were able to contact their doctor by phone and 37%, that they could get an appointment on the same day. The percentage stating that they had to ask for an appointment and wait until their physician was available was lower in small hospitals. There are areas of improvement with regard to knowledge of their disease in patients with UC followed in hospital clinics. Patients followed in small hospitals seem to know their disease better, are followed more frequently in the clinic, and have better access in case of a flare-up.
Full Text Available Background and aim: Education of patients with ulcerative colitis (UC about their disease and access to a specialist are important to improve health outcomes. Our objective was to determine, by collecting information directly from the patients, their information sources and knowledge of the disease, and the options for access to the gastroenterologist. Methods: The information was collected using a printed survey handed out by 39 gastroenterologists to 15 consecutive adult patients with UC. Patients answered anonymously from their home. The responses were stratified by hospital size (> 900; 500-900; < 500 beds. Results: A total of 585 patients received the survey and 436 responded (74.5%; mean age of 46 years [13.5], 53% men. The main information source was the specialist physician (89.2%. Between 32% and 80% of patients had areas of improvement regarding knowledge of their disease. Knowledge of the disease was better in patients from small hospitals (< 500 beds. The frequency of routine visits was also higher in small hospitals. In case of a flare-up, 60% stated they were able to contact their doctor by phone and 37%, that they could get an appointment on the same day. The percentage stating that they had to ask for an appointment and wait until their physician was available was lower in small hospitals. Conclusions: There are areas of improvement with regard to knowledge of their disease in patients with UC followed in hospital clinics. Patients followed in small hospitals seem to know their disease better, are followed more frequently in the clinic, and have better access in case of a flare-up.
McMorrow, Siobhán Mary; Millett, Declan T
To report the opinions of specialist orthodontists regarding the profile, characteristics and treatment of adults currently undergoing orthodontic treatment in the Republic of Ireland (ROI) Design/setting: A national cross-sectional questionnaire study in the ROI. A pilot-tested questionnaire was distributed to 122 specialist orthodontists in the ROI. Questions addressed general and treatment information for current adult orthodontic patients. Those whose treatment involved orthognathic surgery were not excluded. A response of 83% was obtained. Ninety-five per cent of specialists reported treating adults, most of whom were self-referred and were typically professional, female and aged 25-35 years. The overall ratio quoted of professionals to non-professionals was almost 3:2. For 50% of specialists, males were estimated to account for 20-40% of their adult cases and for 23%, this increased to an estimated 40-60%. Class II division 1 malocclusion and skeletal II were considered the most common dentofacial characteristics. Occlusal features encountered in decreasing frequency were generalised crowding, increased overjet, deep overbite, late lower incisor crowding, spacing and impacted teeth. Fifteen per cent reported that at least 10% of their adult cases required orthodontics with maxillofacial surgery but 8% reported that this was at least 50%. Treatment challenges commonly acknowledged were overbite reduction, anchorage management, 'black triangles' and overjet reduction. Tooth whitening was reckoned to be used by 19% of specialists. Aesthetic upper and stainless steel lower brackets were indicated to be used most often whereas only 19% used clear aligners and 10% used lingual appliances often. The profile and characteristics of adults currently undergoing orthodontic treatment in the ROI were diverse. Higher estimates were quoted for self- than for general dental practitioner-referral. A high percentage of treatment was reported to be undertaken for non
Wong, Ting Hway; Lumsdaine, William; Hardy, Benjamin M; Lee, Keegan; Balogh, Zsolt J
Trauma services throughout the world have had positive effects on trauma-related mortality. Australian trauma services are generally more consultative in nature rather than the North American model of full trauma admission service. We hypothesized that the introduction of a consultative specialist trauma service in a Level I Australian trauma center would reduce mortality of the severely injured. A 10-year retrospective study (January 1, 2002-December 31, 2011) was performed on all trauma patients admitted with an Injury Severity Score (ISS) > 15. Patients were identified from the trauma registry, and data for age, sex, mechanism of injury, ISS, survival to discharge, and length of stay were collected. Mortality was examined for patients with severe injury (ISS > 15) and patients with critical injury (ISS > 24) and compared for the three periods: 2002-2004 (without trauma specialist), 2005-2007 (with trauma specialist), and 2008-2011 (with specialist trauma service). A total of 3,869 severely injured (ISS > 15) trauma patients were identified during the 10-year period. Of these, 2,826 (73%) were male, 1,513 (39%) were critically injured (ISS > 24), and more than 97% (3,754) were the victim of blunt trauma. Overall mortality decreased from 12.4% to 9.3% (relative risk, 0.75) from period one to period three and from 25.4% to 20.3% (relative risk, 0.80) for patients with critical injury. A 0.46% per year decrease (p = 0.018) in mortality was detected (odds ratio, 0.63; p 24), the trend was (0.61% per year; odds ratio, 0.68; p = 0.039). The introduction of a specialist trauma service decreased the mortality of patients with severe injury, the model of care should be considered to implement state- and nationwide in Australia. Epidemiologic study, level III.
Thorne, Amanda L; Mercer, Stuart J; Harris, Guy JC; Simson, Jay NL
INTRODUCTION An audit of patients presenting with colorectal cancer to our district general hospital during a 2-year period from November 1994 found that 12.1% of cases were diagnosed later than 6 months after initial presentation to a physician. This audit was repeated for a 2-year period from December 2001, to determine whether the introduction of a specialist coloproctology surgery service had led to a reduction in late diagnosis of colorectal cancer. PATIENTS AND METHODS Case notes were reviewed of all patients presenting with colorectal cancer between December 2001 and November 2003. Late diagnosis was defined as diagnosis of colorectal cancer more than 6 months after their first attendance to either their general practitioner or district general hospital. The results were compared with those of the previous study. RESULTS Of a total of 218 patients presenting with colorectal cancer during the study period, 14 (6.4%; 10 men and 4 women) satisfied the criteria for late diagnosis, with the longest delay being 12.5 months. Reasons for late diagnosis were false-negative reporting of barium studies (n = 3), inaccurate tumour biopsy (n = 2), concurrent pathology causing anaemia (n = 4), inappropriate delay in definitive investigation (n = 3), and refusal of investigation by patients (n = 2). CONCLUSIONS There has been a reduction of nearly 50% (12.1% to 6.4%) in the proportion of patients with a late diagnosis of colorectal cancer compared with our previous audit. It is suggested that an important factor in this improvement in diagnosis has been the introduction of a specialist coloproctology surgery service. PMID:17059718
The objective of the Meeting on Seismic Isolation Technology was to provide a forum for review and discussion of seismic isolation technology applicable to thermal and fast reactors. The meeting was conducted consistent with the recommendations of the IAEA Working Group Meeting on Fast Breeder Reactor-Block Antiseismic Design and Verification in October 1987, to augment a coordinated research program with specific recommendations and an assessment of technology in the area of seismic isolation. Seismic isolation has become an attractive means for mitigating the consequences of severe earthquakes. Although the general idea of seismic isolation has been considered since the turn of the century, real practical applications have evolved, at an accelerating pace, over the last fifteen years aided by several key developments: (1) recent advances in hardware developments in the form of reliable elastomer bearings, (2) development of reliable analytical methods for the prediction of dynamic responses of structures (3) construction of large bearing test machines and large shake tables to simulate earthquake effects on structures for validation analytical models and demonstration of performance characteristics, and (4) advances in seismological engineering. Although the applications and developments of seismic isolation technology have mainly benefited commercial facilities and structures, including office buildings, research laboratories, hospitals, museums, bridges, ship loaders, etc., several seismically isolated nuclear facilities were implemented: the four 900 MWe pressurized water reactor units of the Cruas plant in France, the two Framatome units in Koeberg, South Africa, a nuclear waste storage facility in France and a nuclear fuel reprocessing plant in England. The scope of this specialists' meeting was to review the state-of-the-art technology related to the performance of seismic isolator elements and systems, performance limits and margins, criteria for the
The objective of the Meeting on Seismic Isolation Technology was to provide a forum for review and discussion of seismic isolation technology applicable to thermal and fast reactors. The meeting was conducted consistent with the recommendations of the IAEA Working Group Meeting on Fast Breeder Reactor-Block Antiseismic Design and Verification in October 1987, to augment a coordinated research program with specific recommendations and an assessment of technology in the area of seismic isolation. Seismic isolation has become an attractive means for mitigating the consequences of severe earthquakes. Although the general idea of seismic isolation has been considered since the turn of the century, real practical applications have evolved, at an accelerating pace, over the last fifteen years aided by several key developments: (1) recent advances in hardware developments in the form of reliable elastomer bearings, (2) development of reliable analytical methods for the prediction of dynamic responses of structures (3) construction of large bearing test machines and large shake tables to simulate earthquake effects on structures for validation analytical models and demonstration of performance characteristics, and (4) advances in seismological engineering. Although the applications and developments of seismic isolation technology have mainly benefited commercial facilities and structures, including office buildings, research laboratories, hospitals, museums, bridges, ship loaders, etc., several seismically isolated nuclear facilities were implemented: the four 900 MWe pressurized water reactor units of the Cruas plant in France, the two Framatome units in Koeberg, South Africa, a nuclear waste storage facility in France and a nuclear fuel reprocessing plant in England. The scope of this specialists' meeting was to review the state-of-the-art technology related to the performance of seismic isolator elements and systems, performance limits and margins, criteria for the
Chinman, Matthew; McInnes, D Keith; Eisen, Susan; Ellison, Marsha; Farkas, Marianne; Armstrong, Moe; Resnick, Sandra G
Mental health peer specialists are individuals with serious mental illnesses who receive training to use their lived experiences to help others with serious mental illnesses in clinical settings. This Open Forum discusses the state of the research for mental health peer specialists and suggests a research agenda to advance the field. Studies have suggested that peer specialists vary widely in their roles, settings, and theoretical orientations. Theories of action have been proposed, but none have been tested. Outcome studies have shown benefits of peer specialists; however, many studies have methodological shortcomings. Qualitative descriptions of peer specialists are plentiful but lack grounding in implementation science frameworks. A research agenda advancing the field could include empirically testing theoretical mechanisms of peer specialists, developing a measure of peer specialist fidelity, conducting more rigorous outcomes studies, involving peer specialists in executing the research, and assessing various factors that influence implementing peer specialist services and testing strategies that could address those factors.
Salamanca-Balen, Natalia; Seymour, Jane; Caswell, Glenys; Whynes, David; Tod, Angela
Patients with palliative care needs do not access specialist palliative care services according to their needs. Clinical Nurse Specialists working across a variety of fields are playing an increasingly important role in the care of such patients, but there is limited knowledge of the extent to which their interventions are cost-effective. To present results from a systematic review of the international evidence on the costs, resource use and cost-effectiveness of Clinical Nurse Specialist-led interventions for patients with palliative care needs, defined as seriously ill patients and those with advanced disease or frailty who are unlikely to be cured, recover or stabilize. Systematic review following PRISMA methodology. Medline, Embase, CINAHL and Cochrane Library up to 2015. Studies focusing on the outcomes of Clinical Nurse Specialist interventions for patients with palliative care needs, and including at least one economic outcome, were considered. The quality of studies was assessed using tools from the Joanna Briggs Institute. A total of 79 papers were included: 37 randomized controlled trials, 22 quasi-experimental studies, 7 service evaluations and other studies, and 13 economic analyses. The studies included a wide variety of interventions including clinical, support and education, as well as care coordination activities. The quality of the studies varied greatly. Clinical Nurse Specialist interventions may be effective in reducing specific resource use such as hospitalizations/re-hospitalizations/admissions, length of stay and health care costs. There is mixed evidence regarding their cost-effectiveness. Future studies should ensure that Clinical Nurse Specialists' roles and activities are clearly described and evaluated.
Management of hemodynamically unstable pelvic trauma: results of the first Italian consensus conference (cooperative guidelines of the Italian Society of Surgery, the Italian Association of Hospital Surgeons, the Multi-specialist Italian Society of Young Surgeons, the Italian Society of Emergency Surgery and Trauma, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, the Italian Society of Orthopaedics and Traumatology, the Italian Society of Emergency Medicine, the Italian Society of Medical Radiology -Section of Vascular and Interventional Radiology- and the World Society of Emergency Surgery)
Hemodynamically Unstable Pelvic Trauma is a major problem in blunt traumatic injury. No cosensus has been reached in literature on the optimal treatment of this condition. We present the results of the First Italian Consensus Conference on Pelvic Trauma which took place in Bergamo on April 13 2013. An extensive review of the literature has been undertaken by the Organizing Committee (OC) and forwarded to the Scientific Committee (SC) and the Panel (JP). Members of them were appointed by surgery, critical care, radiology, emergency medicine and orthopedics Italian and International societies: the Italian Society of Surgery, the Italian Association of Hospital Surgeons, the Multi-specialist Italian Society of Young Surgeons, the Italian Society of Emergency Surgery and Trauma, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, the Italian Society of Orthopaedics and Traumatology, the Italian Society of Emergency Medicine, the Italian Society of Medical Radiology, Section of Vascular and Interventional Radiology and the World Society of Emergency Surgery. From November 2012 to January 2013 the SC undertook the critical revision and prepared the presentation to the audience and the Panel on the day of the Conference. Then 3 recommendations were presented according to the 3 submitted questions. The Panel voted the recommendations after discussion and amendments with the audience. Later on a email debate took place until December 2013 to reach a unanimous consent. We present results on the 3 following questions: which hemodynamically unstable patient needs an extraperitoneal pelvic packing? Which hemodynamically unstable patient needs an external fixation? Which hemodynamically unstable patient needs emergent angiography? No longer angiography is considered the first therapeutic maneuver in such a patient. Preperitoneal pelvic packing and external fixation, preceded by pelvic binder have a pivotal role in the management of these patients
Chapman, Michael; Johnston, Nikki; Lovell, Clare; Forbat, Liz; Liu, Wai-Man
Specialist palliative care is not a standardised component of service delivery in nursing home care in Australia. Specialist palliative care services can increase rates of advance care planning, decrease hospital admissions and improve symptom management in such facilities. New approaches are required to support nursing home residents in avoiding unnecessary hospitalisation and improving rates of dying in documented preferred place of death. This study examined whether the addition of a proactive model of specialist palliative care reduced resident transfer to the acute care setting, and achieved a reduction in hospital deaths. A quasi-experimental design was adopted, with participants at 4 residential care facilities. The intervention involved a palliative care nurse practitioner leading 'Palliative Care Needs Rounds' to support clinical decision-making, education and training. Participants were matched with historical decedents using propensity scores based on age, sex, primary diagnosis, comorbidities and the Aged Care Funding Instrument rating. Outcome measures included participants' hospitalisation in the past 3 months of life and the location of death. The data demonstrate that the intervention is associated with a substantial reduction in the length of hospital stays and a lower incidence of death in the acute care setting. While rates of hospitalisation were unchanged on average, length of admission was reduced by an average of 3.22 days (pcare service delivery in residential facilities. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Soban, Lynn M; Finley, Erin P; Miltner, Rebecca S
To describe the presence or absence of key components of hospital pressure ulcer (PU) prevention programs in 6 acute care hospitals. Multisite comparative case study. Using purposeful selection based on PU rates (high vs low) and hospital size, 6 hospitals within the Veterans Health Administration health care system were invited to participate. Key informant interviews (n = 48) were conducted in each of the 6 participating hospitals among individuals playing key roles in PU prevention: senior nursing leadership (n = 9), nurse manager (n = 7), wound care specialist (n = 6), frontline RNs (n = 26). Qualitative data were collected during face-to-face, semistructured interviews. Interview protocols were tailored to each interviewee's role with a core set of common questions covering 3 major content areas: (1) practice environment (eg, policies and wound care specialists), (2) current prevention practices (eg, conduct of PU risk assessment and skin inspection), and (3) barriers to PU prevention. We conducted structured coding of 5 key components of PU prevention programs and cross-case analysis to identify patterns in operationalization and implementation of program components across hospitals based on facility size and PU rates (low vs high). All hospitals had implemented all PU prevention program components. Component operationalization varied considerably across hospitals. Wound care specialists were integral to the operationalization of the 4 other program components examined; however, staffing levels and work assignments of wound care specialists varied widely. Patterns emerged among hospitals with low and high PU rates with respect to wound care specialist staffing, data monitoring, and staff education. We found hospital-level variations in PU prevention programs. Wound care specialist staffing may represent a potential point of leverage in achieving other PU program components, particularly performance monitoring and staff education.
U.S. Department of Health & Human Services — Welcome to hospitalinspections.org, a website run by the Association of Health Care Journalists (AHCJ) that aims to make federal hospital inspection reports easier...
The Niantic Specialist meeting was structured around three main themes, one for each session. During the first session, papers from regulators, research groups, designers/owners groups and some utilities discussed the critical decisions in Severe Accident Management (SAM), how these decisions were addressed and implemented in generic SAM guidelines, what equipment and instrumentation was used, what are the differences in national approaches, etc. During the second session, papers were presented by utility specialists that described approaches chosen to specific implementation of the generic guidelines, the difficulties encountered in the implementation process and the perceived likelihood of success of their SAM program in dealing with severe accidents. The third session was dedicated to discussing what are the remaining uncertainties and open questions in SAM. Experts from several OECD countries presented significant perspectives on remaining open issues
For the third time, during final launch preparations in the Operations and Checkout Building, STS-93 Mission Specialist Catherine G. Coleman (Ph.D.) dons her launch and entry suit. After Space Shuttle Columbia's July 20 and 22 launch attempts were scrubbed, the launch was again rescheduled for Friday, July 23, at 12:24 a.m. EDT. STS-93 is a five-day mission primarily to release the Chandra X-ray Observatory, which will allow scientists from around the world to study some of the most distant, powerful and dynamic objects in the universe. The STS-93 crew numbers five: Commander Eileen M. Collins, Pilot Jeffrey S. Ashby, and Mission Specialists Stephen A. Hawley (Ph.D.), Coleman, and Michel Tognini of France, with the Centre National d'Etudes Spatiales (CNES). Collins is the first woman to serve as commander of a shuttle mission.
For the third time, during final launch preparations in the Operations and Checkout Building, STS-93 Mission Specialist Steven A. Hawley (Ph.D.) waves after donning his launch and entry suit. After Space Shuttle Columbia's July 20 and 22 launch attempts were scrubbed, the launch was again rescheduled for Friday, July 23, at 12:24 a.m. EDT. STS-93 is a five-day mission primarily to release the Chandra X-ray Observatory, which will allow scientists from around the world to study some of the most distant, powerful and dynamic objects in the universe. The STS-93 crew numbers five: Commander Eileen M. Collins, Pilot Jeffrey S. Ashby, and Mission Specialists Hawley, Catherine G. Coleman (Ph.D.) and Michel Tognini of France, with the Centre National d'Etudes Spatiales (CNES). Collins is the first woman to serve as commander of a shuttle mission.
Heck, Michael P.; Schultz, Luke D.; Hockman-Wert, David; Dinger, Eric C.; Dunham, Jason B.
Executive SummaryWater temperature influences most physical and biological processes in streams, and along with streamflows is a major driver of ecosystem processes. Collecting data to measure water temperature is therefore imperative, and relatively straightforward. Several protocols exist for collecting stream temperature data, but these are frequently directed towards specialists. This document was developed to address the need for a protocol intended for non-specialists (non-aquatic) staff. It provides specific step-by-step procedures on (1) how to launch data loggers, (2) check the factory calibration of data loggers prior to field use, (3) how to install data loggers in streams for year-round monitoring, (4) how to download and retrieve data loggers from the field, and (5) how to input project data into organizational databases.
In this study the Repertory Grid interview technique was used to investigate constructs of leadership held by a group of male and female senior managers from within hospice and Specialist Palliative Care Units (SPCUs) in the UK. The themes that emerged were compared with those from existing research models of leadership. Men and women in these roles describe different constructs of effective leadership. The women's constructs that emerged were predominantly transformational, whilst the men's were predominantly transactional. Themes were also identified in this study, which differed from previous studied, i.e. those of political and environment awareness and the valuing of others' views regardless of their status. These themes do not feature highly in other research, and may be in response to the environment within which hospice and specialist palliative care functions.
The Niantic Specialist meeting was structured around three main themes, one for each session. During the first session, papers from regulators, research groups, designers/owners groups and some utilities discussed the critical decisions in Severe Accident Management (SAM), how these decisions were addressed and implemented in generic SAM guidelines, what equipment and instrumentation was used, what are the differences in national approaches, etc. During the second session, papers were presented by utility specialists that described approaches chosen to specific implementation of the generic guidelines, the difficulties encountered in the implementation process and the perceived likelihood of success of their SAM program in dealing with severe accidents. The third session was dedicated to discussing what are the remaining uncertainties and open questions in SAM. Experts from several OECD countries presented significant perspectives on remaining open issues
Full Text Available The process of leadthrough of practical employments is considered on physical education on an experimental model, which are directed on the increase of reserve possibilities of organism of future specialists of management. In an experiment took part 30 students of 2 and 3 courses. It is set that management specialists for high-quality implementation of work need a high mental capacity, enhanceable psychoemotional firmness, general endurance. Directions of prophylaxis of emotional and physical overstrain are recommended, increases of level of positive motivation to systematic employments by physical exercises. It is marked that an experimental model in combination with the fixed form of leadthrough of employments on a body-conditioning and employments on specialization of the chosen type of sport is one the stages of alteration organizationally of methodical aspects of physical culture.
This article looks at a prescribed academic framework for various criteria that serve as a checklist for marketing performance that can be applied to hospital marketing organizations. These guidelines are drawn from some of Dr. Noel Capon of Columbia University's book Marketing Management in the 21st Century and applied to actual practices of hospital marketing organizations. In many ways this checklist can act as a "marketing" balanced scorecard to verify performance effectiveness and develop opportunities for innovation.
Baldwin, Kathleen M; Black, Denice; Hammond, Sheri
This quality improvement project developed a community nursing case management program to decrease preventable readmissions to the hospital and emergency department by providing telephonic case management and, if needed, onsite assessment and treatment by a clinical nurse specialist (CNS) with prescriptive authority. As more people reach Medicare age, the number of individuals with worsening chronic diseases with dramatically increases unless appropriate disease management programs are developed. Care transitions can result in breakdown in continuity of care, resulting in increased preventable readmissions, particularly for indigent patients. The CNS is uniquely educated to managing care transitions and coordination of community resources to prevent readmissions. After a thorough SWOT (strengths, weaknesses, opportunities, and threats) analysis, we developed and implemented a cost-avoidance model to prevent readmissions in our uninsured and underinsured patients. The project CNS used a wide array of interventions to decrease readmissions. In the last 2 years, there have been a total of 22 less than 30-day readmissions to the emergency department or hospital in 13 patients, a significant decrease from readmissions in these patients prior to the program. Three of them required transfer to a larger hospital for a higher level of care. Using advanced practice nurses in transitional care can prevent readmissions, resulting in cost avoidance. The coordination of community resources during transition from hospital to home is a job best suited to CNSs, because they are educated to work within organizations/systems. The money we saved with this project more than justified the cost of hiring a CNS to lead it. More research is needed into this technology. Guidelines for this intervention need to be developed. Replicating our cost-avoidance transitional care model can help other facilities limit that loss.
