Why are some medical specialists working part-time, while others work full-time?

NARCIS (Netherlands)

Jong, Judith D. de; Heiligers, Phil; Groenewegen, Peter P.; Hingstman, Lammert

2006-01-01

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

Collaboration with general practitioners: preferences of medical specialists – a qualitative study

Directory of Open Access Journals (Sweden)

Slaets Joris PJ

2006-12-01

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

Supporting smoking cessation in the medical specialist practice

NARCIS (Netherlands)

Schippers, G. M.

2004-01-01

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

Specialist medication review does not benefit short-term outcomes and net costs in continuing-care patients.

LENUS (Irish Health Repository)

Pope, George

2012-01-31

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.

[Beginners' operations and medical specialist standards : Avoidance of criminal liability and civil liability].

Science.gov (United States)

Schneider, H

2018-05-16

In all phases, patients are entitled to receive medical treatment according to medical specialist standards. This does not mean that patients necessarily have to be treated by a medical specialist. Operations performed by "beginners", e. g. assistant physicians, are permitted. However, there are increased liability risks, both for the specialist and the assistant physician. Furthermore, there are risks of criminal responsibility for causing bodily harm by negligence or negligent manslaughter. This article portrays the requirements of civil liability and criminal responsibility concerning beginners' operations on the basis of cases and judgments of the Federal Court and the Higher Regional Courts in Germany. Additionally, the reception of the jurisprudence by the relevant legal literature will be discussed. Jurisprudence and legal literature categorize breaches of duty of care. Assistant physicians can be subject to contributory negligence liabilities, while specialists can bear liabilities for negligent selection, organization or supervision. Responsible specialist and assistant physicians can protect themselves (and the patient) and avoid legal risks by only performing operations adequate to their educational level or by delegating operations to beginners and ensuring intervention by a specialist by supervision of the operation which is suitable to the assistant physician's level of education.

Images of psychiatry: Attitude survey of teaching medical specialists of India

Directory of Open Access Journals (Sweden)

Suravi Patra

2017-01-01

Full Text Available Context: Attitude of teaching medical specialists shapes those of future doctors. Region-specific data on teaching medical specialists' attitudes toward psychiatry (ATP are lacking from India. Aims: This study aimed to assess the attitudes of teaching medical specialists toward psychiatry and its association with sociodemographic profile and career stage. Settings and Design: This is a cross-sectional descriptive survey. Materials and Methods: Attitude towards psychiatry (ATP was assessed from 188 specialists from All India Institute of Medical Sciences (AIIMS Bhubaneswar and AIIMS Jodhpur using modified ATP scale-30. Statistical Analysis: Descriptive statistical analysis was done using SPSS version 16.0. Associations of ATP with sociodemographic status, career stage, and family history of psychiatric illness were done using logistic regression analysis. Results: Overall response rate was 81.68%, and gender (confidence interval [C.I.]: 2.026–7.410, P = 0.000 and super-specialization (C.I.: 2.167–19.479, P = 0.021 were independent significant predictors for difference in attitudes. Female gender and super-specialization were associated with better attitudes. Ninety percent of participants had favorable attitude toward psychiatric illness. Four-fifth felt psychiatric patients to be as human as other patients and found psychiatric treatments effective. More than half felt that psychiatry does not stand among the three most exciting specialties and psychiatrists get less work satisfaction. Only one third said that they would have liked to be a psychiatrist. Conclusions: Attitudes were favorable toward patients and psychiatric interventions whereas unfavorable toward psychiatry as a discipline.

Perceived inequity: Does it explain burnout among medical specialists?

NARCIS (Netherlands)

Smets, E. M. A.; Visser, M. R. M.; Oort, F. J.; Schaufeli, W. B.; de Haes, H. J. C. J. M.

2004-01-01

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,

Pediatric Specialists

Science.gov (United States)

... 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 ...

Training Medical Specialists to Communicate Better with Patients with Medically Unexplained Physical Symptoms (MUPS. A Randomized, Controlled Trial.