Chan, Wai Fong; Bond, Trevor G; Adamson, Bob; Chow, Meyrick
To confirm a core competency scale for Hong Kong infection control nurses at the advanced nursing practice level from the core competency items proposed in a previous phase of this study. This would serve as the foundation of competency assurance in Hong Kong hospitals. A cross-sectional survey design was used. All public and private hospitals in Hong Kong. All infection control nurses in hospitals of Hong Kong. The 83-item proposed core competency list established in an earlier study was transformed into a questionnaire and sent to 112 infection control nurses in 48 hospitals in Hong Kong. They were asked to rate the importance of each infection prevention and control item using Likert-style response categories. Data were analyzed using the Rasch model. The response rate of 81.25% was achieved. Seven items were removed from the proposed core competency list, leaving a scale of 76 items that fit the measurement requirements of the unidimensional Rasch model. Essential core competency items of advanced practice for infection control nurses in Hong Kong were identified based on the measurement criteria of the Rasch model. Several items of the scale that reflect local Hong Kong contextual characteristics are distinguished from the overseas standards. This local-specific competency list could serve as the foundation for education and for certification of infection control nurse specialists in Hong Kong. Rasch measurement is an appropriate analytical tool for identifying core competencies of advanced practice nurses in other specialties and in other locations in a manner that incorporates practitioner judgment and expertise.
Full Text Available In this paper we discuss the tradeoff between educating specialists and generalists in the Medialogy Master education at Aalborg University in Copenhagen. The Medialogy education was established in 2002 with the goal to combine technology and creativity in designing, implementing and evaluating media technology applications. The curriculum of the education has been through several revisions, the last of which, discussed in this paper, was performed during the Spring 2011.
Polish experience in training specialists in international marketing in the context of globalization and integration processes has been studied. A range of theoretical resources, namely Market Entry Strategy for Poland; the articles dedicated to international marketing and economy development (W. Grzegorczyk, M. Viachevskyi, M. Urbanetst); program specifications and structures at Polish universities, namely University of Lodz and Collegium Civitas, have been analyzed. It has been defined that...
Z T Golenkova
Full Text Available The article considers the behaviour and values of «specialists» as a particular quantitatively representative group of modern Russian society. It gives a detailed description of their status and disposition dimensions such as wealth, income, living conditions, labour motivation as well as attitudes to economic and social institutions. The authors base their conclusions on the latest statistics and empiric sociological research.
Lancaster, Harriet; Finlay, Ilora; Downman, Maxwell; Dumas, James
Some failures in end-of-life care have been attributed to inconsistent provision of palliative care across England. We aimed to explore the variation in commissioning of services by Clinical Commissioning Groups (CCGs) using a data collection exercise. We sent a Freedom of Information request in the form of an open questionnaire to all 209 CCGs in England to assess their commissioning of palliative and end-of-life care services, mainly focused on the provision of specialist palliative care services. 29 CCGs provided information about the number of patients with some form of palliative care needs in their population. For specialist palliative care services, CCGs allocated budgets ranging from £51.83 to £2329.19 per patient per annum. 163 CCGs (77.90%) currently commission 7-day admission to their specialist palliative care beds. 82.84% of CCGs commission 7-day specialist palliative care services in patients' own homes and out-of-hours services rely heavily on hospice provision. 64 CCGs (31.37%) commission pain control teams, the majority of whom only operate in regular working hours. 68.14% of CCGs reported commissioning palliative care education of any sort for healthcare professionals and 44.85% of CCGs had no plans to update or review their palliative care services. The most important finding from this exercise is that the information CCGs hold about their population and services is not standardised. However, information based on data that are more objective, for example, population and total budget for palliative care, demonstrate wide variations in commissioning. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Lazcano-Gomez, Gabriel; Alvarez-Ascencio, Daniela; Haro-Zuno, Cindy; Turati-Acosta, Mauricio; Garcia-Huerta, Magdalena; Jimenez-Arroyo, Jesus; Castañeda-Diez, Rafael; Castillejos-Chevez, Armando; Gonzalez-Salinas, Roberto; Dominguez-Dueñas, Francisca; Jimenez-Roman, Jesus
Aim To determine the glaucoma specialists’ preferences for the different brands of topical glaucoma medications available in Mexico. Materials and methods A web-based survey was sent to 150 board-certified glaucoma specialists in Mexico, with 14 questions related to brand preferences for all glaucoma medications available in Mexico. Participants were asked to select each glaucoma medication class by brand and to state the factors leading to their choice. Results Data from 111 (74%) glaucoma s...
Anne Marie Russell
To explain the similarities and differences between clinical nurse specialists (CNSs and advanced nurse practitioners (ANPs in the context of ILD specialism To review contemporary nursing specialism in the UK’s government subsidised healthcare system To stimulate discussion and debate across the European/international respiratory community regarding the clinical and academic development of the ILD CNS To identify key priorities that will support collaboration across the ILD interdisciplinary workforce in clinical practice and research
Department of Health; Social Services and Public Safety
The Directory of Colon and Rectal Cancer Specialist Teams has been produced under the auspices of the Northern Ireland Regional Advisory Committee on Cancer. It contains details of the full membership of the clinical teams providing care for colon and rectal cancer in each of Health and Social Services Board Area. Lead Clinicians For Colon and Rectal Cancer Services (PDF 74 KB) EHSSB (PDF 198 KB) NHSSB (PDF 107 KB) SHSSB (PDF 130 KB) WHSSB (PDF 131 KB)
As cancer is the leading cause of death worldwide, every nurse will be required to care for patients with the condition at some point in his\\/her career. However, non-specialized oncology nurses are often ill-prepared to nurse patients suffering from cancer. This literature review aims to provide an overview of current trends and developments in cancer care nursing in an attempt to identify the range of previous research pertaining to caring for patients with cancer on non-specialist wards. The review finds that non-specialized cancer nurses report a lack of education and training with regard to cancer care and cancer treatments, which acts as a barrier to providing quality nursing care. Emotional and communication issues with patients and their families can also cause non-specialist nurses significant distress. International research has shown that specialist oncology nurses make a considerable difference to physical and psychosocial patient care. It is therefore paramount that non-speciality nurses\\' educational needs are met to develop clinical competence and to provide supportive holistic care for both patients and their families.
Training opportunities for singing voice rehabilitation specialists are growing and changing. This is happening despite a lack of agreed-on guidelines or an accredited certification acknowledged by the governing bodies in the fields of speech-language pathology and vocal pedagogy, the American Speech-Language Hearing Association and the National Association of Teachers of Singing, respectively. The roles of the speech-language pathologist, the singing teacher, and the person who bridges this gap, the singing voice rehabilitation specialist, are now becoming better defined and more common among the voice care community. To that end, this article aims to review the current opportunities for training in the field of singing voice rehabilitation. A review of available university training programs, private training programs and mentorships, clinical fellowships, professional organizations, conferences, vocal training across genres, and self-study opportunities was conducted. All institutional listings are with permission from program leaders. Although many avenues are available for training of singing voice rehabilitation specialists, there is no accredited comprehensive training program at this point. This review gathers information on current training opportunities from across various modalities. The listings are not intended to be comprehensive but rather representative of possibilities for interested practitioners. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Neurofibromatosis (NF) is a genetic condition that mainly involves the nervous system. There are two types: NF1 affects about one in 2,500 of the population worldwide and NF2 affects one in 35,000. Both types result in complex health problems for patients and can pose significant challenges for all those involved in their management. Established in 1981, The Neuro Foundation is a patient-focused charity that funds a network of specialist advisers who work in partnership with the NHS to offer support and advice for families affected by NF and the professionals who care for them. With a significant level of autonomy, the specialist adviser role is flexible in matching the needs of those affected while working cooperatively alongside the national specialist services for NF1 and NF2. ©2012 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.
T. A. Fugelova
Full Text Available Training professional mobile specialists capable of responding flexibly to dynamic changes in society is considered to be the most important issue of the modern educational system. The paper justifies the idea that technical universities should take responsibility for solving this problem by means of humanization of technical education, which implies reconsidering its values and general notions. For overcoming the technocratic trends, the author recommends to cultivate the value of professionalism in the humanization context.Professionalism is defined by using the «professional service» idea as a «purpose acknowledgment, supertask, even a mission». The main components of the above attitude lie in finding the harmony with the world and its basic values. Therefore, technical universities face the challenge of training people of intelligence with a high moral and business responsibility. The basic value of such a person is regarded as «dedication to the cause» - the constant desire to improve the world and leave behind them- selves something of value to society. For training such specialists, the educational process should provide teachers dialogue and collaboration with students to facilitate the process of self-determination and self-development of the prospective specialists.
Research shows the increasing part the Clinical Nurse Specialist (CNS) plays in healthcare today. But what does a CNS actually do in their day-to day-work? This study, set in the Republic of Ireland, aimed to explore the CNS and clinical midwife specialist (CMS) roles in practice. Quantitative methodology was used to explore the roles and activities of the CNS and CMS. Following ethics approval, a valid and reliable questionnaire was circulated to the total population of CNS/CMS in Ireland. The data were analysed using SPSS. This study articulates the individual role elements and activity level. The findings show the CNS/CMS to be active in the roles of researcher, educator, communicator, change agent, leader and clinical specialist, but the level of activity varies between different roles and individual role elements. The CNS/CMS is seen as a valuable resource in health care today and has potential to have a positive effect on patient care. The majority of CNS/CMSs are active in varying roles but the analysis shows lesser activity in some areas, such as research. The findings merit further study on role activity and possible variables that influence role activity.
Thompson, Cathy J; Nelson-Marten, Paula
The purpose of this article was to show how sequenced educational strategies aid in the acquisition of systems leadership and change agent skills, as well as other essential skills for professional clinical nurse specialist (CNS) practice. Clinical nurse specialist education offers the graduate student both didactic and clinical experiences to help the student transition into the CNS role. Clinical nurse specialist faculty have a responsibility to prepare students for the realities of advanced practice. Systems leadership is an integral competency of CNS practice. The contemporary CNS is to be a leader in the translation of evidence into practice. To assist students to acquire this competency, all CNS students are expected to use research and other sources of evidence to identify, design, implement, and evaluate a specific practice change. Anecdotal comments from students completing the projects are offered. Student projects have been focused in acute and critical care, palliative care, and adult/gerontologic health clinical settings; community outreach has been the focus of a few change projects. Examples of student projects related to the systems leadership competency and correlated to the spheres of influence impacted are presented.
Long, Jennifer; Long, Airdrie
Ergonomics is a holistic discipline encompassing a wide range of special interest groups. The role of an ergonomics consultant is to provide integrated solutions to improve comfort, safety and productivity. In Australia, there are two types of consultants--generalists and specialists. Both have training in ergonomics but specialist knowledge may be the result of previous education or work experience. This paper presents three projects illustrating generalist and specialist (visual ergonomics) consultancy: development of a vision screening protocol, solving visual discomfort in an office environment and solving postural discomfort in heavy industry. These case studies demonstrate how multiple ergonomics consultants may work together to solve ergonomics problems. It also describes some of the challenges for consultants, for those engaging their services and for the ergonomics profession, e.g. recognizing the boundaries of expertise, sharing information with business competitors, the costs-benefits of engaging multiple consultants and the risk of fragmentation of ergonomics knowledge and solutions. Since ergonomics problems are often multifaceted, ergonomics consultants should have a solid grounding in all domains of ergonomics, even if they ultimately only practice in one specialty or domain. This will benefit the profession and ensure that ergonomics remains a holistic discipline.
Cohn, Kenneth H; Allyn, Thomas R; Rosenfield, Robert H; Schwartz, Richard
An ongoing environment of reimbursement lagging behind escalating expenses has led physicians to explore new sources of revenue. The goal of physician-hospital ventures is to create a valuable entity that benefits patients, physicians, and the hospital. Physicians may choose to invest in healthcare facilities to improve patient care and obtain increased control over daily operations. If so, they should seek counsel to avoid violating Stark laws and anti-kickback laws. Modalities for investing in physician-hospital ventures are joint equity (stock) ventures, participating bond transactions (PBTs), and contractual integration, a new method to align the goals of specialists and hospital management without using joint equity ventures. Physicians and management should invest time in developing a shared vision of the future before beginning contract negotiations. Successful partnering requires transparency and stepwise building of trust. The greatest gain in joint ventures arises when both sides become active owners, rather than passive investors.
Background: Surgical outreach to rural areas is aimed at improving access to surgical treatment to a deprived community. The study reports the experience of a team consisting of specialist surgical and anaesthetic manpower during a five day surgical outreach at Ogoja General Hospital, Nigeria in 2010. This was on the ...
Brown, Pauline; Craig, Andrew
Homerton University Hospital trust, a first-wave foundation, commissioned a specialist consultancy to devise an induction programme for the governors. It was vital to tailor activities to individual needs while retaining overall consistency. A concluding exercise demonstrated that the majority agreed they had overcome initial hesitancy.
Full Text Available This paper describes the system of future specialists-cartographers education in Lviv polytechnic national university. Main targets of the department of cartography and geospatial modelling are listed. Key research areas of the department, the educational specifics of students at «Bachelor» and «Master‘s» levels are described. At present, the main task of the department is to train specialists with good knowledge of cartographic investigation method, GIS technologies, because digital cartography, web-mapping, web-portal are things of the future. Cartography specialists must know how to create traditional maps (topographic, thematic, tourist using computer technologies and electronic maps that can be used in the creation of GIS systems, informational resources in navigation, military affairs and so on. The main scientific direction of the department is general geographic and thematic mapping, GIS mapping and development of GIS, history of the cartography, mathematic modelling in geodesy, astronomy and geophysics. The department trains bachelors on specialty 103 «Earth sciences», specialization 103.02 «Cartography». The feature of master’s education is maximum approach to education content for future employment. Master degree students are improving their professional knowledge and skills received during their study for the bachelor’s degree. They are deeply studying modern methods of cartographic digital terrain models with GIS technologies, combining their work with development of cartographic databases. They get acquainted with the principles of base sets of geospatial data, conduct thematic evaluation and forecast maps, using GIS. The students also study methods and order of design, edition, and maps development in detail. Modern mapping needs to be more efficient in the use of both natural and human resources, reflect a complex system man - society - environment. Such problem can be solved using various modeling techniques with
... Business Networks Services, Inc., Specialist-Tech Customer Service, Philadelphia, PA; Verizon Business Networks Services, Inc., Specialist-Tech Customer Service, Tampa, Florida; Amended Certification Regarding... should [[Page 14360
McKenzie, Barbara K.; And Others
As pressure increases to integrate technology into instruction, many teachers and library media specialists are having difficulty coping with "technostress." Presents suggestions and activities for teachers and library media specialists designed to reduce "technostress." (PEN)
Dossey, John A.
A plea is made for the mathematics education community to support the need for elementary school mathematics specialists. Roles of such specialists in primary as well as intermediate grades are listed. (MNS)
Georgalas, Christos; Hadjihannas, Edward; Ghufoor, Khalid; Pracy, Paul; Papesch, Michael
OBJECTIVE: To assess the current status of operative training for otolaryngology specialist registrars in the United Kingdom. DESIGN: Web-based questionnaire survey. PARTICIPANTS: All otolaryngology specialist registrars in the United Kingdom. MAIN OUTCOME MEASURES: The overall satisfaction with
O'Malley, Ann S; Draper, Debra A; Felland, Laurie E
The nation's community hospitals face increasing problems obtaining emergency on-call coverage from specialist physicians, according to findings from the Center for Studying Health System Change's (HSC) 2007 site visits to 12 nationally representative metropolitan communities. The diminished willingness of specialist physicians to provide on-call coverage is occurring as hospital emergency departments confront an ever-increasing demand for services. Factors influencing physician reluctance to provide on-call coverage include decreased dependence on hospital admitting privileges as more services shift to non-hospital settings; payment for emergency care, especially for uninsured patients; and medical liability concerns. Hospital strategies to secure on-call coverage include enforcing hospital medical staff bylaws that require physicians to take call, contracting with physicians to provide coverage, paying physicians stipends, and employing physicians. Nonetheless, many hospitals continue to struggle with inadequate on-call coverage, which threatens patients' timely access to high-quality emergency care and may raise health care costs.
Nørgaard, Kirsten; Pedersen, Juri; Ravn, Lisbeth; Albrecht-Beste, Elisabeth; Holck, Kim; Fredløv, Maj; Møller, Lars Krag
Assessment of physicians' performance focuses on the quality of their work. The aim of this study was to develop a valid, usable and acceptable multisource feedback assessment tool (MFAT) for hospital consultants. Statements were produced on consultant competencies within non-medical areas like collaboration, professionalism, communication, health promotion, academics and administration. The statements were validated by physicians and later by non-physician professionals after adjustments had been made. In a pilot test, a group of consultants was assessed using the final collection of statements of the MFAT. They received a report with their personal results and subsequently evaluated the assessment method. In total, 66 statements were developed and after validation they were reduced and reformulated to 35. Mean scores for relevance and "easy to understand" of the statements were in the range between "very high degree" and "high degree". In the pilot test, 18 consultants were assessed by themselves, by 141 other physicians and by 125 other professionals in the hospital. About two thirds greatly benefited of the assessment report and half identified areas for personal development. About a third did not want the head of their department to know the assessment results directly; however, two thirds found a potential value in discussing the results with the head. We developed an MFAT for consultants with relevant and understandable statements. A pilot test confirmed that most of the consultants gained from the assessment, but some did not like to share their results with their heads. For these specialists other methods should be used.
Yorke, Janelle; Prigmore, Sam; Hodson, Matt; Stonham, Carol; Long, Hannah; Bellhouse, Sarah; Fletcher, Monica; Edwards, Sheila
The National Health Service currently faces significant challenges and must optimise effective workforce planning and management. There are increasing concerns regarding poor workforce planning for respiratory medicine; a greater understanding of the role of respiratory nurse specialists will inform better workforce planning and management. This was a survey study. Two surveys were administered: an organisational-level survey and an individual respiratory nurse survey. There were 148 and 457 respondents to the organisational and individual nurse survey, respectively. Four main themes are presented: (1) breadth of service provided; (2) patient care; (3) work environment; and (4) succession planning. The majority of work conducted by respiratory nurse specialists relates to patient care outside the secondary care setting including supporting self-management in the home, supporting patients on home oxygen, providing hospital-at-home services and facilitating early discharge from acute care environments. Yet, most respiratory nursing teams are employed by secondary care trusts and located within acute environments. There was evidence of multidisciplinary working, although integrated care was not prominent in the free-text responses. High workload was reported with one-quarter of nursing teams short-staffed. Respiratory nurses reported working unpaid extra hours and a lack of administrative support that often took them away from providing direct patient care. Nearly half of the present sample either plan to retire or are eligible for retirement within 10 years. This survey report provides a current snapshot of the respiratory nurse specialist workforce in the UK. This workforce is an ageing population; the results from this survey can be used to inform succession planning and to ensure a viable respiratory nurse specialist workforce in future.
Shah, Peter; Cross, Vinette; Sii, Freda
The potential for "discontinuities in care" arising from the turbulent transition from specialist trainee to consultant specialist presents risks to patient safety. But it is easy to lose sight of the affective needs of individuals facing the burden of keeping patients safe. This article describes a 2-day program focused on new and prospective consultant specialist ophthalmic surgeons entitled "Sailing a Safe Ship" (SASS). The purpose was to facilitate understanding and analysis of their personal holistic learning needs and enhance individual agency in optimizing learning during the transition period. The program used gaming, team challenges, meta-planning, role play and professional actors, interactive presentations, and self-analysis tools to portray the real world of consultant specialist practice in terms of ill-defined problems requiring "elite communication" and effective negotiation of value differences and priorities for their resolution. Participants' insights into their individual learning were recorded in scheduled reflective sessions. The immediate impact on their learning was also considered in terms of direct (instructional) and indirect (nurturant) effects. Participants' insights reflected 4 key themes: admitting vulnerability and uncertainty, taking responsibility for managing risk, being self-aware and reflexive, and internalizing authentic leadership. Four instructional and 4 nurturant effects were revealed. Preliminary findings on long-term impact on participants' practice are outlined. Evidence from the evaluation indicated that participants felt empowered to construct a personal strategic response to unfamiliar and unanticipated workplace demands and pressures, adopt a capability mindset that would accelerate their capacity to fulfill an enhanced leadership role, and take a holistic approach to their continuing self-directed development as leaders and educators. Copyright © 2013 The Alliance for Continuing Education in the Health Professions
Ashton, Toni; Brown, Paul M.; Sopina, Elizaveta (Liza)
and professional development, key sources of dissatisfaction are workload pressures, mentally demanding work and managerial interference. In the private sector specialists value the opportunity to work independently and apply their own ideas in the workplace. Conclusion Sources of job satisfaction...... and dissatisfaction amongst specialists are different for the public and private sectors. Allowing specialists more freedom to work independently and to apply their own ideas in the workplace may enhance recruitment and retention of specialists in the public health system....
Packer, Rowena M A; Berendt, Mette; Bhatti, Sofie
neurology specialists and non-specialists) on the description and classification of videos depicting paroxysmal events, without knowing any results of diagnostic workup. An online questionnaire study was conducted, where participants watched 100 videos of dogs and cats exhibiting paroxysmal events...... low levels of agreement described here highlight the need for further discussions between neurology experts regarding classifying and describing epileptic seizures, and additional training of non-specialists to facilitate accurate diagnosis. There is a need for diagnostic tools (e...
This study aimed to analyse reports prepared by American education specialists visiting Turkey from the Proclamation of the Republic till the end of the 1950's to inspect Turkey's education system. In accordance with this purpose, first, the foreign specialists' reports are briefly introduced chronologically and then American specialist reports…
Moons, P.; Scholte op Reimer, W.; De Geest, S.; Fridlund, B.; Heikkila, J.; Jaarsma, Trijntje (Tiny); Martensson, J.; Smith, K; Stewart, S.; Stromberg, A; Thompson, D.R.
Aim: Recommendations for the management of adults with congenital heart disease indicate that specialist referral centres should employ nurse specialists who are trained and educated in the care for these patients. We surveyed the involvement, education and activities of nurse specialists in the
Full Text Available Pharmaceutical expenditure growth has outpaced GDP and healthcare expenditure growth rates in Denmark as in most OECD countries for the last decade. A major part of this increase was due to high growth rates in specialist areas that are typically located in hospital settings. Yet the market for hospital medicines and their procurement are still poorly understood. The present paper characterises the market for hospital medicines in Denmark in terms of its organisation and developments between 2005 and 2009. In Denmark hospital medicines are publicly financed and procurement is centrally organised. 98% of all medicines administered at Danish public hospitals are purchased through a public procurement agency by means of public tenders. Using data on actual contract prices we decompose pharmaceutical expenditure growth into the contributions from newly introduced medicines, price and volume increases and use summary statistics to compare market performance in both sectors. The market for hospital medicine is more concentrated than the pharmaceutical retail sector and the share of generics and parallel imported products is significantly lower. Between 2005 and 2009 expenditures for hospital medicines more than doubled -accounting for almost 40% of the total Danish pharmaceutical market in 2009. Price increases however - although positive and higher than in the pharmaceutical retail sector - were only moderate. The majority of the expenditure growth was due to an increase in utilisation and the introduction of new medicines in the hospital sector. Centralised tendering may therefore have important implications for competition and industry structure in the long run.
Huttner, A; Cacace, M; d'Andrea, L; Skevaki, C; Otelea, D; Pugliese, F; Tacconelli, E
To explore the social, cultural, psychological and organizational factors associated with inequality in the workplace among clinical microbiologists (CM) and infectious disease (ID) specialists in European hospitals. We analysed data from 52 interviews and five focus groups involving 82 CM/ID specialists selected from university, research or community hospitals in five countries, one each in Northern, Western, Eastern, Southeastern and Southwestern Europe. The 80 hours of recordings were transcribed, and the anonymous database coding process was cross-checked iteratively by six researchers. Inequality affects all the institutions in all the countries we looked at, denying or reducing access to professional assets with intensity and form that vary largely according to the cultural and organizational context. Discrimination is generally not explicit and uses disrespectful microbehaviours that are hard to respond to when they occur. Inequality affected also loans, distribution of research funds and gender and country representation in boards and conference faculty. Parenthood has a major impact on women's careers, as women are still mainly responsible for family care. Responses to discrimination range from reactive to surrender strategies. Our study offers an effective model for diagnosing discriminatory behaviours in a medical professional setting. Knowledge of inequality's drivers could help national ID/CM societies in collaboration with major European stakeholders to further reduce such discrimination. The effect of discrimination on the quality of healthcare in Europe needs further exploration. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.
Hamdan, M F; Day, A; Millar, J; Carter, F J C; Coleman, M G; Francis, N K
The aim of this study was to explore the feasibility and safety of an outreach model of laparoscopic colorectal training of accredited specialists in advanced laparoscopic techniques and to explore the challenges of this model from the perspective of a National Training Programme (NTP) trainer. Prospective data were collected for unselected laparoscopic colorectal training procedures performed by five laparoscopic colorectal NTP trainees supervised by a single NTP trainer with an outreach model between 2009 and 2012. The operative and postoperative outcomes were compared with standard laparoscopic colorectal training procedures performed by six senior colorectal trainees under the supervision of the same NTP trainer within the same study period. The primary outcome was 30-day mortality. The Mann-Whitney test was used to compare continuous variables and the Chi squared or Fisher's exact tests were applied for the analysis of categorical variables. The level of statistical significance was set at P groups. Seventy-eight per cent of the patients operated on by the NTP trainees had had no previous abdominal surgery, compared with 50% in the supervised trainees' group (P = 0.0005). There were no significant differences in 30-day mortality or the operative and postoperative outcome between both groups. There were, however, difficulties in training an already established consultant in his or her own hospital and these were overcome by certain adjustments to the programme. Outreach laparoscopic training of colorectal surgeons is a feasible and safe model of training accredited specialists and does not compromise patient care. The challenges encountered can be overcome with optimum training and preparation. Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.
Bartlett Ellis, Rebecca J; Embree, Jennifer L; Ellis, Kurt G
The purpose of this article is to describe a business case framework that can guide clinical nurse specialists (CNS) in clinical intervention development. Increased emphasis on cost-effective interventions in healthcare requires skills in analyzing the need to make the business case, especially for resource-intensive interventions. This framework assists the CNS to anticipate resource use and then consider if the intervention makes good business sense. We describe a business case framework that can assist the CNS to fully explore the problem and determine if developing an intervention is a good investment. We describe several analyses that facilitate making the business case to include the following: problem identification and alignment with strategic priorities, needs assessment, stakeholder analysis, market analysis, intervention implementation planning, financial analysis, and outcome evaluation. The findings from these analyses can be used to develop a formal proposal to present to hospital leaders in a position to make decisions. By aligning intervention planning with organizational priorities and engaging patients in the process, interventions will be more likely to be implemented in practice and produce robust outcomes. The business case framework can be used to justify to organization decision makers the need to invest resources in new interventions that will make a difference for quality outcomes as well as the financial bottom line. This framework can be used to plan interventions that align with organizational strategic priorities, plan for associated costs and benefits, and outcome evaluation. Clinical nurse specialists are well positioned to lead clinical intervention projects that will improve the quality of patient care and be cost-effective. To do so requires skill development in making the business case.
Layton, Deborah; Shakir, Saad A W
The evolving regulatory landscape has heightened the need for innovative, proactive, efficient and more meaningful solutions for 'real-world' post-authorization safety studies (PASS) that not only align with risk management objectives to gather additional safety monitoring information or assess a pattern of drug utilization, but also satisfy key regulatory requirements for marketing authorization holder risk management planning and execution needs. There is a need for data capture across the primary care and secondary care interface, or for exploring use of new medicines in secondary care to support conducting PASS. To fulfil this need, event monitoring has evolved. The Specialist Cohort Event Monitoring (SCEM) study is a new application that enables a cohort of patients prescribed a medicine in the hospital and secondary care settings to be monitored. The method also permits the inclusion of a comparator cohort of patients receiving standard care, or another counterfactual comparator group, to be monitored concurrently, depending on the study question. The approach has been developed in parallel with the new legislative requirement for pharmaceutical companies to undertake a risk management plan as part of post-authorization safety monitoring. SCEM studies recognize that the study population comprises those patients who may have treatment initiated under the care of specialist health care professionals and who are more complex in terms of underlying disease, co-morbidities and concomitant medications than the general disease population treated in primary care. The aims of this paper are to discuss the SCEM new-user study design, rationale and features that aim to address possible bias (such as selection bias) and current applications.
Iliffe, Steve; Davies, Susan L; Gordon, Adam L; Schneider, Justine; Dening, Tom; Bowman, Clive; Gage, Heather; Martin, Finbarr C; Gladman, John R F; Victor, Christina; Meyer, Julienne; Goodman, Claire
The number of beds in care homes (with and without nurses) in the United Kingdom is three times greater than the number of beds in National Health Service (NHS) hospitals. Care homes are predominantly owned by a range of commercial, not-for-profit or charitable providers and their residents have high levels of disability, frailty and co-morbidity. NHS support for care home residents is very variable, and it is unclear what models of clinical support work and are cost-effective. To critically evaluate how the NHS works with care homes. A review of surveys of NHS services provided to care homes that had been completed since 2008. It included published national surveys, local surveys commissioned by Primary Care organisations, studies from charities and academic centres, grey literature identified across the nine government regions, and information from care home, primary care and other research networks. Data extraction captured forms of NHS service provision for care homes in England in terms of frequency, location, focus and purpose. Five surveys focused primarily on general practitioner services, and 10 on specialist services to care home. Working relationships between the NHS and care homes lack structure and purpose and have generally evolved locally. There are wide variations in provision of both generalist and specialist healthcare services to care homes. Larger care home chains may take a systematic approach to both organising access to NHS generalist and specialist services, and to supplementing gaps with in-house provision. Access to dental care for care home residents appears to be particularly deficient. Historical differences in innovation and provision of NHS services, the complexities of collaborating across different sectors (private and public, health and social care, general and mental health), and variable levels of organisation of care homes, all lead to persistent and embedded inequity in the distribution of NHS resources to this population
Filler, Guido; Kovesi, Tom; Bourdon, Erik; Jones, Sarah Ann; Givelichian, Laurentiu; Rockman-Greenberg, Cheryl; Gilliland, Jason; Williams, Marion; Orrbine, Elaine; Piedboeuf, Bruno
Pediatrician and pediatric subspecialist density varies substantially among the various Canadian provinces, as well as among various states in the US. It is unknown whether this variability impacts health outcomes. To study this knowledge gap, we evaluated pediatric asthma admission rates within the 2 Canadian provinces of Manitoba and Saskatchewan, which have similarly sized pediatric populations and substantially different physician densities. This was a retrospective cross-sectional cohort study. Health regions defined by the provincial governments, have, in turn, been classified into "peer groups" by Statistics Canada, on the basis of common socio-economic characteristics and socio-demographic determinants of health. To study the relationship between the distribution of the pediatric workforce and health outcomes in Canadian children, asthma admission rates within comparable peer group regions in both provinces were examined by combining multiple national and provincial health databases. We generated physician density maps for general practitioners, and general pediatricians practicing in Manitoba and Saskatchewan in 2011. At the provincial level, Manitoba had 48.6 pediatricians/100,000 child population, compared to 23.5/100,000 in Saskatchewan. There were 3.1 pediatric asthma specialists/100,000 child population in Manitoba and 1.4/100,000 in Saskatchewan. Among peer-group A, the differences were even more striking. A significantly higher number of patients were admitted in Saskatchewan (590.3/100,000 children) compared to Manitoba (309.3/100,000, p < 0.0001). Saskatchewan, which has a lower pediatrician and pediatric asthma specialist supply, had a higher asthma admission rate than Manitoba. Our data suggest that there is an inverse relationship between asthma admissions and pediatrician and asthma specialist supply.
Phipps, Alison; Barnett, Ronald
Academic hospitality is a feature of academic life. It takes many forms. It takes material form in the hosting of academics giving papers. It takes epistemological form in the welcome of new ideas. It takes linguistic form in the translation of academic work into other languages, and it takes touristic form through the welcome and generosity with…
BACKGROUND AND OBJECTIVES: Teaching is an important responsibility of non-consultant hospital doctors. In Ireland, specialist registrars (SpRs) in anaesthesia are contractually obliged to teach medical students, other doctors and nurses. Both medical students and fellow non-consultant hospital doctors attribute between 30 and 40% of their knowledge gain to non-consultant hospital doctors. METHODS: We carried out a confidential telephone survey of anaesthetic SpRs in Ireland regarding their current teaching practices and the perceptions of their role as undergraduate teachers. All the SpRs currently working in clinical practice in Ireland were eligible. RESULTS: Fifty-five of the 79 (70%) SpRs responded to the questionnaire. Only 7 (12.7%) of the respondents said they had been well trained as a teacher. The majority of the respondents stated that they would attend a learning-to-teach course\\/workshop if one was available, and felt that such a course would improve their ability as a teacher. Only 8 (14.5%) agreed that adequate emphasis is placed on commitment to teaching in the assessment of SpRs, both by individual departments and by the College of Anaesthetists. Anaesthetic SpRs in Ireland spend a considerable amount of time each day teaching undergraduate medical students, the majority (68.9%) stated that they had inadequate time to prepare for teaching. CONCLUSION: The majority of the respondents stated that they enjoy teaching, feel that they play an important role in undergraduate teaching but have inadequate time to prepare for teaching. An adequate emphasis is not placed on their commitment to teaching.
Full Text Available Abstract Background The internet is a relatively new medium of disseminating health information. Studies on Internet usage for health information are mainly done in developed countries and very few studies have been carried out in developing countries. Methods The Internet usage of patients who were attending specialist clinics in Teaching Hospital Karapitiya and Southern Hospital in Galle, Sri Lanka was investigated. The study was carried out on the following specialities; General Medicine, Pediatrics, General Surgery and Cardiothoracic surgery. Information was collected using an investigator-administered questionnaire while patients were waiting for a consultation. Results Three hundred and fifty five patients (or guardians in the Pediatric clinic participated in the study. One hundred seventy two (48.3% participants have heard about the Internet. There was a relationship between awareness of the Internet and age, educational level and the clinic attended. There was no difference of awareness depending on the gender or the hospital. Only three participants (0.97% have used the Internet to find information about their disease conditions. Close relatives searched the Internet about the conditions of two participants. Altogether, the Internet was used to search information on the disease condition of five participants (1.4%. Conclusion Very low usage of the Internet for health information retrieval in this study is probably due to low awareness of the Internet and low educational level. This low usage of Internet and the associated reasons shown in this study can be generalized to Sri Lanka and probably to other low-income countries that have lower educational level than Sri Lanka.
Bibby, Anna C; Williams, Katie; Smith, Sarah; Bhatt, Nidhi; Maskell, Nick A
Multidisciplinary team meetings are standard care for cancer in the UK and Europe. Professional bodies recommend that mesothelioma cases should be discussed at specialist multidisciplinary team meetings. However, no evidence exists exploring the role of the specialist mesothelioma multidisciplinary team meeting. To evaluate the clinical activity of 1 specialist mesothelioma multidisciplinary team meeting and to determine how often a definitive diagnosis was made, whether the core requirements of the meeting were met and whether there was any associated benefit or detriment. A service evaluation using routinely collected data from 1 specialist mesothelioma multidisciplinary team meeting in a tertiary referral hospital in the South-West of England. All cases discussed between 1/1/2014 and 31/12/2015. The primary outcome measure was whether a definitive diagnosis was made. Secondary outcomes included whether treatment advice was offered, information on clinical trials provided or further investigations suggested. Additional benefits of the multidisciplinary team meeting and time taken from referral to outcome were also collected. A definitive diagnosis was reached in 171 of 210 cases discussed (81%). Mesothelioma was diagnosed in 153/210 (73%). Treatment advice was provided for 127 of 171 diagnostic cases (74%) and further investigations suggested for all 35 non-diagnostic cases. 86/210 cases (41%) were invited to participate in a trial, of whom 43/86 (50%) subsequently enrolled. Additional benefits included the avoidance of postmortem examination if the coroner was satisfied with the multidisciplinary team decision. The overall process from referral to outcome dispatch was specialist mesothelioma multidisciplinary team meeting was effective at making diagnoses and providing recommendations for further investigations or treatment. The core requirements of a specialist mesothelioma multidisciplinary team meeting were met. The process was timely, with most outcomes
In the Operations and Checkout Building, STS-95 Mission Specialist Pedro Duque of Spain, with the European Space Agency, gets help with his suit from suit technician Tommy McDonald. The STS-95 crew were conducting flight crew equipment fit checks prior to launch on Oct. 29. STS-95 is expected to launch at 2 p.m. EST on Oct. 29, last 8 days, 21 hours and 49 minutes, and land at 11:49 a.m. EST on Nov. 7.
In the environmental chamber known as the white room, STS-95 Mission Specialist Pedro Duque of Spain, with the European Space Agency, is prepared by white room crew members Danny Wyatt (left) and Travis Thompson (right) for entry into the Space Shuttle Discovery for his first flight into space. The STS-95 mission, targeted for launch at 2 p.m. EST on Oct. 29, is expected to last 8 days, 21 hours and 49 minutes, and return to KSC at 11:49 a.m. EST on Nov. 7.
Full Text Available Digital forensic practitioners are faced with an extraordinary opportunity. In fact, we may never again be faced with such an opportunity, and this opportunity will challenge us in ways we may never again be challenged.At this point in the history of the Digital Forensics profession, digital forensic specialists have the unique opportunity to help this profession emerge from its infancy. But for this profession to mature -- and to flourish -- individuals and organizations integral to the practice must assemble and shape its future. This is our opportunity. In fact, this is our mandate.(see PDF for full column
The purpose of the specialists' meeting was to summarize the IWGFR member countries' knowledge of sodium combustion and extinguishment technology, including prevention and detection of sodium fires and protective clothes and to review and discuss critical features of sodium fires contaminated with fission products and fuel, evolution and filtration of aerosols and to determine the critical gaps in our knowledge and what should be done to develop knowledge in this area. The technical parts of the meeting were divided into three major sections, as follows: sodium fires; prevention and extinguishing of sodium fires, and aerosols
Tanaka, Kyoko; Yoshikawa, Naomi; Kudo, Noriko; Negishi, Yoshie; Shimizu, Toshiaki; Hayata, Noriko
The importance of distraction techniques and play therapy for sick children has long been recognised by nurses in the UK and other western countries. Although these techniques are not so well established in Japan there is growing interest in them. The authors conducted a survey and found that children's nurses in Japan appreciated the value of distraction techniques and play therapy. They argue that attitudes to using them on children's wards in Japan are changing, but there is still a lack of training and few play specialists.
The purpose of the specialists' meeting was to summarize the IWGFR member countries' knowledge of sodium combustion and extinguishment technology, including prevention and detection of sodium fires and protective clothes and to review and discuss critical features of sodium fires contaminated with fission products and fuel, evolution and filtration of aerosols and to determine the critical gaps in our knowledge and what should be done to develop knowledge in this area. The technical parts of the meeting were divided into three major sections, as follows: sodium fires; prevention and extinguishing of sodium fires, and aerosols.
Isotope diagnostic specialists are required to possess general paraclinical knowledge about nuclear physical principles, basic radiological measuring methods including up-to-date ones such as scintiscanning and tomography, as well as about radiopharmacology, radiation biology, health physics, radiation protection and organizational and economic aspects of the examinations. Clinical isotope diagnostic requirements comprise the proper selection among different radiological methods, the correct application of certain diagnostic procedures in practise, and the evaluation of the results in accordance with the symptoms on various fields of medical science. (V.N.)
This report gives details of a project to develop and test a specialist chip shuttle vehicle for conveying woodchips out of the forest with the aim of reducing the cost of woodfuel production. The design objectives are described and include the need to allow easy transfer of the chips from the chipper to the shuttle and on into haulage units, good performance and manoeuvrability on and off roads, and high-tip capacity. Estimates of the improved production and reduced woodfuel production costs are discussed along with the anticipated satisfactory operation of the chipper-shuttle combination in a forestry site.
The deontological rules defining the relations between the general practitioners and specialists about domestic emergencies are clearly exposed in the code edited by the National Medical Council of Belgium. Ethical particularities exist. During an emergency situation, the patient could lose his freedom as well as his autonomy and might become a technical subject rather than an ethical person. The ethical values are in opposition with a medical practice trying to be more and more efficient with as a corollary, the necessity to have a full and permanent access to personal medical data.
Unit Acca =o N I1. Title (Include Security Classification) The Training and Employment of Area Specialists in the Military 12 Personal Author(s) Randy P...informally allows FAOs at DLI/FLC to audit courses if they so desire yet there is no obvious effort underway to reverse the Army’s earlier deci- sion...NPS profes- sors. Others cannot even find the time to audit any classes and often turn to magazines at DLI/FLC and/or NPS for their information. Given
Sanson, H; Priollet, P
In France, the Leonetti law, adopted on April 22, 2005, stipulates the regulations concerning advanced directives. This is a patient's right that is not well known and rarely applied. In 2015, a new law project was thus presented in which the French National Authority for Health recommended that doctors, including all specialists, bring up the subject, especially during consultation. To evaluate the vascular specialist's possibility to mention the topic of advanced directives during consultations. A single and non-interventional prospective study conducted with the help of patients who consulted a private practitioner vascular specialist: recurrent patients regularly consulting a private practitioner vascular specialist were included. First-time consultants, minors and patients to whom it was not adapted to speak about the subject were not included. Between July 27 and September 23, 2015, 159 consecutive patients were examined. Fifty-five first-time consultants and four patients for whom the interview was unsuitable were excluded. In all, 100 patients were questioned. None of them refused to talk about the subject. Women made up a majority of the population (63 %) with an average age of 67 years (23-97). The principal diagnostics were common to vascular medicine consultations: deep vein thrombosis (20 %), peripheral arterial disease (15 %), varicose veins (11 %), lymphedema (11 %) and leg ulcers (9 %). Thirteen percent of the people had a history of cancer. Half of the patients had had follow-ups for over 10 years. The average time devoted to discussing the topic was 12minutes (5-40). Only 22 % of the patients declared having been familiar with advance directives. Once informed however, 78 % chose to write up an adapted form: 36 % with the help of their doctor and 42 % with a doctor and a relative. Seventy-three percent of the consultants thought that talking about the advance directives would reinforce the confidence link between the doctor and the
Full Text Available Individually-psychological characteristics were studied and profiles of the styles of self-regulation of the employees engaged in hazardous were determined. The mainly group consisted of 30 men aged 21 to 60 years, who are specialists of dangerous professions. The comparison group included 30 men from 22 to 60 years, whose professional activity was not associated with risk. The following methods were used: questionnaire "Style of self-regulation of behavior" by V. I. Morosanova; questionnaire of self-control (H. Grasmik, 1993, adaptation Bulygina V. G., Abdrazakova A. M., 2009; the questionnaire BIS/BAS, used to study the sensitivity to punishment and reward; the questionnaire formal-dynamic properties of individuality by V. M. Rusalov; the aggression questionnaire by A. Buss and M. Perry (adaptation Enikolopov S. N., Cybulski N. P., 2007; the scale of anxiety Charles D. Spielberger (State-Trait Anxiety Inventory – STAI; personal questionnaire of the G. and S. Eysenck – EPQ. It was found that specialists hazardous professions are distinguished by: a higher level of development of the regulatory flexibility and individual system of conscious self-regulation activity; higher levels of extroversion, communication activity, the total adaptability; a lower level of reactive anxiety, trait anxiety and general emotional. Moreover, impulsiveness, egocentrism, lack of restraint and physical activity in the structure of self-monitoring specialists of dangerous professions associated with high levels of affective component of aggression and incoherence of parts of the process of self-regulation. There were allocated a 3 profile of self-regulation in specialists of dangerous professions: a a high level of self-regulation – coupled with a high intellectual and physical development, the highest level of adaptability and general activity; b medium – rapid response to emerging changes in the situation, the successful production alternatives, greater
Ma, Junling; Levin, Simon A
Why and how specialist and generalist strategies evolve are important questions in evolutionary ecology. In this paper, with the method of adaptive dynamics and evolutionary branching, we identify conditions that select for specialist and generalist strategies. Generally, generalist strategies evolve if there is a switching benefit; specialists evolve if there is a switching cost. If the switching cost is large, specialists always evolve. If the switching cost is small, even though the consumer will first evolve toward a generalist strategy, it will eventually branch into two specialists.
Jensen, Tina Blegind; Aanestad, Margunn
The purpose of this paper is to discuss the adoption of healthcare information systems (HIS) from a user perspective. Our case study concerns how a group of orthopaedic surgeons experienced and reacted to the adoption and mandatory use of an Electronic Patient Record system in a Danish hospital. We...... propose to use the concepts of hospitality and hostility to turn our attention to the interaction between the host (the surgeons) and the guest (the information system) and consider how the boundaries between them evolved in the everyday work practices. As an alternative to previous studies on technology...
Bracun Sova, Rajka
Since Bourdieu, it has been argued that art appreciation requires "knowledge". The focus of this qualitative study was to examine art appreciation as a learned competence by exploring two different groups of museum visitors: art specialists and art non-specialists. The research was conducted at Moderna galerija in Ljubljana. Twenty-three…
Ahmed Hersi, Afra; Horan, Deborah A.; Lewis, Mark A.