Directory of Open Access Journals (Sweden)

Anne Weiland

Full Text Available Patients with medically unexplained physical symptoms (MUPS are prevalent 25-50% in general and specialist care. Medical specialists and residents often find patients without underlying pathology difficult to deal with, whereas patients sometimes don't feel understood. We developed an evidence-based communication training, aimed to improve specialists' interviewing, information-giving and planning skills in MUPS consultations, and tested its effectiveness.The intervention group in this multi-center randomized controlled trial received a 14-hour training program to which experiential learning and feedback were essential. Using techniques from Cognitive Behavioral Therapy, they were stimulated to seek interrelating factors (symptoms, cognitions, emotions, behavior, and social environment that reinforced a patient's symptoms. They were taught to explain MUPS understandably, reassure patients effectively and avoid unnecessary diagnostic testing. Before and after the intervention training, specialists videotaped a total of six consultations with different MUPS patients. These were evaluated to assess doctors' MUPS-focused communicating skills using an adapted version of the Four Habit Coding Scheme on five-point Likert scales. Participants evaluated the training by self-report on three-point Likert scales. Doctors in the control group received training after completion of the study.123 doctors (40% specialists, 60% residents and 478 MUPS patients from 11 specialties were included; 98 doctors completed the study (80% and 449 videotaped consultations were assessed. Trained doctors interviewed patients more effectively than untrained ones (p < 0.001, summarized information in a more patient-centered way (p = 0.001, and better explained MUPS and the role of perpetuating factors (p < 0.05. No effects on planning skills were found. On a 3-point scale the training was evaluated with 2.79.MUPS-focused communication training increases the interviewing and

The effectiveness of a computer-assisted instruction programme on communication skills of medical specialists in oncology

NARCIS (Netherlands)

Hulsman, Robert L.; Ros, Wynand J. G.; Winnubst, Jacques A. M.; Bensing, Jozien M.

2002-01-01

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

It's more than money: policy options to secure medical specialist workforce for regional centres.

Science.gov (United States)

May, Jennifer; Walker, Judi; McGrail, Mathew; Rolley, Fran

2017-12-01

Objectives Regional centres and their rural hinterlands support significant populations of non-metropolitan Australians. Despite their importance in the settlement hierarchy and the key medical services provided from these centres, little research has focused on their issues of workforce supply and long-term service requirements. In addition, they are a critical component of the recent growth of 'regional' hub-and-spoke specialist models of service delivery. Methods The present study interviewed 62 resident specialists in four regional centres, seeking to explore recruitment and retention factors important to their location decision making. The findings were used to develop a framework of possible evidence-informed policies. Results This article identifies key professional, social and locational factors, several of which are modifiable and amenable to policy redesign, including work variety, workplace culture, sense of community and spousal employment; these factors that can be targeted through initiatives in selection, training and incentives. Conclusions Commonwealth, state and local governments in collaboration with communities and specialist colleges can work synergistically, with a multiplicity of interdigitating strategies, to ensure a positive approach to the maintenance of a critical mass of long-term rural specialists. What is known about the topic? Rural origin increases likelihood of long-term retention to rural locations, with rural clinical school training associated with increased rural intent. Recruitment and retention policy has been directed at general practitioners in rural communities, with little focus on regional centres or medical specialists. What does this study add? Rural origin is associated with regional centre recruitment. Professional, social and locational factors are all moderately important in both recruitment and retention. Specialist medical training for regional centres ideally requires both generalist and subspecialist skills

The effect of medical malpractice liability on rate of referrals received by specialist physicians.

Science.gov (United States)

Xu, Xiao; Spurr, Stephen J; Nan, Bin; Fendrick, A Mark

2013-10-01

Using nationally representative data from the United States, this paper analyzed the effect of a state’s medical malpractice environment on referral visits received by specialist physicians. The analytic sample included 12,839 ambulatory visits to specialist care doctors in office-based settings in the United States during 2003–2007. Whether the patient was referred for the visit was examined for its association with the state’s malpractice environment, assessed by the frequency and severity of paid medical malpractice claims, medical malpractice insurance premiums and an indicator for whether the state had a cap on non-economic damages. After accounting for potential confounders such as economic or professional incentives within practices, the analysis showed that statutory caps on non-economic damages of $250,000 were significantly associated with lower likelihood of a specialist receiving referrals, suggesting a potential impact of a state’s medical malpractice environment on physicians’ referral behavior.

The effectiveness of a computer-assisted instruction programme on communication skills of medical specialists in oncology.