This article explores the development of a professional learning community through a case study of three teachers--an ESOL specialist, a literacy specialist, and a fifth-grade teacher--who engaged in co-teaching and collaboration. The emerging community of practice offered these teachers a space to learn and problem-solve by utilizing their…
The meeting provided the forum for graphite specialists representing operating and research organizations worldwide to exchange information in the following areas: the status of graphite development; operation and safety procedures for existing and future graphite moderated reactors; graphite testing techniques; review of the experiences gained and data acquired on the influence of neutron irradiation and oxidizing conditions on key graphite properties; and to exchange information useful for decommissioning activities. The participants provided twenty-seven papers on behalf of their countries and respective technical organizations. An open discussion followed each of the presentations. A consistently reoccurring theme throughout the specialists meeting was the noticeable reduction in the number of graphite experts remaining the nuclear power industry. Graphite moderated power reactors have provided a significant contribution to the generation of electricity throughout the past forty years and will continue to be a prominent energy source for the future. Yet, many of the renowned experts in the field of nuclear graphites are nearing the end of their careers without apparent replacement. This, coupled with changes in the focus on nuclear power by some industrialized countries, has prompted the IAEA to initiate an evaluation on the feasibility and interest by Member States of establishing a central archive facility for the storage of data on irradiated graphites. Refs, figs, tabs
Full Text Available We justified the introduction of the professional standard of specialist of guardianship and custodianship agency taking into consideration the psychological characteristics of the target group of customers. We describe the situation in our country with qualification of professionals, the international trends in the field of protection of the rights of minors in the countries – members of the Organization for Economic Cooperation and Development. We analyze the reflection of the theme of labor functions in the Russian legislation. We reveal the need for psychological and pedagogical knowledge for successful professional of guardianship authorities, compile a list of the necessary skills and knowledge. The main focus of the work of specialists is to maintain the child in the biological family at all stages of working with child and family problems. We characterize the trends in professional activities related to the development of the regional legislation in comparison with federal, increased number of international instruments to which Russia joined in the protection of children's rights. It is stressed that a requirement for education is additional retraining for new programs on the basis of higher education in the following professions and fields of study: law, pedagogy and psychology, social pedagogy and social work.
The meeting provided the forum for graphite specialists representing operating and research organizations worldwide to exchange information in the following areas: the status of graphite development; operation and safety procedures for existing and future graphite moderated reactors; graphite testing techniques; review of the experiences gained and data acquired on the influence of neutron irradiation and oxidizing conditions on key graphite properties; and to exchange information useful for decommissioning activities. The participants provided twenty-seven papers on behalf of their countries and respective technical organizations. An open discussion followed each of the presentations. A consistently reoccurring theme throughout the specialists meeting was the noticeable reduction in the number of graphite experts remaining the nuclear power industry. Graphite moderated power reactors have provided a significant contribution to the generation of electricity throughout the past forty years and will continue to be a prominent energy source for the future. Yet, many of the renowned experts in the field of nuclear graphites are nearing the end of their careers without apparent replacement. This, coupled with changes in the focus on nuclear power by some industrialized countries, has prompted the IAEA to initiate an evaluation on the feasibility and interest by Member States of establishing a central archive facility for the storage of data on irradiated graphites. Refs, figs, tabs.
Doody, Owen; Slevin, Eamonn; Taggart, Laurence
The aim of this study was to identify the contribution of Irish intellectual disability clinical nurse specialists (ID CNSs) to service delivery. A nonexperimental descriptive design was selected to survey ID CNSs presently working in Ireland. The questionnaire was developed based on focus group interviews, available literature, and expert panel views. Ethical approval and access were granted to all ID CNSs in Ireland. Thirty-two responded (33.68% response rate) from all work areas (voluntary organizations or health service executive) practicing within residential, community, or school services. Respondents were surveyed across a range of areas (demographic details and support to client, staff, family, organization, community, other agencies, and professional development). Findings identify that ID CNSs are active in all aspects of their roles as clinical specialist, educator, communicator, researcher, change agent, and leader, thus supporting person-centered care and improving service delivery. To meet changing healthcare demands, promote person-centered care, and improve service delivery, the CNS role in ID should be developed and supported. The findings merit a further study on ID CNS role activity, possible variables influencing role activity, and team members' views.
Wehner, Jeannine; Mittelbach, Moritz; Rillig, Matthias C.; Verbruggen, Erik
Nectar yeasts are common inhabitants of insect-pollinated flowers but factors determining their distribution are not well understood. We studied the influence of host identity, environmental factors related to pollution/urbanization, and the distance to a target beehive on local distribution of nectar yeasts within Robinia pseudoacacia L. and Tilia tomentosa Moench in Berlin, Germany. Nectar samples of six individuals per species were collected at seven sites in a 2 km radius from each target beehive and plated on YM-Agar to visualise the different morphotypes, which were then identified by sequencing a section of the 26S rDNA gene. Multivariate linear models were used to analyze the effects of all investigated factors on yeast occurrence per tree. Yeast distribution was mainly driven by host identity. The influence of the environmental factors (NO2, height of construction, soil sealing) strongly depended on the radius around the tree, similar to the distance of the sampled beehive. Incidence of specialist nectar-borne yeast species decreased with increasing pollution/urbanization index. Given that specialist yeast species gave way to generalist yeasts that have a reduced dependency on pollinators for between-flower dispersal, our results indicate that increased urbanization may restrict the movement of nectar-specialized yeasts, via limitations of pollinator foraging behavior.
R N Abramov
Full Text Available Sociology of professions focus on the role of interpersonal and intergroup communications in the professional communities as an element of professional culture. The article considers forms and features of professional communications of Russian engineers and technicians in the context of their professional culture defined as the constellation of ideology, values, beliefs, language, and forms of activity typical for the community, which rarely becomes an object of Russian sociologists’ studies. The author shows that interpersonal professional communications on the various aspects of professional activity is an important element of professional culture. The article is based on the results of online survey of Russian engineers and expert interviews with Russian technical specialists - they were questioned on the ways of updating their professional knowledge and on the role of various channels of communication in this process. At the beginning of the article, the author provides an overview of approaches to the study of professional culture in Russia and abroad, and underlines the significant role of the Internet and the declining role of literature as a source of new knowledge for the engineering and technical staff. The results of the study also revealed an important role of informal and direct communications in the transfer of professional knowledge within the engineering community, while organizational environment has a relatively low impact on the updating of professional knowledge, which can be explained by the lack of management attention to the professional development of specialists.
Drouin, Antoine; Roos, Clément
The two first CEAS (Council of European Aerospace Societies) Specialist Conferences on Guidance, Navigation and Control (CEAS EuroGNC) were held in Munich, Germany in 2011 and in Delft, The Netherlands in 2013. ONERA The French Aerospace Lab, ISAE (Institut Supérieur de l’Aéronautique et de l’Espace) and ENAC (Ecole Nationale de l’Aviation Civile) accepted the challenge of jointly organizing the 3rd edition. The conference aims at promoting new advances in aerospace GNC theory and technologies for enhancing safety, survivability, efficiency, performance, autonomy and intelligence of aerospace systems. It represents a unique forum for communication and information exchange between specialists in the fields of GNC systems design and operation, including air traffic management. This book contains the forty best papers and gives an interesting snapshot of the latest advances over the following topics: l Control theory, analysis, and design l Novel navigation, estimation, and tracking methods l Aircr...
Lui, D H; McDonald, J J; de Beaux, A; Tulloh, B; Brady, R R W
Healthcare professional engagement is increasing. This study aims to identify levels of adoption and engagement of several social media platforms by a large international cohort of hernia surgery specialists. Hernia specialists attending the 38th International Congress of the European Hernia Society were identified. A manual search was then performed on Twitter, ResearchGate, and LinkedIn to identify those who had named accounts. Where accounts were identified, data on markers of utilisation were assessed. 759 surgeons (88.5% male) from 57 countries were identified. 334 surgeons (44%) engaged with a social media platform. 39 (5.1%) had Twitter accounts, 189 (24.9%) had ResearchGate accounts and 265 (34.9%) had LinkedIn accounts. 137 surgeons (18.1%) had accounts on 2 or more social media platforms. There was no gender association with social media account ownership (p > 0.05). Engagement in one social media platform was associated with increased engagement and utilisation on other platforms; LinkedIn users were more likely to have Twitter accounts (p social media amongst Hernia surgeons is similar to other surgical specialities. Geographical variation in SM engagement is seen. Engagement with one SM platform is associated with presence on multiple platforms.
This report is the Proceedings of the Specialists' Meeting on Delayed Neutron Nuclear Data. The meeting was held on January 28-29, 1999, at the Tokai Research Establishment of Japan Atomic Energy Research Institute with the participation of thirty specialists, who are evaluators, theorist, experimentalists. Although the fraction of the delayed neutron is no more than 1% in the total neutrons emitted in the fission process, it plays an important roll in the control of fission reactor. In the meeting, the following topics were reported: the present status of delayed neutron data in the major evaluated data libraries, measurements of effective delayed neutron fraction using FCA (Fast Critical Assembly) and TCA (Tank-type Critical Assembly) and their analyses, sensitivity analysis for fast reactor, measurements of delayed neutron emission from actinides and so on. As another topics, delayed neutron in transmutation system and fission yield data were also presented. Free discussion was held on the future activity of delayed neutron data evaluation. The discussion was helpful for the future activity of the delayed neutron working group of JNDC aiming to the evaluation of delayed neutron data for JENDL-3.3. The 15 of the presented papers are indexed individually. (J.P.N.)
Full Text Available In KwaZulu-Natal more than 50% of the population lives in the rural area but most of the health workers are based in urban centres where teaching hospitals and high incomes are common. Nursing provides the backbone of health care in the public sector. Specialist nurses such as advanced midwives or specialist HIV nurses are in short supply. Teaching via live synchronous videoconference (VC provides an opportunity to extend specialist education to nurses at rural hospitals. Aim: The aim of the study was to review and evaluate the current use of videoconference education for nurses in KwaZulu-Natal. Methodology: A review the literature on VC education in nursing using bibliometric review strategies was conducted and two nurses’ education courses conducted via videoconferencing was evaluated against a set of criteria developed and validated by the Department of TeleHealth at the University. Results: 81 publications addressing videoconference nurse education were found, most being published after 2000. Over half were descriptive studies, but were still valuable for informing this study. Based on the evaluation of the two courses against the set of criteria, the two courses were aligned sufficiently well with the measurement criteria. Additionally, the delivery of the courses via videoconferencing allowed for the identification of potential cost savings. Discussion: This evaluation indicates that these two courses have been successfully implemented using VC. In the light of the potential savings of time and money, VC can be used to teach specialist nursing courses to rural nurses. Recommendations to improve the VC courses included orientation training for presenters and encouraging more research regarding the effectiveness of VC as a teaching modality for clinical nurses in rural areas. Conclusion: More attention should be given to developing the infrastructure and skills to make this technology available and commonly used in health services in
Chapman, Sarah C E; Barnes, Neil; Barnes, Mari; Wilkinson, Andrea; Hartley, John; Piddock, Cher; Weinman, John; Horne, Rob
The Necessity-Concerns Framework (NCF) posits that non-adherence to inhaled corticosteroids (ICS) in asthma is influenced by doubts about the necessity for ICS and concerns about their potential adverse effects. This feasibility study examined whether these beliefs could be changed by briefing asthma nurse specialists on ways of addressing necessity beliefs and concerns within consultations. Pre-post intervention study. Secondary care. Patients with a diagnosis of moderate to severe asthma who were prescribed daily ICS were recruited to either a hospital care group (n=79; 71.0% female) or intervention group (n=57; 66.7% female). Asthma nurse specialists attended a 1.5-day NCF briefing. Beliefs about ICS (primary outcome) and self-reported adherence were measured preconsultation and 1 month postconsultation. Participants also rated their satisfaction with their consultations immediately after the consultation. Consultation recordings were coded to assess intervention delivery. After the NCF briefing, nurse specialists elicited and addressed beliefs about medicine more frequently. The frequency of using the NCF remained low, for example, open questions eliciting adherence were used in 0/59 hospital care versus 14/49 (28.6%) intervention consultations. Doubts about personal necessity for, and concerns about, ICS were reduced at 1 month postbriefing (pchanged nurse consultations, but not sufficiently enough to fully address non-adherence or adherence-related ICS beliefs (necessity and concerns). More effective techniques are needed to support nurse specialists and other practitioners to apply the intervention in hospital asthma review consultations. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Full Text Available This study was conducted to determine the factors that affect the level of satisfaction of services provided by public hospitals. Patients' satisfaction levels were measured by interviewing 156 patients in a public hospital. Factor analysis of the data obtained from the research resulted in five factors called nurses 'behaviors, physical conditions, doctors' behavior, technical staff behaviors, food and beverage. MANOVA analysis was conducted to determine the differences in the perception of factors with respect to the demographic characteristics of the patients and differences were found in terms of profession. It has been seen that it is important that public hospitals have specialist doctors and modern equipment and that they have qualities such as the quality of the health personnel in preferring patients to public hospitals.
Malnutrition seen in hospitals usually occurs as some form of protein-energy malnutrition (PEM). Primary PEM results from an acute or chronic deficiency of both protein and calories. Secondary PEM, or cachexia, results from a disease or medical condition such as cancer or gastrointestinal disease that alters requirements or impairs utilization of nutrients. This record was migrated from the OpenDepot repository service in June, 2017 before shutting down.
Korea has a unique health care system, of which the private sector comprises most of the country's health resources: 88% of the beds and 91% of specialists in Korea, but are funded by public financing, such as national health insurance and the national aid program. However, the public financing pays only 50% of actual costs and the patient's co-payment is still high. Healthcare organizations in Korea are categorized into four types; tertiary care hospitals, general hospitals, hospitals and clinics by scale of operator: number of beds. General hospitals must have 100 beds and over, and compulsorily specialties in internal medicine, surgery, obstetrics-gynecology, pediatrics, dental service, other ancillary service units and an emergency care unit. General hospitals with 300 beds and more must operate an intensive care unit. There are many challenges facing the Korean healthcare system, such as reformation of primary healthcare system, enhancing hospitals' competitiveness, and permission of for-profit hospital, introduction of private health insurance, enhancement of geriatric care. These challenges can be resolved with long-term vision, willingness and strategies of the Korean government to ensure equitable financing and access to healthcare, combined with the active participation and utilization of the private sector.
Miseda, Mumbo Hazel; Were, Samuel Odhiambo; Murianki, Cirindi Anne; Mutuku, Milo Peter; Mutwiwa, Stephen N
Globally, there is an acute shortage of human resources for health (HRH), and the greatest burden is borne by low-income countries especially in sub-Saharan Africa and some parts of Asia. This shortage has not only considerably constrained the achievement of health-related development goals but also impeded accelerated progress towards universal health coverage (UHC). Like any other low-income country, Kenya is experiencing health workforce shortage particularly in specialized healthcare workers to cater for the rapidly growing need for specialized health care (MOH Training Needs Assessment report (2015)). Efficient use of the existing health workforce including task shifting is under consideration as a short-term stop gap measure while deliberate efforts are being put on retention policies and increased production of HRH. The Ministry of Health (MOH) with support from the United States Agency for International Development-funded FUNZOKenya project and MOH/Japan International Cooperation Agency (JICA) project conducted a country-wide training needs assessment (TNA) to identify skill gaps in the provision of specialized health care in private and public hospitals in 46 out of Kenya's 47 counties between April and June 2015. A total of 99 respondents participated in the TNA. Structured questionnaires were used to undertake this assessment. The assessment sought to determine the extent of skill gaps on the basis of the national guidelines and as perceived by the County Directors of Health (CDH). The questionnaires were posted to and received by all the respondents a week prior to a face-to-face interview with the respondents for familiarization. Data analysis was done using SPSS statistical package. Overall, the findings revealed average skill gaps on selected specialists (healthcare professional whose practice is limited to a particular area, such as a branch of medicine, surgery, or nursing, especially, one who by virtue of advanced training is certified by a
Onishi, Mami; Kanda, Katsuya
This study explored (1) expected roles for specialist nurses in Japan and (2) nurse administrators' experience-based management strategies for effective implementation of these roles. Background In Japan, specialist nurses have begun to be recognized as valuable human resources. However, managerial issues in utilizing specialist nurses, including unclear roles and lack of reports on effective management strategies, remain. Three focus-group discussions were conducted. Nine nurse administrators participated. Data were analysed using qualitative content analysis techniques. The expected roles for specialist nurses were: (1) facilitating general nurses' learning; (2) monitoring and improving the patient care standard; and (3) developing new roles for nursing. Two management strategies were: (1) enhancing specialist nurses' influence, and (2) enhancing specialist nurses' motivation. Specialist nurses are important human resources able to assume responsibility for process improvement in nursing care. Effective ways to enhance specialist nurses' influence and motivation include developing their management and communication skills, and coordinating their workload and relationships with other health care professionals. Process improvement indicators may be useful for evaluating specialist nurses' work. Nurse administrators can contribute to effective implementation of specialist nurses' roles not only by clarifying their roles but also by empowering them to keep up with changing organizational needs.
Cleland, Jennifer; Burr, Jacqueline; Johnston, Peter
The continued professional development of staff and associate specialist doctors in the UK was ill served prior to the introduction of the new staff and associate specialist doctor's contract in 2008. The aim of this study was to independently evaluate NHS Education for Scotland's approach to improving professional development for staff and associate specialist doctors, the staff and associate specialist Professional Development Fund. Semi-structured telephone interviews with key stakeholders, framed by a realistic approach to evaluate what works, for whom and in how and under what circumstances. An inductive and data-driven thematic analysis was carried out and then the realist framework was applied to the data. We interviewed 22 key stakeholders: staff and associate specialist doctors, staff and associate specialist educational advisors, programme architects and clinical directors, between end February and May 2014. The resultant data indicated five broad themes: organisational barriers to continued professional development for staff and associate specialist doctors, the purpose of funding, gains from funding, the need for better communication about the staff and associate specialist Programme Development Fund, and the interplay between individual and systems factors. The staff and associate specialist Programme Development Fund has changed the opportunities available to staff and associate specialist doctors in Scotland and, in that sense, has changed the context for this group - or at least those who have realised the opportunities. © The Author(s) 2016.
STS-95 Mission Specialist Pedro Duque of Spain, with the European Space Agency, is helped with his flight suit by suit tech Tommy McDonald in the Operations and Checkout Building. The final fitting takes place prior to the crew walkout and transport to Launch Pad 39B. Targeted for launch at 2 p.m. EST on Oct. 29, the mission is expected to last 8 days, 21 hours and 49 minutes, and return to KSC at 11:49 a.m. EST on Nov. 7. The STS-95 mission includes research payloads such as the Spartan solar-observing deployable spacecraft, the Hubble Space Telescope Orbital Systems Test Platform, the International Extreme Ultraviolet Hitchhiker, as well as the SPACEHAB single module with experiments on space flight and the aging process.
During the first session of this meeting, regulators, research groups, designers/owners' groups and some utilities discussed the critical decisions in SAM (Severe Accident Management), how these decisions were addressed and implemented in generic SAM guidelines, what equipment and instrumentation was used, what are the differences in national approaches, etc. During the second session, papers were presented by utility specialists that described approaches chosen for specific implementation of the generic guidelines, the difficulties encountered in the implementation process and the perceived likelihood of success of their SAM programme in dealing with severe accidents. The third and final sessions was dedicated to discussing what are the remaining uncertainties and open questions in SAM. Experts from several OECD countries presented significant perspectives on remaining open issues
Rothwell, Erin; Ellington, Lee; Planalp, Sally; Crouch, Barbara
The use of the telephone for providing health care is growing. A significant amount of social meaning is derived from visual information, and the absence of visual stimuli provides unique barriers to communication and increases the risks for misunderstandings and distractions. Understanding challenges to telephone communication can provide insight into training opportunities for overcoming these difficulties and improving patient care. The purpose of this research was to explore through focus groups the challenges of phone communication perceived by specialists in poison information. General types of challenges to effective phone communication included developing new communication skills to compensate for lack of visual information, difficulty assessing caller understanding, difficulty managing caller misunderstandings, maintaining distinctive assessments for routine calls, and managing the multifaceted aspects of job stress. The desire for training to enhance telehealth and cultural competency skills was also mentioned, and these findings might provide guidance for the development of training opportunities for telehealth professionals.
Lundh, Andreas; Skjelsager, Karen; Wildgaard, Kim
INTRODUCTION: The seven roles of the CanMEDS system have been implemented in Danish postgraduate medical training. For each medical specialty, a professional profile describes which elements of the seven roles the specialty deems important for applicants for a specialist training position. We...... investigated use of professional profiles among the 38 Danish specialty societies in order to ascertain the use of the seven roles. MATERIAL AND METHODS: We used information from the websites of the Postgraduate Medical Training Secretariats in March 2012. For each profile, we extracted information on how...... the seven roles were described, how the roles were ranked by importance, whether a score sheet was used by the appointment committee and whether the profile had been updated. RESULTS: Twenty-four (63%) of the 38 profiles described the contents for all of the seven roles and four (11%) described the contents...
Hercigonja-Szekeres, Mira; Simić, Diana; Božikov, Jadranka; Vondra, Petra
Paper presents an overview of the EU funded Project of Curriculum Development for Interdisciplinary Postgraduate Specialist Study in Medical Informatics named MEDINFO to be introduced in Croatia. The target group for the program is formed by professionals in any of the areas of medicine, IT professionals working on applications of IT for health and researchers and teachers in medical informatics. In addition to Croatian students, the program will also provide opportunity for enrolling students from a wider region of Southeast Europe. Project partners are two faculties of the University of Zagreb - Faculty of Organization and Informatics from Varaždin and School of Medicine, Andrija Štampar School of Public Health from Zagreb with the Croatian Society for Medical Informatics, Croatian Chamber of Economy, and Ericsson Nikola Tesla Company as associates.
Perez, Patricia; Rios, Heriberto; Andrade, Armando; Ramirez, Mario
The need for companies to be more competitive has led them to resort to training, external consultantship, continuous improvement programs, but with the aim of achieving maximum productivity, the big companies go even further: they are opting to focus on their high-priority activities, leaving some nonstrategic functions in the hands of third parties (organizations or individuals). Acoustic outsourcing presents immense business opportunities for the specialists in this area when offering services or completing a production process that the company carries out in an internal way but that is not its main function or activity. Outsourcing contemplates a serious long term commitment between the two parties; a kind of strategic alliance, all with the purpose of increasing efficiency and the quality of the products that the company develops, besides solving acoustic problems related to the production stage. (To be presented in Spanish.)
Treister, N W
Marketing means more than just communicating or advertising to potential patients; marketing means identifying your customers and working to meet or exceed their expectations. There are five key areas of a marketing plan: (1) Establish the foundation, beginning with your mission statement; (2) Assess your marketing environment by internal and external research; (3) Target your efforts, looking at image and perception; (4) Develop your particular mix of product, price, place of distribution, and promotion; and (5) implement and evaluate your marketing process. This article discusses the importance of a marketing plan for the medical specialist and highlights the features unique to a practice working in a system of capitated reimbursement. Applying these principles will help to demonstrate added value, protect the fundamental role of the patient-physician relationship, ensure that our efforts are aligned with professional missions and goals, and ultimately increase profitability and professional success.
Haibeck, S V; Howard, J L
NUMEROUS WORK TIME options have been developed to attract, retain and meet the various needs of nurses. Job sharing, a work option little known to nurses, can be a successful alternative for balancing professional and personal lifestyle. The business literature supports job sharing and other innovative work options as successful mechanisms in retaining quality employees in their respective professions. After exploring the literature in this area, a proposal for job sharing the oncology clinical nurse specialist (CNS) position was presented to the Personnel Director and Vice President of Nursing at our institution. The proposal addressed the advantages and disadvantages of the concept. These included: (1) scheduling flexibility, (2) reduced absenteeism and turnover, (3) increased productivity, (4) handling fringe benefits, and (5) job satisfaction. The proposal was accepted, and the job sharing position has been successfully implemented for more than 2 years now. This paper describes issues relevant to designing and implementing job sharing in a CNS position.
The Specialists' Meeting on Bellows for Sodium Systems was sponsored by the IAEA on the recommendation of the International Working Group on Fast Reactors (IWGFR) was attended by participants and observers from France, the Federal Republic of Germany, Italy, Japan, the Netherlands, the United Kingdom and the IAEA. The purpose of the meeting was to provide forum for exchanging views on application of bellows for FBR use, problems found in service in sodium systems, design and fabrication of bellows for sodium systems and studies necessary for estimation and improvement of reliability of bellows in long term use under the condition of high temperature sodium. The technical parts of the meeting were divided into five major sessions, as follows: Experience of Bellows Applications for Sodium Systems; Design and Analysis; Fabrication; In-Service Inspection and Repair; Research Work.
Ginger, Tracey; Ritchie, Georgina
The ever-evolving role of the Specialist Practitioner Qualified District Nurse (SPQDN) presents an increasing number of challenges for Practice Teachers and mentors in preparing SPQDN students for the elevated level clinical and transformational leadership necessary to ensure high-quality patient care. The daily challenges of clinical practice within the community nursing setting in addition to undertaking educational interventions in the clinical arena demand that a structured approach to supervision and mentorship is crucial. Employing learning plans to assess individual students learning needs, prepare plans for educational developments and interventions and evaluate a student's progress can be a helpful tool in aiding the learning journey for both the SPQDN student and Practice Teacher or mentor. This article examines how and why a structured learning plan may be used in supporting learning and competency in achieving the necessary level of practice to meet the requirements of the SPQDN.
STS-95 Mission Specialist Scott E. Parazynski gets help with his flight suit in the Operations and Checkout Building from a suit technician George Brittingham. The final fitting takes place prior to the crew walkout and transport to Launch Pad 39B. Targeted for launch at 2 p.m. EST on Oct. 29, the mission is expected to last 8 days, 21 hours and 49 minutes, and return to KSC at 11:49 a.m. EST on Nov. 7. The STS-95 mission includes research payloads such as the Spartan solar-observing deployable spacecraft, the Hubble Space Telescope Orbital Systems Test Platform, the International Extreme Ultraviolet Hitchhiker, as well as the SPACEHAB single module with experiments on space flight and the aging process.
Meehan, Karen Anne
The purpose of this article is to describe the impact the clinical nurse specialist (CNS) has on the advance directive process within the cardiac surgery patient population. As a change agent, the CNS needs to be able to increase the number of advance directives obtained and increase the provision of dignified, self-directed, quality patient care. With requirements from The Joint Commission and the Patient Self-determination Act, the change in process must take place to ensure that healthcare professionals are doing all they can do to carry out a patient's wishes. The 6-Source Influencer Model is applied to a case study to illustrate the role of the CNS as a change agent. Following this model, the CNS can facilitate lasting institutional change in the advance directive process. Based on the example, it is possible that a CNS can act as a change agent for other patient populations within the healthcare setting.
N. O. Tkachenko
Full Text Available Today professionalism is important not only for the characteristics of an individual, but also for the manifestation of professional activities. Self-education, self-training and training on the working place are integral elements of the whole continuous professional development. Various components of professionalism form the social responsibility of pharmacist in contemporary conditions. During all professional activities of pharmacists the continuous formation of administrative, economic, legal, communication, social and information competence takes place. Professionally oriented periodical publications, scientific and practical activities act as assistants in it. The aim of this work was to study the sources of the information professional field of pharmaceutical establishments’ staff in the South-eastern region of Ukraine and to determine the frequency of their use and orientation. Gathering of information was carried out using questionnaires. The structure of the developed questionnaire provided conventional separation of questions into two blocks. The first set of questions in the questionnaire provided respondents’ characteristics by demographic and psychological criteria: age, position, length of service, type of enterprise’s ownership. The second set of questions provided the opportunity to identify the main sources of professional information of the specialists in the region, the frequency of their use and the orientation of information for practical activities. Results and discussion. The respondents were proposed the list of periodicals, which today pharmacy specialists are guided by for understanding of modern trends in medicine and pharmacy. The survey results made it possible to determine the most required in practice, sources of information on modern medicine and pharmacy: special edition "Mister blister", "Weekly Drugstore" and "Pharmacist Practical worker". Experts of various levels of pharmacy management use these
Breuer, G; Lütcke, B; St Pierre, M; Hüttl, S
The world of medicine is becoming from year to year more complex. This necessitates efficient learning processes, which incorporate the principles of adult education but with unchanged periods of further education. The subject matter must be processed, organized, visualized, networked and comprehended. The learning process should be voluntary and self-driven with the aim of learning the profession and becoming an expert in a specialist field. Learning is an individual process. Despite this, the constantly cited learning styles are nowadays more controversial. An important factor is a healthy mixture of blended learning methods, which also use new technical possibilities. These include a multitude of e‑learning options and simulations, which partly enable situative learning in a "shielded" environment. An exemplary role model of the teacher and feedback for the person in training also remain core and sustainable aspects in medical further education.
Full Text Available This study investigated the injuries sustained by an Australian specialist police division. Injury records spanning four-years were analyzed. The role being performed when the injury occurred, injury cause, body part injured, and injury-related costs were quantified. The percentage of personnel injured multiple times was documented. One hundred and thirty eight personnel reported injuries, 58 of these on multiple occasions. This resulted in 229 injuries and 76 claims being raised. Half of the injuries occurred during operational policing tasks, however training activities accounted for >30% of injuries. The most common injury was strain/sprain, and upper body injuries were 2.5-times more common than lower-body or torso injuries. 1107 shifts were lost, and injuries cost the organization $487,159 (Australian Dollars over the four-year period. The injury costs (both financial and in manpower may prompt policy makers to review the current training and post-injury rehabilitation protocols.
Bondareva, Evgeniya; Chistyakova, Galina; Kleshevskyi, Yury; Sergeev, Sergey; Stepanov, Aleksey
Nowadays foreign language competence is one of the main professional skills of mining engineers. Modern competitive conditions require the ability for meeting production challenges in a foreign language from specialists and managers of mining enterprises. This is the reason of high demand on foreign language training/retraining courses. Language training of adult learners fundamentally differs from children and adolescent education. The article describes the features of andragogical learning model. The authors conclude that distance learning is the most productive education form having a number of obvious advantages over traditional (in-class) one. Interactive learning method that involves active engagement of adult trainees appears to be of the greatest interest due to introduction of modern information and communication technologies for distance learning.
Mulder, Bob; Choukroun, Daniel; Kampen, Erik-Jan; Visser, Coen; Looye, Gertjan
Following the successful 1st CEAS (Council of European Aerospace Societies) Specialist Conference on Guidance, Navigation and Control (CEAS EuroGNC) held in Munich, Germany in 2011, Delft University of Technology happily accepted the invitation of organizing the 2nd CEAS EuroGNC in Delft, The Netherlands in 2013. The goal of the conference is to promote new advances in aerospace GNC theory and technologies for enhancing safety, survivability, efficiency, performance, autonomy and intelligence of aerospace systems using on-board sensing, computing and systems. A great push for new developments in GNC are the ever higher safety and sustainability requirements in aviation. Impressive progress was made in new research fields such as sensor and actuator fault detection and diagnosis, reconfigurable and fault tolerant flight control, online safe flight envelop prediction and protection, online global aerodynamic model identification, online global optimization and flight upset recovery. All of these challenges de...
The Specialists' Meeting on Bellows for Sodium Systems was sponsored by the IAEA on the recommendation of the International Working Group on Fast Reactors (IWGFR) was attended by participants and observers from France, the Federal Republic of Germany, Italy, Japan, the Netherlands, the United Kingdom and the IAEA. The purpose of the meeting was to provide forum for exchanging views on application of bellows for FBR use, problems found in service in sodium systems, design and fabrication of bellows for sodium systems and studies necessary for estimation and improvement of reliability of bellows in long term use under the condition of high temperature sodium. The technical parts of the meeting were divided into five major sessions, as follows: Experience of Bellows Applications for Sodium Systems; Design and Analysis; Fabrication; In-Service Inspection and Repair; Research Work
Kovas, Yulia; Plomin, Robert
Twin studies comparing identical and fraternal twins consistently show substantial genetic influence on individual differences in learning abilities such as reading and mathematics, as well as in other cognitive abilities such as spatial ability and memory. Multivariate genetic research has shown that the same set of genes is largely responsible for genetic influence on these diverse cognitive areas. We call these "generalist genes." What differentiates these abilities is largely the environment, especially nonshared environments that make children growing up in the same family different from one another. These multivariate genetic findings of generalist genes and specialist environments have far-reaching implications for diagnosis and treatment of learning disabilities and for understanding the brain mechanisms that mediate these effects.
Gulli, Giosuè; Peron, Elisa; Ricci, Giorgio; Formaglio, Eva; Micheletti, Nicola; Tomelleri, Giampaolo; Moretto, Giuseppe
In Italy the vast majority of TIA and minor strokes are seen in the A&E. Early diagnosis and management of TIA and minor stroke in this setting is habitually difficult and often lead to cost-ineffective hospital admissions. We set up an ultra-rapid TIA service run by neurovascular physicians based on early specialist assessment and ultrasound vascular imaging. We audit the clinical effectiveness and feasibility of the service and the impact of this service on TIA and minor strokes hospital admissions. We compared the rate of TIA and minor stroke admissions/discharges in the year before (T0) and in the year during which the TIA service was operating (T1). At T1 57 patients had specialist evaluation and 51 (89.5 %) of them were discharged home. Two (3.5 %) patients had recurrent symptoms after discharge. Seven had a pathological carotid Doppler ultrasound. Four of them had hospital admission and subsequent carotid endoarterectomy within a week. Taking the whole neurology department into consideration at T1 there was a 30-41 % reduction in discharges of patients with TIA or minor stroke. Taking the stroke unit section into consideration at T1 there was a 25 % reduction in admissions of patients with NIHSS score TIA service we implemented based on ultra-rapid stroke physician assessment and carotid ultrasound investigation is feasible and clinically valid. Indirect evidence suggests that it reduced the rate of expensive TIA/minor stroke hospital admissions.
Cox, Sarah; Murtagh, Fliss E M; Tookman, Adrian; Gage, Andrew; Sykes, Nigel; McGinn, Maureen; Kathoria, Meeta; Wilderspin, Hilary; Chart, Liz
Palliative care provision varies by diagnosis, geography, and setting. The Minimum Data-set provides high-level data on provision, but comprehensive comparative information about specialist palliative care (SPC) provision is lacking. The London Cancer Alliance - now RM Partners' Accountable Cancer Network - palliative care group (West/South London) and PallE8 (North/East London), with Marie Curie, sought to address this gap. The aim was to provide comparative data on SPC provision across London to support commissioners and providers to assess provision, identify gaps, and reduce inequity. A data-collection template was developed through expert consensus. Demographic, diagnostic, and service data was collected, plus models of care, staffing levels, and use of clinical outcome/experience measures. Results were collated by organisation and CCG. Cleaned data was provided back to each organisation for verification before final analyses. All 50 adult SPC providers in London participated, representing hospitals, hospices and community services. •Patients in all 32 CCGs have access to hospice beds, with 322 beds from 15 providers (4 NHS) for a population of 9,323,570 (with 47,583 deaths annually).•SPC in London sees more non-cancer patients than is reported nationally; 79% of hospital advisory, 74% of community, and 88% of hospice in-patient services have higher proportions of non-cancer patients.•Considerable variation in out-of-hours availability of both hospital SPC and community SPC services across London; only 9 of 30 hospital and 17 of 26 community services provide seven-day visiting.•Wide variation in the models of community-based SPC; proportions of community patients attending day services vary from 1 in 4, to 1 in 17, just 13 CCGs have H@H-type provision, with few Rapid Response or Care Coordination services. This detailed survey demonstrates important gaps in availability and provision of SPC services. Recommendations are made for commissioners and
Elena V. Voevoda
Full Text Available The article considers new tasks of universities and faculties training students of international relations. The author analyzes the essence of the concept "paradigm" in education because paradigm serves as the basis of the educational process in universities. The content of professional education depends on the aims of professional education of specialists in international relations. The process of globalization, global changes, challenges and threats bring about the necessity to study specific features of international cooperation in ecology, psychology of conflict, psychology of leadership, etc. In the age of globalization, national economies are converging while national cultures are diverging. Representatives of different nations realize the importance of preserving cultural identity. It is of vital importance to instil tolerance in future specialists in international relations and prepare them for cross-cultural communication. At the same time, it is necessary that they should not only enjoy individual freedom and national cultural identity, but realize their own responsibility to the state. In the modern world, the axiological and educational functions of professional training are growing. At the same time, it is crucial to let the students build a number of professionally relevant competences that will make it possible for them to effectively perform their professional functions. It is the competence-based approach that makes the basis of Federal state education standards, including education standards for faculties of international relations. Another direction that needs developing is training and retraining lecturers for universities specializing in international relations. Foreign language training of lecturers in basic subjects will make it possible for the, to give lectures in foreign languages, particularly in English, which, in its turn, will help to make Russia's universities more competitive.
Russell, Anne Marie; Olive, Sandra; Lines, Sarah; Murphy, Anna; Hocking, Julie; Newell, Karen; Morris, Helen; Harris, Emma; Dixon, Catherine; Agnew, Sarah; Burge, Geraldine
The role of clinical nurse specialists (CNSs) in interstitial lung disease (ILD) is evolving in response to clinical guidelines and the growth of clinical research. The role is well established in the UK, although more ILD posts are needed to ensure supply meets clinical demand. This phenomenon is also happening across Europe. An appreciation of the similarities and differences between CNS and advanced nurse practitioners is important given the challenges in defining, developing and supporting this nursing specialisation. Globally, different models exist. In some countries charitable organisations take a leading role in supporting patients. Many European centres look to the National Institute for Health and Care Excellence guidelines and quality standards as a template to develop and evaluate the role of the ILD CNS. We present a UK perspective in the context of a government subsidised healthcare system to promote professional discussion and debate regarding the future of nursing practice in the ILD specialty. ILDs are often complex and associated with significant mortality, morbidity and co-morbid conditions that require a technical healthcare skill setThere is worldwide shortage of nurses, low retention rates and retirement of many skilled nursesCollaboration across the ILD interdisciplinary community is needed to safeguard the future of our professions and high-quality patient careThe ILD interdisciplinary and nurse network has identified key priorities to help secure the future of the ILD clinical and academic nurse specialism. To explain the similarities and differences between clinical nurse specialists (CNSs) and advanced nurse practitioners (ANPs) in the context of ILD specialismTo review contemporary nursing specialism in the UK's government subsidised healthcare systemTo stimulate discussion and debate across the European/international respiratory community regarding the clinical and academic development of the ILD CNSTo identify key priorities that will
Astell-Burt, Thomas; Flowerdew, Robin; Boyle, Paul; Dillon, John
Little is known about why many people diagnosed with hepatitis C virus (HCV) infection fail to reach and stay within specialist care services. We used a Geographic Information System and logit regression to investigate whether travel-time to a specialist centre was associated with an increased likelihood of non-referral, non-attendance and loss to follow-up among persons diagnosed with HCV between 1991 and 2003 in Tayside, Scotland (UK). Information was available on referral to, and utilisation of, the single HCV specialist centre in Tayside between 1991 and 2006. Longer travel-time to a specialist centre was associated with an increased likelihood of non-referral to a specialist centre following diagnosis (Odds Ratio: 1.25, 95% Confidence Interval: 1.09, 1.44). Patients living further from an HCV specialist centre were less likely to be referred to it for treatment that could cure their HCV infection. Neither a history of intravenous drug use (IDU), nor area deprivation predicted non-referral. Subsequent to referral, travel-time to a specialist centre was not associated with either non-attendance (0.83 (0.56, 1.21)) or loss to follow-up (0.98 (0.78, 1.22)), although a history of IDU was a strong predictor of both non-attendance and loss to follow-up. Non-attendance was less likely among older patients, while loss to follow-up was more common among those living in deprived areas. Once referred, patients appear able to cope with stress and financial cost of long and frequent journeys to hospital. However, as rates of referral improve from more geographically remote areas, long travel-times to an HCV specialist centre may become an important factor determining future utilisation. Copyright © 2012 Elsevier Ltd. All rights reserved.
Thompson, Jo; Brown, Jayne; Davies, Andrew
This report describes a service evaluation of the 'added value' of routine specialist palliative care team (SPCT) involvement with patients on the Liverpool Care Pathway for the Dying Patient (LCP). In the authors' hospital, patients that are commenced on the LCP are routinely referred to the SPCT. They are reviewed on the day of referral and then at least every other day, depending on the clinical situation. The data for this report was obtained by reviewing the SPCT's clinical database and the patients' LCP proformas. The SPCT intervened in the care of 80% of 158 newly referred patients, e.g. for alteration of continuous subcutaneous infusion (23%) or alteration of use of non-pharmacological interventions (21%). Furthermore, 11% of patients were taken off the LCP, around one quarter of whom were later put back on. The authors' model of care could overcome many of the issues relating to the LCP and would ameliorate the developing vacuum of care for patients at the end of life.
AlKindi, N A; Nunn, J
Access to health services is a right for every individual. However, there is evidence that people with disabilities face barriers in accessing dental health. One of the reasons associated with this is the unclear referral pathway existing in the Irish dental health service. The appropriate assignment of patients to relevant services is an important issue to ensure better access to healthcare. This is all the more pertinent because there are only a few trained dental practitioners to provide dental treatment for people with disabilities, as well as even fewer qualified specialists in special care dentistry. The aim of this part of the study was to assess the use of the BDA Case Mix Model to determine the need for referral of patients to specialist dental services, and to determine any association between patient complexity and the need for adjunct measures, such as sedation and general anaesthesia for the management of people with disabilities and complex needs. A retrospective analysis of dental records using the BDA Case Mix Model.Results The results showed that patients with different levels of complexities were being referred to the special care dentistry clinic at the Dublin Dental University Hospital. The results also showed that the need for supportive adjunct measures such as sedation and general anaesthesia was not necessarily the main reason for referring patients to specialist services. The assessment with the BDA Case Mix Model was comprehensive as it looked at many factors contributing to the cases' complexity. Not all categories in the Case Mix Model had significant association with the need for an adjunct.Conclusion The BDA Case Mix Model can be used to measure the need for supportive adjunct measures, such as sedation and general anaesthesia.
Sammut, Mario R.; Abela, Gunther
The Specialist Training Programme in Family Medicine (STPFM) – Malta was drawn up by the Malta College of Family Doctors in 2006, approved by Malta’s Specialist Accreditation Committee, and launched in 2007 by the Primary Health Care Department and the Malta College of Family Doctors. This article regarding the work-based assessment of specialist training in family medicine in Malta was prepared by consulting various local / international documents and publications tha...
Full Text Available The uses of simulation games given about directions are resulted in pedagogical practice. Practice is conducted during the increase of professional qualification of specialists. Possibilities of the use of pedagogical situations are considered in the system of preparation of specialist. Pedagogical situations are an aggregate of facilities and methods of becoming of professional specialist. The prospects of the use of simulation games are indicated in an educational process. Acquisition of the proper qualities options are rotined.
O'Sullivan, Belinda; McGrail, Matthew; Russell, Deborah
Systematically describe the characteristics of rural specialists, their work and job satisfaction by geographical location of work. Cross-sectional. Three thousand, four hundred and seventy-nine medical specialists participating in the 2014 Medicine in Australia: Balancing Employment and Life (MABEL) survey of doctors. Location of practice, whether metropolitan, large (>50 000 population) or small regional centres (Rural specialists had more on-call requirements and poorer professional development opportunities. However, satisfaction with work hours, remuneration, variety of work, level of responsibility, opportunities to use abilities and overall satisfaction did not differ. Specialists in general medicine and general surgery were significantly more likely to work rurally compared with anaesthetists, particularly in small regional centres, whereas a range of other relevant specialists had lower than the average rural distribution and paediatricians and endocrinologists were significantly less likely to work in large regional centres. Rural specialists are just as satisfied as metropolitan counterparts reporting equivalent variety and responsibility at work. Better support for on-call demands and access to professional development could attract more specialists to rural practice. Increased rural training opportunities and regional workforce planning is needed to develop and recruit relevant specialties. Specifically, targeted support is warranted for training and development of specialists in general medicine and general surgery and overseas-trained specialists, who provide essential services in smaller regional centres. © 2017 National Rural Health Alliance Inc.
Full Text Available Relevance and importance of training of tourism specialists on the regional level have been revealed. General principles of training of tourism services specialists in Ukraine have been found out. The structure and professional specialization of Ukrainian universities, where the “Tourism” specialists are trained have been analyzed. Pofessional requirements for future employees of tourism industry have been defined. Relevance of training of tourism specialists in Kryvyi Rih in the context of the implementation of the Program of Industrial Tourism Development has been revealed. Potential scope of employment of tourism graduates has been defined. Main tasks of tourism education in Ukraine have been generalized.
Broaddus, Michelle R; Owczarzak, Jill; Schumann, Casey; Koester, Kimberly A
To address barriers to adequate engagement in medical care among people living with HIV, Wisconsin's AIDS/HIV Program created a new position, the Linkage to Care (LTC) Specialist. Specialists provide intensive, short-term case management and patient navigation services for small caseloads of individuals at high risk of disengaging with medical care. Clients are eligible if they are newly diagnosed with HIV or new to medical care, recently released from incarceration, recently out of care, nonadherent to scheduled medical care visits, or have detectable viral load while in care. Interviews with 30 clients of Specialists were conducted to understand experiences with the program and medical care. Common themes included the ability of Specialists to navigate complex systems of care and support services, the unique role Specialists played in their clients' lives, and the challenges of transitioning out of the program. Although the primary goal of Specialists is to address barriers to medical care, they often adopted a holistic approach that also included housing, financial assistance, and other social determinants of health. Descriptions of the Specialist's role in implementation manuals focus on their functional roles and the services provided. However, clients often discussed the emotional support they received, especially for clients without strong social support networks. Many clients also desired an ongoing relationship with their Specialists even after discharge, but had been able to establish independence and self-efficacy. The LTC Specialists are resource-intensive considering their small caseloads, but fill an important gap in existing, often overtaxed case management systems.
O'Sullivan, Belinda G; McGrail, Matthew R; Stoelwinder, Johannes U
The purpose of the study is to explore the reasons why specialist doctors travel to provide regular rural outreach services, and whether reasons relate to (1) salaried or private fee-for-service practice and (2) providing rural outreach services in more remote locations. A national cross-sectional study of specialist doctors from the Medicine in Australia: Balancing Employment and Life (MABEL) survey in 2014 was implemented. Specialists providing rural outreach services self-reported on a 5-point scale their level of agreement with five reasons for participating. Chi-squared analysis tested association between agreement and variables of interest. Of 567 specialists undertaking rural outreach services, reasons for participating include to grow the practice (54%), maintain a regional connection (26%), provide complex healthcare (18%), healthcare for disadvantaged people (12%) and support rural staff (6%). Salaried specialists more commonly participated to grow the practice compared with specialists in fee-for-service practice (68 vs 49%). This reason was also related to travelling further and providing outreach services in outer regional/remote locations. Private fee-for-service specialists more commonly undertook outreach services to provide complex healthcare (22 vs 14%). Specialist doctors undertake rural outreach services for a range of reasons, mainly to complement the growth and diversity of their main practice or maintain a regional connection. Structuring rural outreach around the specialist's main practice is likely to support participation and improve service distribution.