NARCIS (Netherlands)

Hulsman, R.L.; Ros, W.J.G.; Winnubst, J.A.M.; Bensing, J.M.

2002-01-01

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 computer-assisted

Shadowing emergency medicine residents by medical education specialists to provide feedback on non-medical knowledge-based ACGME sub-competencies

Directory of Open Access Journals (Sweden)

Waterbrook AL

2018-05-01

Full Text Available Anna L Waterbrook,1 Karen C Spear Ellinwood,2 T Gail Pritchard,3 Karen Bertels,1 Ariel C Johnson,4 Alice Min,1 Lisa R Stoneking1 1Department of Emergency Medicine, The University of Arizona College of Medicine, Tucson, AZ, USA; 2Department of Obstetrics and Gynecology, The University of Arizona College of Medicine, Tucson, AZ, USA; 3Department of Pediatrics, The University of Arizona College of Medicine, Tucson, AZ, USA; 4College of Medicine, The University of Arizona College of Medicine, Tucson, AZ, USA Objective: Non-medical knowledge-based sub-competencies (multitasking, professionalism, accountability, patient-centered communication, and team management are challenging for a supervising emergency medicine (EM physician to evaluate in real-time on shift while also managing a busy emergency department (ED. This study examines residents’ perceptions of having a medical education specialist shadow and evaluate their nonmedical knowledge skills.Methods: Medical education specialists shadowed postgraduate year 1 and postgraduate year 2 EM residents during an ED shift once per academic year. In an attempt to increase meaningful feedback to the residents, these specialists evaluated resident performance in selected non-medical knowledge-based Accreditation Council of Graduate Medical Education (ACGME sub-competencies and provided residents with direct, real-time feedback, followed by a written evaluation sent via email. Evaluations provided specific references to examples of behaviors observed during the shift and connected these back to ACGME competencies and milestones.Results: Twelve residents participated in this shadow experience (six post graduate year 1 and six postgraduate year 2. Two residents emailed the medical education specialists ahead of the scheduled shadow shift requesting specific feedback. When queried, five residents voluntarily requested their feedback to be included in their formal biannual review. Residents received

Training Medical Specialists to Communicate Better with Patients with Medically Unexplained Physical Symptoms (MUPS). A Randomized, Controlled Trial

Science.gov (United States)

Weiland, Anne; Blankenstein, Annette H.; Van Saase, Jan L. C. M.; Van der Molen, Henk T.; Jacobs, Mariël E.; Abels, Dineke C.; Köse, Nedim; Van Dulmen, Sandra; Vernhout, René M.; Arends, Lidia R.

2015-01-01

Background Patients with medically unexplained physical symptoms (MUPS) are prevalent 25–50% in general and specialist care. Medical specialists and residents often find patients without underlying pathology difficult to deal with, whereas patients sometimes don’t feel understood. We developed an evidence-based communication training, aimed to improve specialists’ interviewing, information-giving and planning skills in MUPS consultations, and tested its effectiveness. Methods The intervention group in this multi-center randomized controlled trial received a 14-hour training program to which experiential learning and feedback were essential. Using techniques from Cognitive Behavioral Therapy, they were stimulated to seek interrelating factors (symptoms, cognitions, emotions, behavior, and social environment) that reinforced a patient’s symptoms. They were taught to explain MUPS understandably, reassure patients effectively and avoid unnecessary diagnostic testing. Before and after the intervention training, specialists videotaped a total of six consultations with different MUPS patients. These were evaluated to assess doctors’ MUPS-focused communicating skills using an adapted version of the Four Habit Coding Scheme on five-point Likert scales. Participants evaluated the training by self-report on three-point Likert scales. Doctors in the control group received training after completion of the study. Results 123 doctors (40% specialists, 60% residents) and 478 MUPS patients from 11 specialties were included; 98 doctors completed the study (80%) and 449 videotaped consultations were assessed. Trained doctors interviewed patients more effectively than untrained ones (p < 0.001), summarized information in a more patient-centered way (p = 0.001), and better explained MUPS and the role of perpetuating factors (p < 0.05). No effects on planning skills were found. On a 3-point scale the training was evaluated with 2.79. Conclusion MUPS-focused communication

Oxygen tolerance test : A standardised protocol

Directory of Open Access Journals (Sweden)

D K Ghosh

2015-01-01

Conclusion: By following a standardised protocol for Oxygen Tolerance Test, an objective assessment and recordkeeping is possible. This shall entail a more effective screening during the initial diving medical examination.

Do patients discharged from advanced practice physiotherapy-led clinics re-present to specialist medical services?

Science.gov (United States)

Chang, Angela T; Gavaghan, Belinda; O'Leary, Shaun; McBride, Liza-Jane; Raymer, Maree

2017-05-15

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

Survey of medical specialists on their attitudes to and resources for ...

African Journals Online (AJOL)

2011-06-15

Jun 15, 2011 ... protected research time for Nigerian medical specialists in order to boost their research function. Keywords: .... to assess comprehension and feasibility. As a part of a ..... Bridging the gap between outputs of clinical research ...

Corrigendum to: It's more than money: policy options to secure medical specialist workforce for regional centres.

Science.gov (United States)

May, Jennifer; Walker, Judi; McGrail, Mathew; Rolley, Fran

2017-12-01

Objectives Regional centres and their rural hinterlands support significant populations of non-metropolitan Australians. Despite their importance in the settlement hierarchy and the key medical services provided from these centres, little research has focused on their issues of workforce supply and long-term service requirements. In addition, they are a critical component of the recent growth of 'regional' hub-and-spoke specialist models of service delivery. Methods The present study interviewed 62 resident specialists in four regional centres, seeking to explore recruitment and retention factors important to their location decision making. The findings were used to develop a framework of possible evidence-informed policies. Results This article identifies key professional, social and locational factors, several of which are modifiable and amenable to policy redesign, including work variety, workplace culture, sense of community and spousal employment; these factors that can be targeted through initiatives in selection, training and incentives. Conclusions Commonwealth, state and local governments in collaboration with communities and specialist colleges can work synergistically, with a multiplicity of interdigitating strategies, to ensure a positive approach to the maintenance of a critical mass of long-term rural specialists. What is known about the topic? Rural origin increases likelihood of long-term retention to rural locations, with rural clinical school training associated with increased rural intent. Recruitment and retention policy has been directed at general practitioners in rural communities, with little focus on regional centres or medical specialists. What does this study add? Rural origin is associated with regional centre recruitment. Professional, social and locational factors are all moderately important in both recruitment and retention. Specialist medical training for regional centres ideally requires both generalist and subspecialist skills

Medical cost of Lassa fever treatment in Irrua Specialist Teaching ...

African Journals Online (AJOL)

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, ...

Medical audit: threat or opportunity for the medical profession. A comparative study of medical audit among medical specialists in general hospitals in The Netherlands and England, 1970-1999

NARCIS (Netherlands)

van Herk, R.; Klazinga, N. S.; Schepers, R. M.; Casparie, A. F.

2001-01-01

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

Medicare rebate for specialist medical practitioners from physiotherapy referrals: analysis of the potential impact on the Australian healthcare system.

Science.gov (United States)

Byrnes, Joshua M; Comans, Tracy A

2015-02-01

Abstract To identify and examine the likely impact on referrals to specialist medical practitioners, cost to government and patient out-of-pocket costs by providing a rebate under the Medicare Benefits Scheme to patients who attend a specialist medical practitioner upon referral direct from a physiotherapist. A model was constructed to synthesise the costs and benefits of referral with a rebate. Data to inform the model was obtained from administrative sources and from a direct survey of physiotherapists. Given that six referrals per month are made by physiotherapists for a specialist consultation, allowing direct referral to medical specialists and providing patients with a Medicare rebate would result in a likely cost saving to the government ofup to $13 million per year. A range of sensitivity analyses were conducted with all scenarios resulting in some cost savings. The impact of the proposed policy shift to allow direct referral of patients by physiotherapists to specialist medical practitioners and provide patients with a Medicare rebate would be cost saving.

48 CFR 801.602-73 - Review requirements for scarce medical specialist contracts and contracts for health-care resources.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Review requirements for scarce medical specialist contracts and contracts for health-care resources. 801.602-73 Section 801.602... Responsibilities 801.602-73 Review requirements for scarce medical specialist contracts and contracts for health...

Compliance with referrals to medical specialist care: patient and general practice determinants: a cross-sectional study.