Vadivelu, Nalini; Kai, Alice M; Kodumudi, Vijay; Berger, Jack M
Ambulatory surgery is on the rise, with an unmet need for optimum pain control in ambulatory surgery centers worldwide. It is important that there is a proportionate increase in the availability of acute pain-management services to match the rapid rise of clinical patient load with pain issues in the ambulatory surgery setting. Focus on ambulatory pain control with its special challenges is vital to achieve optimum pain control and prevent morbidity and mortality. Management of perioperative pain in the ambulatory surgery setting is becoming increasingly complex, and requires the employment of a multimodal approach and interventions facilitated by ambulatory surgery pain specialists, which is a new concept. A focused ambulatory pain specialist on site at each ambulatory surgery center, in addition to providing safe anesthesia, could intervene early once problematic pain issues are recognized, thus preventing emergency room visits, as well as readmissions for uncontrolled pain. This paper reviews methods of acute-pain management in the ambulatory setting with risk stratification, the utilization of multimodal interventions, including pharmacological and nonpharmacological options, opioids, nonopioids, and various routes with the goal of preventing delayed discharge and unexpected hospital admissions after ambulatory surgery. Continued research and investigation in the area of pain management with outcome studies in acute surgically inflicted pain in patients with underlying chronic pain treated with opioids and the pattern and predictive factors for pain in the ambulatory surgical setting is needed.
van Sambeeck, S J L; Janssen, E J M; Hundscheid, T; Martens, S J L; Vos, G D
To gain insight into how the acute care of critically ill children at general hospitals is organised, whether staff is sufficiently trained and whether the necessary materials and medications are present. Questionnaire combined with a site visit. Questionnaires were sent to all primarily involved specialists (emergency room specialists and paediatricians), and to the auxiliary anaesthetists and intensivists involved, at the nine general hospitals in Southeast Netherlands. Two researchers performed standardised interviews with the lead paediatricians on site and checked for materials and medication present in the emergency and paediatric departments. Of the 195 questionnaires sent, 97 (49.7%) were deemed suitable for analysis. The response from the primary specialists involved (77.6%) was more than twice that of the auxiliary specialists (31.9%). At 7 hospitals, verbal agreements on the organisation of acute care were maintained, 1 hospital had a written protocol, and 2 hospitals had a task force addressing this topic. One out of 5 respondents was unaware of the verbal agreements and 1 out of 3 mistakenly assumed that a protocol existed. Two out of 3 primary specialists involved were certified for Advanced Paediatric Life Support (APLS); 1 out of 13 of the auxiliary specialists had such a certificate. Scenario training was being conducted at 8 hospitals. A paediatric resuscitation cart was available at both the emergency and paediatric departments of 8 hospitals, 3 of which were fully stocked at both departments. Laryngeal mask airways and PEEP-valves (Positive End Expiratory Pressure) were lacking at 6 of the 9 hospitals. The medication stock was complete at all the hospitals. The organisation of and training for the acute care of critically ill children and presence of materials - the aspects we investigated - need attention at all general hospitals evaluated. It appeared that many specialists are not APLS certified and written protocols concerning organisation
Community hospitals provide many services for older people. They are mainly managed by nursing staff, with some specialist input. Little is known about education provided in these facilities. Most education in geriatric medicine is provided in hospitals, despite most elderly care being provided in the community. The authors surveyed senior nursing staff in Irish community hospitals to examine this area in more detail. Staff in all 18hospitals in the Health Service Executive (South) area were invited to participate. The response rate was 100%. Sixteen of the 18 respondents (89%) felt staff did not have enough education in geriatric medicine. Just over half of hospitals had regular staff education sessions in the area, with a minority of sessions led by a geriatrician, and none by GPs. Geriatrician visits were valued, but were requested only every 1-3 months. Staff identified challenging behaviour and dementia care as the areas that posed most difficulty.
Dovzhenko, Iu M; Panov, G D
The computerization of data processing in multi-disciplinary hospitals is the key factor in raising the quality of medical care provided to the population, intensifying the work of the personnel, improving the curative and diagnostic process and the use of resources. Even a small experience in complex computerization at the Botkin Hospital indicates that due to the use of the automated system the quality of data processing in being improved, a high level of patients' examination is being provided, a speedy training of young specialists is being achieved, conditions are being created for continuing education of physicians through the analysis of their own activity. At big hospitals a complex solution of administrative and curative diagnostic tasks on the basis of general hospital network of display connection and general hospital data bank is the most prospective form of computerization.
Amanda R. Meier
Full Text Available Multitrophic species interactions are shaped by both top-down and bottom-up factors. Belowground symbionts of plants, such as arbuscular mycorrhizal fungi (AMF, can alter the strength of these forces by altering plant phenotype. For example, AMF-mediated changes in foliar toxin and nutrient concentrations may influence herbivore growth and fecundity. In addition, many specialist herbivores sequester toxins from their host plants to resist natural enemies, and the extent of sequestration varies with host plant secondary chemistry. Therefore, by altering plant phenotype, AMF may affect both herbivore performance and their resistance to natural enemies. We examined how inoculation of plants with AMF influences toxin sequestration and performance of two specialist herbivores feeding upon four milkweed species (Asclepias incarnata, A. curassavica, A. latifolia, A. syriaca. We raised aphids (Aphis nerii and caterpillars (Danaus plexippus on plants for 6 days in a fully factorial manipulation of milkweed species and level of AMF inoculation (zero, medium, and high. We then assessed aphid and caterpillar sequestration of toxins (cardenolides and performance, and measured defensive and nutritive traits of control plants. Aphids and caterpillars sequestered higher concentrations of cardenolides from plants inoculated with AMF across all milkweed species. Aphid per capita growth rates and aphid body mass varied non-linearly with increasing AMF inoculum availability; across all milkweed species, aphids had the lowest performance under medium levels of AMF availability and highest performance under high AMF availability. In contrast, caterpillar survival varied strongly with AMF availability in a plant species-specific manner, and caterpillar growth was unaffected by AMF. Inoculation with AMF increased foliar cardenolide concentrations consistently among milkweed species, but altered aboveground biomasses and foliar phosphorous concentrations in a plant
Clamp, Jonathan A; Baiju, Dean; Copas, David P; Hutchinson, James W; Rowles, John M
The introduction of Modernising Medical Careers (MMC) is likely to reduce specialist registrar (SpR) operative experience during higher surgical training (HST). A further negative impact on training by local Independent Sector Treatment Centres (ISTCs) could reduce experience, and thus competence, in primary joint arthroplasty at completion of higher surgical training. Retrospective case note and radiograph analysis of patients receiving primary hip and knee arthroplasty in a teaching hospital, before and after the establishment of a local ISTC. Patients and operative details were recorded from the selected case notes. Corresponding radiographs were assessed and the severity of the disease process assessed. Fewer primary hip and knee replacements were performed by SpRs in the time period after the establishment of an ISTC. ISTCs may adversely affect SpR training in primary joint arthroplasty.
Muniraju, T M; Lillicrap, M H; Horrocks, J L; Fisher, J M; Clark, R M W; Kanagasundaram, N S
Enhanced education has been recommended to improve non-specialist management of acute kidney injury (AKI). However, the extent of any gaps in knowledge has yet to be defined fully. The aim of this study was to assess understanding of trainee doctors in the prevention, diagnosis and initial management of AKI. An anonymised questionnaire was completed by hospital-based trainees across Newcastle Renal Unit's catchment area. Responses were evaluated against a panel of pre-defined ideal answers. The median score was 9.5 out of 20 (n = 146; range 0-17) and was lower in more junior trainees. Fifty percent of trainees could not define AKI, 30% could not name more than two risk factors for AKI and 37% could not name even one indication for renal referral. These serious gaps in knowledge highlight the need for enhanced education aimed at all training grades. Organisational changes may also be required to optimise patient safety.
Wray, Jo; Hobden, Sylvie; Knibbs, Sarah; Oldham, Geralyn
To develop and test patient-reported experience measures (PREMs) for children and young people in a specialist paediatric hospital setting. Six PREMs were developed and tested by children and young people for children and young people aged 8-11, 12-13 and 14-16 years in inpatient and outpatient settings. A week-long pilot was implemented across inpatient wards and outpatient clinics to identify facilitators and barriers to the routine use of PREMs in a real-time setting across our organisation. Tertiary paediatric hospital. Final PREMs; identified facilitators and barriers to implementation. 543 children and young people aged 8-16 years attending outpatient clinics or inpatient wards across a range of specialties. Three key themes about hospital experience were identified during focus groups: facilities, treatment and tests and people working at the hospital, and these provided the structure for the questionnaires. During cognitive testing the questionnaires were generally understood but some revisions to language and length of the questionnaires were required. Two designs were selected for the final PREMs. During acceptability and feasibility testing it was evident that children and young people liked the PREMs and wanted to give feedback on their hospital experience. Particular challenges for routine use of the PREMs focused on sustainability and resources. The new PREMs will provide children and young people receiving care in specialist paediatric hospitals with the opportunity to provide feedback on their experience. Sustainability and ensuring that feedback results in improvements need to be addressed in future work. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Full Text Available Linda Sandberg,1 Lena Borell,1 David Edvardsson,2,3 Lena Rosenberg,1 Anne-Marie Boström1,4,5 1Department of Neurobiology, Care Sciences and Society (NVS, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden; 2School of Nursing and Midwifery, La Trobe University, Heidelberg, VIC, Australia; 3Department of Nursing, Umea University, Umea, Sweden; 4Theme Aging, Karolinska University Hospital, Stockholm, Sweden; 5Department of Nursing, Western Norway University of Applied Sciences, Haugesund, Norway Introduction: An increasing number of older persons worldwide live at home with various functional limitations such as dementia. So, home care staff meet older persons with extensive, complex needs. The staff’s well-being is crucial because it can affect the quality of their work, although literature on job strain among home care staff is limited. Aim: To describe perceived job strain among home care staff and to examine correlations between job strain, personal factors, and organizational factors. Methods: The study applied a cross-sectional survey design. Participants were dementia care specialists who work in home care (n=34 and other home care staff who are not specialized in dementia care (n=35. The Strain in Dementia Care Scale (SDCS and Creative Climate Questionnaire instruments and demographic variables were used. Descriptive and inferential statistics (including regression modeling were applied. The regional ethical review board approved the study. Results: Home care staff perceived job strain – particularly because they could not provide what they perceived to be necessary care. Dementia care specialists ranked job strain higher (m=5.71 than other staff members (m=4.71; p=0.04. Job strain (for total score and for all five SDCS factors correlated with being a dementia care specialist. Correlations also occurred between job strain for SDCS factor 2 (difficulties understanding and interpreting and not having Swedish as
Malogajski, Jelena; Jansen, Marleen E; Ouburg, Sander; Ambrosino, Elena; Terwee, Caroline B; Morré, Servaas A
This study aims to identify elements perceived by Dutch fertility specialists as barriers and facilitators for the introduction of genetic testing, and their attitudes towards the use of genetic information. The genetic test would be implemented in routine screening for tubal pathology and identifies SNPs relevant for the immune response causing tubal pathology. Experienced reproductive specialists working in Dutch Academic Hospitals were interviewed. Based on the results of four interviews a questionnaire was developed and used to survey medical doctors in six out of eight Dutch Academic hospitals. 60.4% (n=91) stated that the addition of genetic markers to the Chlamydia trachomatis antibody test (CAT) in screening for tubal pathology would increase screening accuracy. 68.2% (n=90) agreed they would require additional training on clinical genetics. Clinical utility (91.2%, n=91) and cost-effectiveness (95.6%, n=91) were recognized by the respondents as important factors in gaining support for the new screening strategy. In summary, respondents showed a positive attitude towards the implementation of a genetic test combined with CAT for tubal factor infertility (TFI) screening. To gain their support the majority of respondents agreed that clinical utility, specifically cost-effectiveness, is an important factor. Comprehensive research about economic implications and utility regarding the introduction of genomic markers should be the next step in the implementation strategy. Furthermore, education and training would need to be developed and offered to fertility care professionals about genetic markers, their interpretation, and implications for clinical decision-making. Copyright © 2017 Elsevier B.V. All rights reserved.
Brian D. Smith
Full Text Available River dolphins are among the world’s most threatened mammals, and indeed the baiji (Lipotes vexillifer, a species endemic to China's Yangtze River, is likely extinct. Exploitation for products such as meat, oil, and skins has been a lesser feature in the population histories of river dolphins compared to most large mammals. Habitat factors are therefore of particular interest and concern. In this paper we attempt to describe the population-level responses of river dolphins to habitat transformation. We find circumstantial but compelling evidence supporting the view that, at a local scale, river dolphins are opportunists (generalists capable of adapting to a wide range of habitat conditions while, at a river basin scale, they are more appropriately viewed as vulnerable specialists. The same evidence implies that the distributional responses of river dolphins to basinwide ecological change can be informative about their extinction risk, while their local behaviour patterns may provide important insights about critical ecological attributes. Empirical studies are needed on the ecology of river cetaceans, both to inform conservation efforts on behalf of these threatened animals and to help address broader concerns related to biodiversity conservation and the sustainability of human use in several of the world's largest river systems.
Gaona, E.; Vazquez V, J. A.; Rivera M, T.; Izeta G, A. C.; Azorin V, J. C.; Arreola, M.
In this work are presented the experimental results of determining the dose in different body parts, measured by thermoluminescent dosimeters, to medical specialists of implantation procedures of definitive cardiac pacemaker. The medical personnel in ten intervention procedures were controlled according to the procedure type, pathological indication, fluoroscopy time and machine generating estimates of the patient doses. The doses to the extremities of the cardiologist were measured by means of thermoluminescent dosimeters (TLD). The domains of first level in the hand are in the index finger of the left and the right hand. The medium doses of the skin in the eyes, a report of the dose received during each type of intervention procedure in the glandular thyroid and fingers of the cardiologists is made. The results represent the integrated dose to the cardiologist, received during the implantation procedures of definitive cardiac pacemaker in the same patient. By a half time of detection of 70 minutes for patient, the half dose of the skin, received for the right and left hand, ascended to 1,4 mSv, under the glove. In conclusion, the dose average for the dosimeters of the thyroid gland and forehead was varied from 0,41 up to 1,14 mSv for study. The exposure to the X-rays is a topic to consider, more important every time on the development of systematic procedures little invasive, including the angiography, catheter, worker and patient. (Author)
The CSNI Specialist Meeting on Boron Dilution Reactivity Transients was hosted by the Penn State University in collaboration with the US Nuclear Regulatory Commission and the TRAC Users Group. More than 70 experts from 12 OECD countries, as well as experts from Russia and other non-OECD countries attended the meeting. Thirty papers were presented in five technical sessions. The purpose of the meeting was to bring together experts involved in the different activities related to boron dilution transients. The experts came from all involved parties, including research organizations, regulatory authorities, vendors and utilities. Information was openly shared and discussed on the experimental results, plant and systems analysis, numerical analysis of mixing and probability and consequences of these transients. Regulatory background and licensing implications were also included to provide the proper frame work for the technical discussion. Each of these areas corresponded to a separate session. The meeting focused on the thermal-hydraulic aspects because of the current interest in that subject and the significant amount of new technical information being generated. Three papers of the same conference are already available in INIS as individual reports: Potential for boron dilution during small-break LOCAs in PWRs (Ref. number: 27029412); Analysis of boron dilution in a four-loop PWR (Ref. number: 27051651); Probability and consequences of a rapid boron dilution sequence in a PWR (Ref. number: 27029411)
Miettinen, J.; Holmstroem, H.
The Specialist Meeting on Simulators and Plant Analyzers, held in June 9-12, 1992, in Lappeenranta, Finland, was sponsored by the Committee on the Safety on Nuclear Installations (CSNI) of the OECD Nuclear Energy Agency (NEA). It was organized in collaboration with the Technical Research Centre of Finland (VTT) and the Lappeenranta Technical University of Technology (LTKK). All the presented papers were invited and devided into four sessions. In the first session the objectives, requirements and consepts of simulators were discussed against present standards and guidelines. The second session focused on the capabilities of current analytical models. The third session focused on the experiences gained so far from the applications. The final fourth session concentrated on simulators, which are currently under development, and future plans with regard to both development and utilization. At the end of the meeting topics of the meeting were discussed at the panel discussion. Summaries of the sessions and shortened version of the panel discussion are included into the proceeding. (orig.)
Alai, M. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Askin, A. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Buddemeier, B. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Wogan, L. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Doshi, P. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Tai, L. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)
In support of the Department of Homeland Security / Science and Technology Directorate’s (DHS/S&T) creation of a new position called the Radiological Operations Support Specialist (ROSS), Lawrence Livermore National Laboratory (LLNL) in Sub-task 1.1 and 1.2 has assisted in the development of the ROSS skills, knowledge, and abilities (SKAs); identified potentially relevant training; cross-mapped the training to the SKAs; and identified gaps in the training related to the SKAs, as well as their respective level of training knowledge - current versus desired. In the follow on task, Sub-task 1.3, a 5 day ROSS Pilot Training course was developed to fill the priority gaps identified in Sub-Task 1.2. Additionally, in Sub-Task 1.5, LLNL has performed a gap analysis of electronic tools, handbooks, and job-aides currently available to the ROSS and developed recommendations for additional and next generation tools to ensure the operational effectiveness of the ROSS position. This document summarizes the feedback received from the instructors and pilot course observers on what worked in the course and what could be improved as well as an assessment of the Pre- and Post-Test administered to the students.
Schiebel, Perrin E.; Rieser, Jennifer M.; Hubbard, Alex M.; Chen, Lillian; Goldman, Daniel I.
Limbless locomotors such as snakes move by pressing the trunk against terrain heterogeneities. Our laboratory studies of the desert-dwelling Mojave Shovel-nosed snake (C. occipitalis, 40cm long, N=9) reveal that these animals use a stereotyped sinusoidal traveling wave of curvature. However, this snake also encounters rigid obstacles in its natural environment, and the tradeoff between using a cyclic, shape controlled gait versus one which changes shape in response to the terrain is not well understood. We challenged individuals to move across a model deformable substrate (carpet) through a row of 6.4 mm diameter force-sensitive pegs, a model of obstacles such as grass, oriented perpendicular to the direction of motion. Instead of forward-directed reaction forces, reaction forces generated by the pegs were more often perpendicular to the direction of motion. Distributions of post-peg travel angles displayed preferred directions revealing a diffraction-like pattern with a central peak at zero and symmetric peaks at 193 ° and 415 °. We observed similar dynamics in a robotic snake using shape-based control. This suggests that this sand-specialist snake adheres to its preferred waveform as opposed to changing in response to heterogeneity.
Christian, J; Gilvarry, E
In the UK the broad trend noted in prevalence surveys is towards increased availability, exposure, and use of illicit drugs across all social strata. There is a developing consensus regarding those groups of young people who are at particular risk. They may be homeless, pregnant, leaving local authority or foster care, engaged in prostitution or involved with the criminal justice system. These young people are likely to require intervention from a variety of agencies and professionals to respond to their multiple needs, yet they are faced with a dearth of specialist substance misuse services. Consequently there is a need to develop a range of partnership approaches amongst both providers and commissioners of services. The importance of partnership has been stressed in a succession of professional guidance documents, but there remain considerable bureaucratic, organisational, and historical barriers that must be overcome. Effective service models that exist in the UK and elsewhere are a source of ideas to stimulate appropriate, child-centred developments. Overall the need for a fresh impetus is emphasised, in which new partnerships are formed, and collaborative services are developed and evaluated. In this way future initiatives can be based upon evidence of clinical and cost effectiveness.
Boström, Eva; Hörnsten, Asa; Lundman, Berit; Stenlund, Hans; Isaksson, Ulf
To explore diabetes specialist nurses (DSNs)' perceptions of their role in terms of clarity, conflict and other psychosocial work aspects. A cross-sectional study was conducted among DSNs in a county in northern Sweden. The DSNs answered the Nordic Questionnaire of Psychological and Social Factors at Work (QPS Nordic) about psychosocial aspects of their work. Statistical analysis compared DSNs with a reference group of different health professionals. Correlations between role clarity, role conflict, and other variables were analysed. The DSNs perceived more, and higher, job demands, including quantitative, decision-making and learning demands, but also more positive challenges at work compared with the reference group. Role clarity correlated with experiences of health promotion, perception of mastery, co-worker support, and empowering leadership, while role conflict correlated with quantitative and learning demands. The DSNs perceived high demands but also positive challenges in their work. Their role expectations correlated with several psychosocial work aspects. It is important that DSNs should be presented with positive challenges as meaningful incentives for further role development and enhanced mastery of their work. Copyright © 2013 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
Wilson, R.B.; Beattie, J.D.
The main focus at Ontario Hydro for man-machine interface design is in the design of control centres. Because the control of a nuclear generating unit is highly centralized there is an increasing need for effective information display and control layout. Control panel design innovations such as the use of CRT displays and the extended use of computerized control in the Darlington station have made it possible for Ontario Hydro to continue to have one first operator for each generating unit. The human factors specialist involved in control panel design must deal with people who know much more about the specific systems being controlled, and must become a generalist in all these systems as well. Designers have to use conceptual techniques such as task analysis, systems design, panel mock-ups, anthropometric data, and personal judgement based on experience as they design panels. They must find a balance between becoming locked into existing technology and methods, slavishly following the latest technological trends, and forgetting that real people will be using what they design
Alai, M.; Askin, A.; Buddemeier, B.; Wogan, L.; Doshi, P.; Tai, L.
In support of the Department of Homeland Security / Science and Technology Directorate's (DHS/S&T) creation of a new position called the Radiological Operations Support Specialist (ROSS), Lawrence Livermore National Laboratory (LLNL) in Sub-task 1.1 and 1.2 has assisted in the development of the ROSS skills, knowledge, and abilities (SKAs); identified potentially relevant training; cross-mapped the training to the SKAs; and identified gaps in the training related to the SKAs, as well as their respective level of training knowledge - current versus desired. In the follow on task, Sub-task 1.3, a 5 day ROSS Pilot Training course was developed to fill the priority gaps identified in Sub-Task 1.2. Additionally, in Sub-Task 1.5, LLNL has performed a gap analysis of electronic tools, handbooks, and job-aides currently available to the ROSS and developed recommendations for additional and next generation tools to ensure the operational effectiveness of the ROSS position. This document summarizes the feedback received from the instructors and pilot course observers on what worked in the course and what could be improved as well as an assessment of the Pre- and Post-Test administered to the students.