Science.gov (United States)

van Dijk, Christel E; de Jong, Judith D; Verheij, Robert A; Jansen, Tessa; Korevaar, Joke C; de Bakker, Dinny H

2016-02-01

In a gatekeeper system, primary care physicians and patients jointly decide whether or not medical specialist care is needed. However, it is the patient who decides to actually use the referral. Referral non-compliance could delay diagnosis and treatment. The objective of this study was to assess patient compliance with a referral to medical specialist care and identify patient and practice characteristics that are associated with it. Observational study using data on 48,784 referrals to medical specialist care derived from electronic medical records of 58 general practices for the period 2008-2010. Referral compliance was based on claims data of medical specialist care. Logistic multilevel regression analyses were conducted to determine associations between patient and general practice characteristics and referral compliance. In 86.6% of the referrals, patients complied. Patient and not practice characteristics were significantly associated with compliance. Patients from deprived urban areas and patients aged 18-44 years were less likely to comply, whereas patients aged 65 years and older were more likely to comply. About 1 in 8 patients do not use their referral. These patients may not receive adequate care. Demographic and socio-economic factors appear to affect compliance. The results of this study may be used to make general practitioners more aware that some patients are more likely to be noncompliant with referrals.

Guided graded exercise self-help plus specialist medical care versus specialist medical care alone for chronic fatigue syndrome (GETSET): a pragmatic randomised controlled trial.

Science.gov (United States)

Clark, Lucy V; Pesola, Francesca; Thomas, Janice M; Vergara-Williamson, Mario; Beynon, Michelle; White, Peter D

2017-07-22

Graded exercise therapy is an effective and safe treatment for chronic fatigue syndrome, but it is therapist intensive and availability is limited. We aimed to test the efficacy and safety of graded exercise delivered as guided self-help. In this pragmatic randomised controlled trial, we recruited adult patients (18 years and older) who met the UK National Institute for Health and Care Excellence criteria for chronic fatigue syndrome from two secondary-care clinics in the UK. Patients were randomly assigned to receive specialist medical care (SMC) alone (control group) or SMC with additional guided graded exercise self-help (GES). Block randomisation (randomly varying block sizes) was done at the level of the individual with a computer-generated sequence and was stratified by centre, depression score, and severity of physical disability. Patients and physiotherapists were necessarily unmasked from intervention assignment; the statistician was masked from intervention assignment. SMC was delivered by specialist doctors but was not standardised; GES consisted of a self-help booklet describing a six-step graded exercise programme that would take roughly 12 weeks to complete, and up to four guidance sessions with a physiotherapist over 8 weeks (maximum 90 min in total). Primary outcomes were fatigue (measured by the Chalder Fatigue Questionnaire) and physical function (assessed by the Short Form-36 physical function subscale); both were self-rated by patients at 12 weeks after randomisation and analysed in all randomised patients with outcome data at follow-up (ie, by modified intention to treat). We recorded adverse events, including serious adverse reactions to trial interventions. We used multiple linear regression analysis to compare SMC with GES, adjusting for baseline and stratification factors. This trial is registered at ISRCTN, number ISRCTN22975026. Between May 15, 2012, and Dec 24, 2014, we recruited 211 eligible patients, of whom 107 were assigned to the

20 CFR 10.301 - May the physician designated on Form CA-16 refer the employee to another medical specialist or...

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false May the physician designated on Form CA-16 refer the employee to another medical specialist or medical facility? 10.301 Section 10.301 Employees... another medical specialist or medical facility? The physician designated on Form CA-16 may refer the...

Infectious Disease Specialist: What Is an Infectious Disease Specialist?

Science.gov (United States)

... 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 ...

Career preferences and the work-family balance in medicine: gender differences among medical specialists.

NARCIS (Netherlands)

Heiligers, P.J.M.; Hingstman, L.

2000-01-01

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 specialities. Four different career preferences were offered, each of which implied a possible variation in working hours. A questionnaire

[History of training and certification programs of medical specialists in Peru].

Science.gov (United States)

Burstein Alva, Zuño

2014-01-01

In this paper, historical reference is made about legal provisions for recognition of the training and certification of medical specialists in Peru through university programs provided since 1928 and culminating in 1973 with the legal authorization by the relevant state authority to implement the Second Specialization Program in Human Medicine and to grant the Certification of Specialist in the Name of the Nation upon completion of a university residency program and specialized training by the “regular modality”, and the recognition by the university with the “non-regular modality”. In Peru it has been established to the present that the Professional Certifications of Specialists in Human Medicine “in the Name of the Nation”, both in “regular modality” as well as in “non-regular modality”, can only be granted by public or private universities authorized for this mission and, besides, no other public or private institution can claim this role that corresponds exclusively for the Peruvian University.

INTERACT-CANCER. The development and evaluation of a computer-assisted course on communication skills for medical specialists in oncology

NARCIS (Netherlands)

Hulsman, R. L.; Ros, W. J.; Janssen, M.; Winnubst, J. A.

1997-01-01

One of the main problems in training medical specialists in communication skills is the fact that very few specialists participate in such courses. Most courses on communication skills are hard to combine with a busy medical practice because of the course attendance requirement on working days.

Forecasting the need for medical specialists in Spain: application of a system dynamics model

Science.gov (United States)

2010-01-01

Background Spain has gone from a surplus to a shortage of medical doctors in very few years. Medium and long-term planning for health professionals has become a high priority for health authorities. Methods We created a supply and demand/need simulation model for 43 medical specialties using system dynamics. The model includes demographic, education and labour market variables. Several scenarios were defined. Variables controllable by health planners can be set as parameters to simulate different scenarios. The model calculates the supply and the deficit or surplus. Experts set the ratio of specialists needed per 1000 inhabitants with a Delphi method. Results In the scenario of the baseline model with moderate population growth, the deficit of medical specialists will grow from 2% at present (2800 specialists) to 14.3% in 2025 (almost 21 000). The specialties with the greatest medium-term shortages are Anesthesiology, Orthopedic and Traumatic Surgery, Pediatric Surgery, Plastic Aesthetic and Reparatory Surgery, Family and Community Medicine, Pediatrics, Radiology, and Urology. Conclusions The model suggests the need to increase the number of students admitted to medical school. Training itineraries should be redesigned to facilitate mobility among specialties. In the meantime, the need to make more flexible the supply in the short term is being filled by the immigration of physicians from new members of the European Union and from Latin America. PMID:21034458

Auditing GPs' prescribing habits : Cardiovascular prescribing frequently continues medication initiated by specialists

NARCIS (Netherlands)

de Vries, C.S; van Diepen, N.M; de Jong-van den Berg, L T W

Objective: To determine to what extent general practitioners' (GPs) prescribing behaviour is a result of repeat prescribing of medication which has been initiated by specialists. Method: During a 4-week period, pharmacists identified GPs' prescriptions for a large group of cardiovascular drugs.

'On the doctor's orders': A pilot study of the effects of website marketing for medical specialist providers under gatekeeping arrangements

NARCIS (Netherlands)

Zwier, S.

2017-01-01

Websites from medical specialist providers are becoming increasingly marketing oriented, but there exists a paucity of empirical research on the effects. This experimental study explored effects of exposure to real websites from medical specialist providers among Dutch adults under physician

Publication of research projects for certification as medical specialists at a peruvian university, 2007-2010

OpenAIRE

Ticse, Ray; Hospital Nacional Cayetano Heredia. Lima, Perú. Facultad de Medicina, Universidad Peruana Cayetano Heredia. Lima, Perú. Médico internista endocrinólogo; magíster en Epidemiología Clínica.; Ygreda, Patricia; Facultad de Medicina, Universidad Peruana Cayetano Heredia. Lima, Perú. Médico cirujano.; Samalvides, Frine; Hospital Nacional Cayetano Heredia. Lima, Perú. Facultad de Medicina, Universidad Peruana Cayetano Heredia. Lima, Perú. Médico infectólogo.

2014-01-01

In order to determine the frequency of publication in a scientific journal of the research projects done for medical specialty certification, a search was conducted in Google Scholar, Pubmed, biomedical databases and Peruvian medical society journals. These publications were research projects carried out by medical residents graduated from the Faculty of Medicine at the Universidad Peruana Cayetano Heredia, to obtain the certification of medical specialist. Of 351 medical residents graduated ...

New study program: Interdisciplinary Postgraduate Specialist Study in Medical Informatics.