Yoshimura, Chie; Momose, Yasuyuki; Horie, Takeo; Komase, Yuko; Niimi, Akio; Dobashi, Kunio; Fujimoto, Keisaku; Tohda, Yuuji; Ohta, Ken; Adachi, Mitsuru
The "zero death from asthma strategy" in the medical treatment for bronchial asthma has been promoted by the Ministry of Health, Labour, and Welfare from 2006, and it indicates that medical and non-medical specialists, as well as pharmacists, should cooperate, and strives to build cooperation which is suited the actual conditions of an area. It is also important for COPD. Although hospitals in some areas cooperate with clinics and pharmacies, the overall concept of cooperation appears to be absent in most Japanese hospitals. A questionnaire was administered in early March, 2012 to 477 allergology institutions, and was authorized by an educational establishment. Among 246 replies from the institutions, cooperation between hospitals and clinics was carried out by 98 institutions (39.8%) specializing in bronchial asthma, and in 64 institutions (37.2%) specializing in COPD. However, cooperation tools were used in only 37 of these institutions (15.0%). The ability to fill prescriptions outside the hospital was available in 209 institutions (85.0%). One-hundred and seventeen institutions (47.6%) replied that they have no tools for hospital-pharmacy cooperation. Direct indications were written in prescriptions by 82 institutions (33.3). In order to build inter-regional association and to equalize medical treatment, we suggest that developing tools and organization for cooperation between health professionals who treat patients with bronchial asthma and COPD is necessary.
..., background investigation, and final review process required of career candidates, but normally they will not... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Foreign Service specialist career candidate... SERVICE OFFICERS § 11.20 Foreign Service specialist career candidate appointments. (a) General...
Despite the efforts of local school library media specialists to promote their programming, many administrators do not understand the roles and responsibilities of the school library media specialist. Using a constructivist theoretical framework, this study was designed to examine the local school administrators' perceptions of the role of the…
Doody, Owen; Slevin, Eamonn; Taggart, Laurence
To explore families' perceptions of the contribution of clinical nurse specialists in intellectual disability nursing in Ireland. Clinical nurse specialists roles have developed over the years and are seen as complex and multifaceted, causing confusion, frustration and controversy. 2001 saw the formal introduction of clinical nurse specialists roles in Ireland across nursing including intellectual disability. A exploratory qualitative approach using semistructured one-to-one interviews with 10 family members regarding their perceptions of the clinical nurse specialists in intellectual disability. Data were audio-recorded, transcribed and analysed using Burnard's framework. Ethical approval was gained and access granted by service providers. The study highlights that intellectual disability clinical nurse specialists contribute and support care deliver across a range of areas, including personal caring, supporting and empowering families, liaison, education and leadership. Clinical nurse specialists have an important role and contribution in supporting families and clients, and Ireland is in a unique position to develop knowledge regarding specialist care for people with intellectual disability that can be shared nationally and internationally. Ireland is in a unique position to develop knowledge regarding specialist care for people with intellectual disability that can be shared and adapted by other healthcare professionals in other countries that do not have a specialised intellectual disability nurses. © 2017 John Wiley & Sons Ltd.
Jones, Jimmie L.
This individualized, self-paced course for training an entomology specialist was adapted from military curriculum materials for use in vocational and technical education. Completion of the course should provide students with basic information needed to accomplish the following duties of an entomology specialist: perform entomological work, apply…
Jong, Judith D. de; Heiligers, Phil; Groenewegen, Peter P.; Hingstman, Lammert
Although medical specialists primarily work full-time, part-time work is on the increase, a trend that can be found worldwide. This article seeks to answer the question why some medical specialists work part-time, while others do not although they are willing to work part-time. Two approaches are
Seddon, Frederick; Biasutti, Michele
Prior research has revealed that non-music specialist trainee primary school teachers lack confidence in teaching music in spite of changes to teacher training and the introduction of music in the National Curriculum in England. The current study investigated the effects on non-music specialist trainee primary teachers' confidence to teach music…
Crisan, Cosette; Rodd, Melissa
A non-specialist teacher of mathematics is a school teacher who qualified to teach in a subject other than mathematics yet teaches mathematics to students in secondary school. There is an emerging interest internationally in this population, a brief report of which is given in the paper. Because of concerns about the quality of non-specialists'…
Gu, Feishi; Gu, Lingyuan
This study examines how mathematics teaching research specialists mentor practicing teachers during post-lesson debriefs of a lesson study in China. Based on a systematic, fine-grained analysis of 107 h of videotaped mentoring meetings of 20 groups of teachers and teaching research specialists from different elementary schools, this study reveals…
Sinkinson, Anne J.
The research took place in a mathematics and computing specialist school. The article reports on part of a case study of the mathematics department's experience of being a major contributor to the requirements of being a specialist school. This article aims to explore and describe one model of partnership within the "community" remit of…
Miller, Mary Mock
Reports on the Division of School Media Specialists of the Association for Educational Communications and Technology (AECT). Highlights include the mission statement; publications; board members and committee chairs; activities at the AECT conferences; and future concerns, including public relations and marketing plans for media specialists and…
Berendsen, Annette J.; Benneker, Wim H. G. M.; Schuling, Jan; Rijkers-Koorn, Nienke; Slaets, Joris P. J.; Meyboom-de Jong, Betty
Background: Collaboration between general practitioners (GPs) and specialists has been the focus of many collaborative care projects during the past decade. Unfortunately, quite a number of these projects failed. This raises the question of what motivates medical specialists to initiate and continue
Schutte, T.; Van Eekeren, R.; Richir, M.; Van Staveren, J.; Van Puijenbroek, E.P.; Tichelaar, J.; Van Agtmael, M.A.
Background: In a new prescribing qualifcation course for specialist oncology nurses, we thought it important to emphasize pharma-covigilance and adverse drug reaction (ADR)-reporting. To this end, our aim was to develop and evaluate an ADR reporting assignment for specialist oncology nurses.
... DEPARTMENT OF TRANSPORTATION Surface Transportation Board [Docket No. FD 35726] Transport Handling Specialists, Inc.--Continuance in Control Exemption--RSL Railroad, LLC Transport Handling Specialists, Inc. (THS), has filed a verified notice of exemption (Notice) under 49 CFR 1180.2(d)(2) to continue in...
Levine, Martin Lyon
There is a gap, it is suggested, separating the generally cultured person, not just from the scientist, but from specialists in many fields. Dictionary definitions are seen as one means of seeing the extent to which specialists and those in the general culture speak the same language. (MLW)
Brooks, Caroline; Thompson, Maree Dinan
The purpose of this study is to provide an authentic and legitimate voice to the physical education (PE) specialist teacher in the primary school and to give an insight into professional knowledge. An autoethnographic approach has been used to invite readers to enter my world of the primary PE specialist teacher and observe and respond to its…
Laurent, Jeff; Runia, Elizabeth
The scholarly productivity of school psychology faculty members in specialist-level only programs was examined. Information was gathered from the School Psychology Program Information portion of the website for the National Association of School Psychologists. A total of 137 specialist-level only school psychology programs were identified.…
Quresh S. Latif; Victoria A. Saab; Jonathan G. Dudley; Jeff P. Hollenbeck
To conserve habitat for disturbance specialist species, ecologists must identify where individuals will likely settle in newly disturbed areas. Habitat suitability models can predict which sites at new disturbances will most likely attract specialists. Without validation data from newly disturbed areas, however, the best approach for maximizing predictive accuracy can...
Brooks, Caroline; DinanThompson, Maree
This paper provides a context for exploring the positioning of Physical Education specialist teachers (PE specialist teachers) in primary schools in Queensland in the discourses of teacher professionalism. A critical analysis of literature on the history and status of the subject and its practitioners aims to contextualize discourses in and about…
McKenzie, James F.; Dennis, Dixie; Auld, M. Elaine; Lysoby, Linda; Doyle, Eva; Muenzen, Patricia M.; Caro, Carla M.; Kusorgbor-Narh, Cynthia S.
The Health Education Specialist Practice Analysis 2015 (HESPA 2015) was conducted to update and validate the Areas of Responsibilities, Competencies, and Sub-competencies for Entry- and Advanced-Level Health Education Specialists. Two data collection instruments were developed--one was focused on Sub-competencies and the other on knowledge items…
van Bergen, Diana; Huisman, Annemiek
The emergence of peer specialists with a history of suicidality who work with suicidal care consumers is a recent phenomenon that increasingly receives attention in the field of suicide prevention. Peer specialists aim at: 1) Establishing a more open discussion of suicidality; 2) Enabling attempt
Vlasova, Vera K.; Vakhidova, Luycia V.
Professional self-effectiveness is a key quality of a modern specialist together with cultural, general professional and professional competences, which are realized in his further activity. But in normative documents regulating preparation of a specialist, this quality is not present. The aim of the article is in working out a conception of…
The efficacy of the direct clinical intervention for infectious diseases by a pediatric infectious disease specialist in the pediatric ward of a tertiary medical facility without a pediatric antimicrobial stewardship program.
Hoshina, T; Yamamoto, N; Ogawa, M; Nakamoto, T; Kusuhara, K
Antimicrobial stewardship programs (ASPs) have been introduced in most hospital complexes; however, they are not always useful for pediatric patients. The aim of this study is to investigate the efficacy of direct clinical intervention for infectious diseases by a pediatric infectious disease specialist in a tertiary medical facility without pediatric ASP. This retrospective study included 1,821 patients who were hospitalized in the pediatric ward of a large metropolitan hospital from 2010 to 2015. The clinical course, the use of intravenous antimicrobial agents and the results of a microbiological analysis were compared between the period after the beginning of direct intervention by the specialist (post-intervention period) and the previous period (pre-intervention period). In the post-intervention period, the proportion of the patients who received intravenous antimicrobial agents, the number of antimicrobial agents used for each episode, and the proportion of episodes in which an antimicrobial agent was re-administrated were significantly lower (P = 0.006, P = 0.004, P = 0.036, respectively), and the duration of antimicrobial treatment was significantly shorter (P infectious diseases specialist is useful for the treatment of infectious diseases in the pediatric ward of a tertiary medical facility without a pediatric ASP. The creation of a pediatric ASP is recommended in hospital complexes.
Financial statement audits are still comparatively poor in fraud detection. Forensic specialists can play a significant role in increasing audit quality. In this paper, based on prior academic research, I develop a model of fraud detection and the incorporation of forensic specialists in the audit...... process. The intention of the model is to identify the reasons why the audit is weak in fraud detection and to provide the analytical framework to assess whether the incorporation of forensic specialists can help to improve it. The results show that such specialists can potentially improve the fraud...... detection in the audit, but might also cause some negative implications. Overall, even though fraud detection is one of the main topics in research there are very few studies done on the subject of how auditors co-operate with forensic specialists. Thus, the paper concludes with suggestions for further...
Kjaer, N. K.; Clausen, L. W.; Qvesel, D.
was 58 months. 6% of the recruited doctors had a PhD. 61% of the doctors were graduates from the University of Southern Denmark. 14% graduated from the University of Copenhagen and 12% from Aarhus University. Finally, 13% graduated from a foreign university. CONCLUSION: Applicants accepted for specialist......INTRODUCTION: It was previously shown that applicants for postgraduate medical specialist training in Denmark were old. In order to prevent potential shortage of specialists, the Danish health authorities have passed legislation to speed up the output of new specialists. The aim of this study...... was to highlight the present characteristics of young doctors who entered specialist training. MATERIAL AND METHODS: Data include 443 doctors who were enrolled in a formalized postgraduate medical training programme in the Region of Southern Denmark from 2009 to 2011. RESULTS: 41% of the recruited young doctors...
Виктор Семенович Корнилов
Full Text Available This paper deals with implementation of information technologies within different levels of professional training of the future specialists at A. Yassawi International Kazakh-Turkish University. Information technologies enable the future specialists to engage in online exchanges and it gives great good opportunity in learning the subject efficiently; thereby expanding their study and learning community during the classroom activity. The results obtained by the use of the information technologies show improvements in professional training of the future specialists in teaching foreign language. The use of information technology in teaching is increasing, which should lead to a significant improvement of the training quality of future specialists. Improvements also are observed in the experimental groups of higher levels, which indicates the efficiency of the use of information technologies in the professional training of future specialists.
Pazarli Bostan, Pınar; Elbek, Osman; Kilinç, Oğuz; Akçay, Müşerref Şule; Kiran, Sibel
Although helping patients to stop smoking is a good clinical practice that has to be carried out by physicians everywhere and in every area, it is known that carrying out this help systematically in accordance to a programme in smoking cessation outpatient clinics significantly improves the chance of success. The study is a cross-sectional survey performed among chest disease specialists who are members of Turkish Thoracic Society (TTS), between June 2010 and February 2011. As independent variables relevant to status of performing/not performing Smoking Cessation Outpatient Clinic (SCOC); sex, age (younger or older than 40), being graduated before or after 1996, being or not being in a consultant position, work place (Hospital of Ministry of Health/private hospital/university hospital), having or not having an education for smoking cessation help and being or not being member of a City Tobacco Control Committee (CTCC) were investigated. Data was collected via a web-questionnaire prepared by using WHO Global Health Professionals Questionnaire which was sent to members through TTS secreteriat. 41% (699/1701) of members of TTS responded. 39.5% of responders reported that they perform SCOC. When the factors possibly affecting the performance of SCOC are evaluated with logistic regression analysis; being graduated after 1996, having an education for smoking cessation help, being a member of CTCC and not being an active smoker are found to improve this performance. Our study showed that having an education for smoking cessation help (and tobacco control) makes chest disease specialists get more responsibility on this topic. Accordingly, continuous efforts for improving awareness of personal and social responsibilities of all physicians, especially chest disease specialists, have to be made to provide their taking active roles in tobacco control.
Askarian, Mehrdad; Vakili, Mahmood; Kabir, Gholamhosein
Hospital waste is considered dangerous because it may possess pathogenic agents and can cause undesirable effects on human health and the environment. In Iran, neither rules have been compiled nor does exact information exist regarding hospital waste management. The survey presented in this article was carried out in all 15 private hospitals of Fars province (Iran) from the total numbers of 50 governmental and private hospitals located in this province, in order to determine the amount of different kinds of waste produced and the present situation of waste management. The results indicated that the waste generation rate is 4.45 kg/bed/day, which includes 1830 kg (71.44%) of domestic waste, 712 kg (27.8%) of infectious waste, and 19.6 kg (0.76%) of sharps. Segregation of the different types of waste is not carried out perfectly. Two (13.3%) of the hospitals use containers without lids for on-site transport of wastes. Nine (60%) of the hospitals are equipped with an incinerator and six of them (40%) have operational problems with the incinerators. In all hospitals municipal workers transport waste outside the hospital premises daily or at the most on alternative days. In the hospitals under study, there aren't any training courses about hospital waste management and the hazards associated with them. The training courses that are provided are either ineffective or unsuitable. Performing extensive studies all over the country, compiling and enacting rules, establishing standards and providing effective personnel training are the main challenges for the concerned authorities and specialists in this field
O'Sullivan, Belinda G; McGrail, Matthew R; Stoelwinder, Johannes U
Objective Targeting rural outreach services to areas of highest relative need is challenging because of the higher costs it imposes on health workers to travel longer distances. This paper studied whether subsidies have the potential to support the provision of specialist outreach services into more remote locations. Methods National data about subsidies for medical specialist outreach providers as part of the Wave 7 Medicine in Australia: Balancing Employment and Life (MABEL) Survey in 2014. Results Nearly half received subsidies: 19% (n=110) from a formal policy, namely the Australian Government Rural Health Outreach Fund (RHOF), and 27% (n=154) from other sources. Subsidised specialists travelled for longer and visited more remote locations relative to the non-subsidised group. In addition, compared with non-subsidised specialists, RHOF-subsidised specialists worked in priority areas and provided equally regular services they intended to continue, despite visiting more remote locations. Conclusion This suggests the RHOF, although limited to one in five specialist outreach providers, is important to increase targeted and stable outreach services in areas of highest relative need. Other subsidies also play a role in facilitating remote service distribution, but may need to be more structured to promote regular, sustained outreach practice. What is known about this topic? There are no studies describing subsidies for specialist doctors to undertake rural outreach work and whether subsidies, including formal and structured subsidies via the Australian Government RHOF, support targeted outreach services compared with no financial support. What does this paper add? Using national data from Australia, we describe subsidisation among specialist outreach providers and show that specialists subsidised via the RHOF or another source are more likely to provide remote outreach services. What are the implications for practitioners? Subsidised specialist outreach providers are
Aliu, Oluseyi; Sun, Gordon; Burke, James; Chung, Kevin C; Davis, Matthew M
Improving coordination of care and containing healthcare costs are prominent goals of healthcare reform. Specialist involvement in healthcare delivery transformation efforts like Accountable Care Organizations (ACOs) is necessary to achieve these goals. However, patients’ self-referrals to specialists may undermine care coordination and incur unnecessary costs if patients frequently receive care from specialists not engaged in such healthcare delivery transformation efforts. Additionally, frequent self-referrals may also diminish the incentive for specialist participation in reform endeavors like ACOs to get access to a referral base. To examine recent national trends in self-referred new visits to specialists. A descriptive cross-sectional study of new ambulatory visits to specialists from 2000 to 2009 using data from the National Ambulatory Medical Care Survey. We calculated nationally representative estimates of the proportion of new specialist visits through self-referrals among Medicare and private insurance beneficiaries. We also estimated the nationally representative absolute number of self-referred new specialist visits among both groups of beneficiaries. Among Medicare and private insurance beneficiaries, self-referred visits declined from 32.2% (95% confidence interval [CI], 24.0%-40.4%) to 19.6% (95% CI, 13.9%-23.3%) and from 32.4% (95% CI, 27.9%-36.8%) to 24.1% (95% CI,18.8%-29.4%), respectively. Hence, at least 1 in 5 and 1 in 4 new visits to specialists among Medicare and private insurance beneficiaries, respectively, are self-referred. The current considerable rate of self-referred new specialist visits among both Medicare and private insurance beneficiaries may have adverse implications for organizations attempting to transform healthcare delivery with improved care coordination.
Andrews, Hannah; Singh, Yogen
Following the Safe and Sustainable review of Paediatric Services in 2012/2013, National Health Service England recommended that local paediatric cardiology services should be provided by specially trained paediatricians with expertise in cardiology in all non-specialist hospitals. To understand the variation in local paediatric cardiology services provided across district general hospitals in the United Kingdom. An internet-based questionnaire was sent out via the Paediatrician with Expertise in Cardiology Special Interest Group and the Neonatologists with Interest in Cardiology and Haemodynamics contact databases and the National Health Service directory. Non-responders were followed-up via telephone. The response rate was 80% (141 of 177 hospitals), and paediatricians with expertise in cardiology were available in 68% of those. Local cardiology clinics led by paediatricians with expertise in cardiology were provided in 96 hospitals (68%), whereas specialist outreach clinics were held in 123 centres (87%). A total of 11 hospitals provided neither specialist outreach clinics nor any local cardiology clinics led by paediatricians with expertise in cardiology. Paediatric echocardiography services were provided in 83% of the hospitals, 12-lead electrocardiogram in 96%, Holter electrocardiogram in 91%, and exercise testing in only 47% of the responding hospitals. Telemedicine facilities were established in only 52% of the centres, where sharing echocardiogram images via picture archiving and communication system was used most commonly. There has been a substantial increase in the availability of paediatricians with expertise in cardiology since 2008. Most of the hospitals are well-supported by specialist cardiology centres via outreach clinics; however, there remains significant variation in the local paediatric cardiology services provided across district general hospitals in the United Kingdom.
Stoeckle, J D
Use of the acute hospital has markedly decreased over the past four decades for various reasons: the decentralization of diagnostic treatment technologies to out-of-hospital sites; the clinical substitutions of quick diagnostic testing of the ambulatory patient for the longer diagnostic testing of the hospitalized patient; the diminished use of hospital bed rest and the expanded use of exercise for treatment; the corporate organization of hospital work that emphasizes efficiency; and the group practice organization of generalists and specialists that avoids hospital use for the diagnosis of complex disorders in ambulatory patients. A smaller domain for hospital bed care and renewed attention to chronic disease and prevention in the community diminish the hold of the acute hospital on care. The evolution of more collaborative, decentralized arrangements promises to be a positive development for community care.
Lawton, Rebecca J.; Cole, Andrew J.; Berumen, Michael L.; Pratchett, Morgan S.
Localised patterns of resource use can be constrained by multiple factors. Comparison of resource use at multiple locations with differing resource availability can allow fundamental specialists to be distinguished from species that simply feed predominantly on prey types that are locally abundant. This study investigates geographic variation in the feeding ecology of coral-feeding butterflyfishes to examine whether patterns of resource use and levels of dietary specialisation vary among distinct locations, corresponding with changes in resource availability. Our specific aims were to investigate whether the dietary niche breadth of four butterflyfishes varies among five geographically separated locations and assess whether each species utilises similar resources in each location. Resource availability and dietary composition of four butterflyfishes were quantified at three sites across each of five geographic locations throughout the Pacific. Niche breadth, niche overlap, and resource selection functions were calculated for each species at each site and compared among locations. Availability of dietary resources varied significantly among locations and sites. Chaetodon vagabundus, C. citrinellus and C. lunulatus had low levels of dietary specialisation and used different resources in each location. Chaetodon trifascialis had high levels of dietary specialisation and used the same few resources in each location. Our results indicate that relative levels of dietary specialisation among different butterflyfishes do hold at larger spatial scales, however, geographical variation in the dietary composition of all butterflyfishes indicates that prey availability has a fundamental influence on dietary composition. Highly specialised species such as C. trifascialis will be highly vulnerable to coral loss as they appear to be largely inflexible in their dietary composition. However, the increased feeding plasticity observed here for C. trifascialis suggests this species may
A Specialists' Meeting on LMFBR Flow-Induced Vibrations was held at ANL in the United States which was sponsored by the International Atomic Energy Agency (IAEA) on the recommendations of the International Working Group on Fast Reactors (IWGFR). It was attended by participants from France, the Federal Republic of Germany, Italy, Japan, Netherlands, the United Kingdom, the Union of Soviet Socialist Republics, the United States and the IAEA. The purpose of the meeting was to provide, for the first time, a common forum for the exchange of information on flow-induced vibration programs of the member countries. As this was a first meeting, information was sought in the broad areas of: 1. Design Criteria and Problem Areas in LMFBR Design; 2. Current Design Procedures; and 3. Ongoing Research. A session was devoted to each of the above topics wherein papers were presented and discussed followed by open discussions on the session topic. The objective of the open discussions was to identify, from a review of specific reactor designs, (a) flow induced vibration problem areas (expected and observed) and their potential for occurrence; (b) failure modes and associated design criteria; (c) specific components that are susceptible to flow induced vibration; and (d) probable excitation mechanisms. It was aimed to assess the current state-of-the-art in designing to avoid flow induced vibration with consideration of licensing requirements; to evaluate existing methods of analysis, testing, and surveillance, along with their limitations and to identify areas requiring research and review ongoing research programmes relative to these research needs
A Specialists' Meeting on LMFBR Flow-Induced Vibrations was held at ANL in the United States which was sponsored by the International Atomic Energy Agency (IAEA) on the recommendations of the International Working Group on Fast Reactors (IWGFR). It was attended by participants from France, the Federal Republic of Germany, Italy, Japan, Netherlands, the United Kingdom, the Union of Soviet Socialist Republics, the United States and the IAEA. The purpose of the meeting was to provide, for the first time, a common forum for the exchange of information on flow-induced vibration programs of the member countries. As this was a first meeting, information was sought in the broad areas of: 1. Design Criteria and Problem Areas in LMFBR Design; 2. Current Design Procedures; and 3. Ongoing Research. A session was devoted to each of the above topics wherein papers were presented and discussed followed by open discussions on the session topic. The objective of the open discussions was to identify, from a review of specific reactor designs, (a) flow induced vibration problem areas (expected and observed) and their potential for occurrence; (b) failure modes and associated design criteria; (c) specific components that are susceptible to flow induced vibration; and (d) probable excitation mechanisms. It was aimed to assess the current state-of-the-art in designing to avoid flow induced vibration with consideration of licensing requirements; to evaluate existing methods of analysis, testing, and surveillance, along with their limitations and to identify areas requiring research and review ongoing research programmes relative to these research needs.
Lundh, Andreas; Skjelsager, Karen; Wildgaard, Kim
The seven roles of the CanMEDS system have been implemented in Danish postgraduate medical training. For each medical specialty, a professional profile describes which elements of the seven roles the specialty deems important for applicants for a specialist training position. We investigated use of professional profiles among the 38 Danish specialty societies in order to ascertain the use of the seven roles. We used information from the websites of the Postgraduate Medical Training Secretariats in March 2012. For each profile, we extracted information on how the seven roles were described, how the roles were ranked by importance, whether a score sheet was used by the appointment committee and whether the profile had been updated. Twenty-four (63%) of the 38 profiles described the contents for all of the seven roles and four (11%) described the contents only for some of the roles. Nine specialties (24%) described a clear ranking of the seven roles with the medical expert and scholar roles generally ranked as most important. Seven specialties (18%) used standardised score sheets as part of the application process. Four (11%) specialties had updated their professional profiles. The majority of specialties described the seven roles in their professional profiles, but the level of detail varied substantially. Few specialties described whether the roles were ranked by importance or provided specific guidelines for appointment committees on how the contents of the profiles should be interpreted. We suggest that specialties seek inspiration for updating their profiles, and that they use the contents from all specialties provided at a website. not relevant. not relevant.
This article, based on information from specialists at Johns Hopkins, poses and then answers 3 broad questions about the acquired immunodeficiency syndrome (AIDS). 1st, it is asked, "What is AIDS and how serious is it?" It is noted that AIDS is only 1 of several forms taken by infection with the human T-lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV). The earliest form of infection is believed to occur within a few weeks of exposure to the virus, and some patients develop an acute syndrome that resembles infectious mononucleosis. These symptoms disappear after 4-6 weeks, by which time the patient has developed antibodies to the virus. About 2-4%/year of asymptomatic carriers go on to develop AIDS-related complex (ARC), and 15-30% of ARC patients develop AIDS within 5 years. The 2nd question posed is, "How do you catch AIDS?" To cause infection, the virus must go directly into the blood, although the virus alone may not be enough to cause sickness. Previous viral infections such as hepatitis B, herpes, cytomegalovirus, and intestinal parasites have been suggested as co-factors of AIDS. Promiscuity increases the chances of contracting AIDS. Observations of the families of AIDS patients and health care personnel who work with AIDS patients suggest that AIDS cannot be caught by casual contact. Finally, it is asked, "What is being done about AIDS?" 4 strategies are outlined: 1) as a result of donor screening for antibodies to HTLV-III/LAV, AIDS has been completely removed from the blood banks; 2) virologists are attempting to understand the virus so that it can be attacked, and understanding has been advanced by the theory that HTLV-III might be what is called a "slow virus;" 3) education about AIDS is changing the sexual practices that transmit AIDS; and 4) epidemiologists are carefully following those who are at risk, have been exposed, or are already sick.
Tschuschke, C; Uhthoff, H
The guidelines on outpatient specialist medical treatment (ASV) according to § 116b of the Social Act were published by the Federal Joint Committee on 21 March 2013. The guidelines regulate the framework conditions for the new area of healthcare and the requirements for potential participants. The ASV guidelines are designed to ultimately bridge the sectorial borders for the treatment of rare diseases and those with unusual courses. In the past the reforms in § 116b have not fulfilled the criteria expected by the legislation. The reforms have already led to an increase in the costs for medical services by a factor of 50 within 6 years. The spectrum of diseases to be treated has remained practically unchanged. The healthcare providers must now fulfil a catalogue of prerequisites which will be formulated by the Federal Joint Committee for each entity in the still to be provided annexes to the guidelines in order to be approved on notification by the extended National Committee. The guidelines are based on the prototype further education regulations according to the old law. An important detail is the obligatory formation of cooperation and teams for all participants outside the traditional sectorial limits. Each partner must perform the duties at least 1 day in the week at the site of the team leader. Specific and organizational requirements, extent of treatment and lower limits will be regulated by the still to be formulated annexes. Costing and business effectiveness will be tested by the medical services. No patient has yet been treated under the ASV but the winner is already known: bureaucracy.
Mohr, Lynn D; Coke, Lola A
Today's healthcare environment poses diverse and complex patient care challenges and requires a highly qualified and experienced nursing workforce. To mitigate these challenges are graduate nursing roles, each with a different set of competencies and expertise. With the availability of many different graduate nursing roles, both patients and healthcare professionals can be confused in understanding the benefit of each role. To gain the maximum benefit from each role, it is important that healthcare providers and administrators are able to distinguish the uniqueness of each role to best use the role and develop strategies for effective collaboration and interprofessional interaction. The purpose of this article was to define the role, educational preparation, role differences, and practice competencies for the clinical nurse specialist (CNS), nurse practitioner, clinical nurse leader, and nurse educator/staff development educator roles. A second purpose was to provide role clarity and demonstrate the unique value the CNS brings to the healthcare environment. Using evidence and reviewing role competencies established by varying organizations, each role is presented with similarities and differences among the roles discussed. In addition, collaboration among the identified roles was reviewed, and recommendations were provided for the new and practicing CNSs. Although there are some similarities among the graduate nursing roles such as in educational, licensing, and certification requirements, each role must be understood to gain the full role scope and benefit and glean the anticipated outcomes. Healthcare providers must be aware of the differences in graduate nursing roles, especially in comparing the CNS with other roles to avoid confusion that may lead to roles being underused with a limited job scope. The CNS provides a unique set of services at all system outcome levels and is an essential part of the healthcare team especially in the acute care setting.
Weller, J M; Castanelli, D J; Chen, Y; Jolly, B
Workplace-based assessments should provide a reliable measure of trainee performance, but have met with mixed success. We proposed that using an entrustability scale, where supervisors scored trainees on the level of supervision required for the case would improve the utility of compulsory mini-clinical evaluation exercise (CEX) assessments in a large anaesthesia training program. We analysed mini-CEX scores from all Australian and New Zealand College of Anaesthetists trainees submitted to an online database over a 12-month period. Supervisors' scores were adjusted for the expected supervision requirement for the case for trainees at different stages of training. We used generalisability theory to determine score reliability. 7808 assessments were available for analysis. Supervision requirements decreased significantly (P 0.7) with a feasible number of assessments. Adjusting scores against the expected supervision requirement considerably improved reliability, with G > 0.8 achieved with only nine assessments. Three per cent of trainees generated average mini-CEX scores below the expected standard. Using an entrustment scoring system, where supervisors score trainees on the level of supervision required, mini-CEX scores demonstrated moderate reliability within a feasible number of assessments, and evidence of validity. When scores were adjusted against an expected standard, underperforming trainees could be identified, and reliability much improved. Taken together with other evidence on trainee ability, the mini-CEX is of sufficient reliability for inclusion in high stakes decisions on trainee progression towards independent specialist practice. © The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: firstname.lastname@example.org.
Lawton, Rebecca J.
Localised patterns of resource use can be constrained by multiple factors. Comparison of resource use at multiple locations with differing resource availability can allow fundamental specialists to be distinguished from species that simply feed predominantly on prey types that are locally abundant. This study investigates geographic variation in the feeding ecology of coral-feeding butterflyfishes to examine whether patterns of resource use and levels of dietary specialisation vary among distinct locations, corresponding with changes in resource availability. Our specific aims were to investigate whether the dietary niche breadth of four butterflyfishes varies among five geographically separated locations and assess whether each species utilises similar resources in each location. Resource availability and dietary composition of four butterflyfishes were quantified at three sites across each of five geographic locations throughout the Pacific. Niche breadth, niche overlap, and resource selection functions were calculated for each species at each site and compared among locations. Availability of dietary resources varied significantly among locations and sites. Chaetodon vagabundus, C. citrinellus and C. lunulatus had low levels of dietary specialisation and used different resources in each location. Chaetodon trifascialis had high levels of dietary specialisation and used the same few resources in each location. Our results indicate that relative levels of dietary specialisation among different butterflyfishes do hold at larger spatial scales, however, geographical variation in the dietary composition of all butterflyfishes indicates that prey availability has a fundamental influence on dietary composition. Highly specialised species such as C. trifascialis will be highly vulnerable to coral loss as they appear to be largely inflexible in their dietary composition. However, the increased feeding plasticity observed here for C. trifascialis suggests this species may
Sievers, Beth; Wolf, Sherry
Without formal education, many healthcare professionals fail to develop interdisciplinary team skills; however, when students are socialized to interdisciplinary practice through academic clinical learning experiences, effective collaboration skills can be developed. Increasingly, educational environments are challenged to include clinical experiences for students that teach and model interdisciplinary collaboration. The purpose of this quality improvement initiative was to create an interdisciplinary educational experience for clinical nurse specialist (CNS) students and postgraduate physicians. The interdisciplinary learning experience, supported by an educational grant, provided an interdisciplinary cohort of learners an opportunity to engage in a clinically focused learning experience. The interdisciplinary cohort consisted of CNS students and physicians in various stages of postgraduate training. The clinical experience selected was a quality improvement initiative in which the students were introduced to the concepts and tools of quality improvement. During this 1-month clinical experience, students applied the new skills by implementing a quality improvement project focusing on medication reconciliation in the outpatient setting. The CNS core competencies and outcomes were used to shape the experience for the CNS students. The CNS students exhibited 5 of the 7 essential characteristics of the CNS (leadership, collaboration, consultation skills, ethical conduct, and professional attributes) while demonstrating competencies and fulfilling performance expectations. During this learning experience, the CNS students focused on competencies and outcomes in the organizational sphere of influence. Multiple facilitating factors and barriers were identified. This interdisciplinary clinical experience in a quality improvement initiative provided valuable opportunities for CNS students to develop essential CNS characteristics and to explore practice competencies in the
Levy, M L; Robb, M; Allen, J; Doherty, C; Bland, J M; Winter, R J
We investigated whether hospital-based specialist asthma nurses improved recognition and self-treatment of asthma episodes by patients followed up after attending accident and emergency departments (A&E) for asthma exacerbations. We carried out a randomized prospective controlled trial of adult asthma self-management, following a hospital outpatient nurse consultation in two outer-London District General Hospitals (secondary care centres). The study included 211 adults, over 18 years old (mean age 40 years) who attended for asthma in two accident and emergency departments over 13 months. One hundred and eight evaluable patients were randomized into the control group who continued with their usual medical treatment and were not offered any intervention during the study period. One hundred and three evaluable patients were randomized into the intervention group. They were offered three 6-weekly outpatient appointments with one of two specialist asthma nurses for a structured asthma consultation, after attendance at the accident and emergency department. Following assessment of their asthma treatment and control, the nurses advised patients, through the use of self-management-plans, how to recognize and manage uncontrolled asthma and when to seek medical assistance. Medication and inhaler device type were altered if necessary The primary outcome was patient reported self-management of asthma exacerbations for 6 months. Secondary outcomes were assessed at baseline, 3 months and 6 months. These included home peak flow and symptom diaries, structured telephone questionnaires and audit of general practitioner records to determine utilization of services (6 months before and after A&E). Data were analysed on an intention to treat basis by multiple and logistic regression. The intervention group increased their use of inhaled topical steroids in 31/61 (51%) vs. 15/70 (21%) attacks in controls (OR 3.91 CI 1.8-8.4, Pentry. Thirty-four percent of intervention patients vs. 42
U.S. Department of Health & Human Services — Hospital Outpatient Prospective Payment System (OPPS) Partial Hospitalization Program LDS This file contains select claim level data and is derived from 2010 claims...
Sadat, Somayeh; Abouee-Mehrizi, Hossein; Carter, Michael W
In this paper, we consider two hospitals with different perceived quality of care competing to capture a fraction of the total market demand. Patients select the hospital that provides the highest utility, which is a function of price and the patient's perceived quality of life during their life expectancy. We consider a market with a single class of patients and show that depending on the market demand and perceived quality of care of the hospitals, patients may enjoy a positive utility. Moreover, hospitals share the market demand based on their perceived quality of care and capacity. We also show that in a monopoly market (a market with a single hospital) the optimal demand captured by the hospital is independent of the perceived quality of care. We investigate the effects of different parameters including the market demand, hospitals' capacities, and perceived quality of care on the fraction of the demand that each hospital captures using some numerical examples.
Zhou, Ying; Yuan, Huikang; Li, Yang; Zhao, Xia; Yi, Lihua
The rapidly advancing implementation of public hospital reform urgently requires the identification and classification of a pool of exceptional medical specialists, corresponding with incentives to attract and retain them, providing a nucleus of distinguished expertise to ensure public hospital preeminence. This paper examines the significance of academic leadership, from a strategic management perspective, including various tools, methods and mechanisms used in the theory and practice of performance evaluation, and employed in the selection, training and appointment of academic leaders. Objective methods of assessing leadership performance are also provided for reference.
Cui, Jing; Zhou, Lingjun; Zhang, Lingjuan; Li, Li; Zhao, Jijun
To train pain nursing specialists through a pain education program, 20 nurses from six hospitals in Shanghai Province and seven in six provinces of China received the training of 2-month pain education and 4-month clinical practice. This nonrandomized pilot study examined the results of tests before and after the program, case report evaluations, future plan evaluations, clinical practice, and satisfaction questionnaire. After the program, the score of the test increased significantly compared with that before the program (44.1 ± 3.19; paired-sample t = 10.363; p pain management, 17 (85%) thought that the program had improved their skills in clinical practice, and 15 (75%) thought that the program had played a role in enhancing their research abilities. Considering the whole program, most students (n = 17; 85%) were quite satisfied, and 3 (15%) were simply satisfied. By content analysis of the opening questions, we found that the participants had deeper and broader ideas about nurses' role and pain nursing specialists' responsibilities in pain management. The program improved nurses' attitudes, knowledge, and skills in pain management. The participants recognized pain nursing specialists' responsibilities in pain management more clearly. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
Suner, Aslı; Oruc, Ozlem Ege; Buke, Cagri; Ozkaya, Hacer Deniz; Kitapcioglu, Gul
Hand hygiene is one of the most effective attempts to control nosocomial infections, and it is an important measure to avoid the transmission of pathogens. However, the compliance of healthcare workers (HCWs) with hand washing is still poor worldwide. Herein, we aimed to determine the best hand hygiene preference of the infectious diseases and clinical microbiology (IDCM) specialists to prevent transmission of microorganisms from one patient to another. Expert opinions regarding the criteria that influence the best hand hygiene preference were collected through a questionnaire via face-to-face interviews. Afterwards, these opinions were examined with two widely used multi-criteria decision analysis (MCDA) methods, the Multi-Attribute Utility Theory (MAUT) and the Analytic Hierarchy Process (AHP). A total of 15 IDCM specialist opinions were collected from diverse private and public hospitals located in İzmir, Turkey. The mean age of the participants was 49.73 ± 8.46, and the mean experience year of the participants in their fields was 17.67 ± 11.98. The findings that we obtained through two distinct decision making methods, the MAUT and the AHP, suggest that alcohol-based antiseptic solution (ABAS) has the highest utility (0.86) and priority (0.69) among the experts' choices. In conclusion, the MAUT and the AHP, decision models developed here indicate that rubbing the hands with ABAS is the most favorable choice for IDCM specialists to prevent nosocomial infection.
... this page: //medlineplus.gov/ency/patientinstructions/000618.htm Help prevent hospital errors To use the sharing features ... in the hospital. If You Are Having Surgery, Help Keep Yourself Safe Go to a hospital you ...
Full Text Available The issue of whether to establish Specialist Chambers within the Kosovo justice system for alleged war crimes committed in Kosovo has been, arguably, one of the most heated debates not only from a political and social point of view, but also from a legal one. While the required amendments in the Constitution and several laws of Kosovo necessary to establish the Specialist Chambers in furtherance of the agreement dated 14 April 2014 between the Republic of Kosovo and the European Union on the Mission of the European Union Rule of Law Mission in Kosovo (“EULEX” will certainly create heated debates in the political level, one may argue that the legal issues that are expected to be encountered when the Specialist Chambers will be operational, may be even more pressing. This is in consideration of the peculiar nature of the Specialist Chambers, which are meant to have their basis within the laws of Kosovo, but at the same time, be independent from them and from control of Kosovo authorities. The purpose of this article is to delineate the possible legal issues that might confront the Specialist Chambers of Kosovo. Its main argument is that, while the Specialist Chambers seem to follow the experience of other hybrid internationalised courts, it still differs from them in some aspects. The challenges that the new Specialist Chambers may need to tackle deal with its jurisdiction and position within the Kosovo Judicial system, and its legitimacy and legal basis.
Cheung, Gary; Casey, Jane
Suicide in older people is a growing public health concern in many parts of the world. The literature on this issue is lacking in New Zealand. The aim of this study is to ascertain whether this group is accessing specialist psychogeriatric services. A retrospective case series study of completed suicides in older people (≥65 years) during a three-year period from January 2010 to December 2012 was performed. An online survey detailing demographic and clinical information was completed by psychiatrists in 15 of the 20 District Health Boards in New Zealand. Only about 15% of older people who committed suicide were accessing specialist psychogeriatric services and the group with the highest suicide rate (men≥85 years) did not feature in specialist services. Depression (61%) was the most common diagnosis and nearly half (35%) had had contact with specialist services within three days prior to the suicide. Over half (52%) had a history of past suicide attempt(s). Older people who complete suicide are infrequently accessing specialist services. In those that do, there are questions to be answered regarding suicide prediction and prevention for this high-risk group of vulnerable individuals. More research is required targeting those not accessing specialist services, in particular the high risk group of older men. The role of general practitioner, community care, the assessment and management of depression and whether there is any access issue to specialist psychogeriatric services require elucidation. © The Royal Australian and New Zealand College of Psychiatrists 2014.
Badger, Nathan J; Frizelle, Dorothy; Adams, Debi; Johnson, Miriam J
UK guidelines recommend palliative care access for people with Parkinson's disease; however, this remains sporadic, and it is unknown whether specialist palliative care helps patients and carers cope with this distressing condition. This study aimed to explore whether, and how, access to specialist palliative care services affected patients' and carers' coping with Parkinson's disease. Semistructured interviews were conducted, audio-recorded and verbatim transcribed. Data were analysed using interpretative phenomenological analysis. Participants were patients with advanced idiopathic Parkinson's disease (n=3), and carers of people with Parkinson's disease (n=5, however, one diagnosis was reviewed) receiving care from an integrated specialist palliative care and Parkinson's disease service in North East England. Access to specialist palliative care helped participants cope with some aspects of advanced Parkinson's disease. Three superordinate themes were developed:' managing uncertainty', 'impacts on the self' and 'specialist palliative care maintaining a positive outlook'. Specialist palliative care helped patients and carers cope with advanced Parkinson's disease. Specialist palliative care is a complex intervention that acknowledges the complex and holistic nature of Parkinson's disease, enabling health in some domains despite continued presence of pathology. These exploratory findings support the utility of this approach for people living with Parkinson's disease. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Full Text Available Abstract Background The aim of this study is to describe the magnitude of educational inequalities in utilisation of general practitioner (GP and specialist services in 9 European countries. In addition to West European countries, we have included 3 Eastern European countries: Hungary, Estonia and Latvia. To cover the gap in knowledge we pay a special attention to the magnitude of inequalities among patients with chronic conditions. Methods Data on the use of GP and specialist services were derived from national health surveys of Belgium, Estonia, France, Germany, Hungary, Ireland, Latvia, the Netherlands and Norway. For each country and education level we calculated the absolute prevalence and relative inequalities in utilisation of GP and specialist services. In order to account for the need for care, the results were adjusted by the measure of self-assessed health. Results People with lower education used GP services equally often in most countries (except Belgium and Germany compared with those with a higher level of education. At the same time people with a higher education used specialist care services significantly more often in all countries, except in the Netherlands. The general pattern of educational inequalities in utilisation of specialist care was similar for both men and women. Inequalities in utilisation of specialist care were equally large in Eastern European and in Western European countries, except for Latvia where the inequalities were somewhat larger. Similarly, large inequalities were found in the utilisation of specialist care among patients with chronic diseases, diabetes, and hypertension. Conclusions We found large inequalities in the utilisation of specialist care. These inequalities were not compensated by utilisation of GP services. Of particular concern is the presence of inequalities among patients with a high need for specialist care, such as those with chronic diseases.
Stirbu, Irina; Kunst, Anton E; Mielck, Andreas; Mackenbach, Johan P
The aim of this study is to describe the magnitude of educational inequalities in utilisation of general practitioner (GP) and specialist services in 9 European countries. In addition to West European countries, we have included 3 Eastern European countries: Hungary, Estonia and Latvia. To cover the gap in knowledge we pay a special attention to the magnitude of inequalities among patients with chronic conditions. Data on the use of GP and specialist services were derived from national health surveys of Belgium, Estonia, France, Germany, Hungary, Ireland, Latvia, the Netherlands and Norway. For each country and education level we calculated the absolute prevalence and relative inequalities in utilisation of GP and specialist services. In order to account for the need for care, the results were adjusted by the measure of self-assessed health. People with lower education used GP services equally often in most countries (except Belgium and Germany) compared with those with a higher level of education. At the same time people with a higher education used specialist care services significantly more often in all countries, except in the Netherlands. The general pattern of educational inequalities in utilisation of specialist care was similar for both men and women. Inequalities in utilisation of specialist care were equally large in Eastern European and in Western European countries, except for Latvia where the inequalities were somewhat larger. Similarly, large inequalities were found in the utilisation of specialist care among patients with chronic diseases, diabetes, and hypertension. We found large inequalities in the utilisation of specialist care. These inequalities were not compensated by utilisation of GP services. Of particular concern is the presence of inequalities among patients with a high need for specialist care, such as those with chronic diseases. © 2011 Stirbu et al; licensee BioMed Central Ltd.
Hulsman, Robert L.; Ros, Wynand J. G.; Winnubst, Jacques A. M.; Bensing, Jozien M.
Background Although doctor-patient communication is important in health care, medical specialists are generally not well trained in communication skills. Conventional training programmes are generally time consuming and hard to fit into busy working schedules of medical specialists. A