Science.gov (United States)

Hercigonja-Szekeres, Mira; Simić, Diana; Božikov, Jadranka; Vondra, Petra

2014-01-01

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.

"On the doctor's orders": A pilot study of the effects of website marketing for medical specialist providers under gatekeeping arrangements.

Science.gov (United States)

Zwier, Sandra

2017-01-01

Websites from medical specialist providers are becoming increasingly marketing oriented, but there exists a paucity of empirical research on the effects. This experimental study explored effects of exposure to real websites from medical specialist providers among Dutch adults under physician gatekeeper arrangements. Exposure led to a stronger intention to seek treatment from the specialist provider and motivation to rely on the providers' claims. Weaker to absent effects were found for intention to question the physician gatekeeper's referral and this was chiefly motivated by the belief that "the doctor knows best." Implications for specialist provider marketing under gatekeeping arrangements are discussed.

New Standardisation Fora and their Relationships with Traditional Standardisation Organisations

DEFF Research Database (Denmark)

Øst, Alexander G.

The paper sets off by defining the fundamental concept of standards and proceeds by describing generic forms of standards (de facto and de jure) and various ways for standards to emerge. Then, the generic players (government, users, companies etc.) involved in the standardisation processes......, a synthesis of the identified development and standardisation trends of the converging landscape is made, providing a basis for prediction of future standardisation regimes....

Improvement of the training system of medical and pharmaceutical specialists at medical college of Saratov State Medical University

Directory of Open Access Journals (Sweden)

Popkov V.M.

2015-06-01

Full Text Available The development of high-technological medical care in Russia has improved the quality of rendering of medical aid to the population, but at the same time the lack of efficient, qualified specialists has been revealed. Today graduates of professional educational institution are characterized by the knowledge in theory and inefficient practical experience, while the employer is interested in the optimal combination of these qualities. All of these facts lead to the necessity of introducing into the educational process technologies of dual training as a tool of approximation theory to practice Saratov. Medical University may share the experience of introduction and organization of elements of the complex educational system in the process of realization of the programs of secondary professional education through the creation of educational-productive cluster on the bases of clinics.

[Supply and demand of medical specialists in the health facilities of the Ministry of Health: national, regional and by type of specialty gaps].

Science.gov (United States)

Zevallos, Leslie; Pastor, Reyna; Moscoso, Betsy

2011-06-01

To characterize the supply, demand and the gap of medical specialists in facilities of the Ministry of Health of Peru (MINSA) at the national, regional and specialty type levels. Observational, descriptive study through which we calculated the supply of medical specialists using secondary sources of MINSA. The analysis of the demand for medical specialists was based on two methodologies: the need for specialists according to the guidelines of classification of the health facilities and according to the epidemiological and demographic profile. The arithmetic difference between the estimated demand and the supply was the procedure used to calculate the gap of medical specialists. The Ministry of Health has a total supply at the national level of 6,074 medical specialists of which 61.5% belong to the clinical specialties, 33.2% to the surgical specialties, 4.9% specialities related to aid to diagnosis and treatment and 0.4% to public health specialties. According to the categorization guideline there is a total demand of 11,176 medical specialists and according to the epidemiological and demographic profile of 11,738. The national estimated gaps found are similar in both methods, although they differ widely across regions and by type of specialty. At the regional level, the gaps are greater in Loreto, Piura, Puno and Madre de Dios when estimating the defficit in relation to the supply. Regarding the speciality, the gap is greater in the four basic specialties: gynecology and obstetrics, pediatrics, internal medicine and general surgery. There is a waid gap between supply and demand of medical specialists at the national and regional levels, as a whole representing approximately 45% of the current offer, regardless of the estimation method.

Educational support for specialist international medical graduates in anaesthesia.

Science.gov (United States)

Higgins, Niall S; Taraporewalla, Kersi; Edirippulige, Sisira; Ware, Robert S; Steyn, Michael; Watson, Marcus O

2013-08-19

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.

Medical specialists' choice of location: the role of geographical attachment in Norway.

Science.gov (United States)

Kristiansen, I S; Førde, O H

1992-01-01

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.

Career preferences and the work-family balance in medicine: gender differences among medical specialists.

Science.gov (United States)

Heiliger, P J; Hingstman, L

2000-05-01

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

Specialist Physicians' Attitudes and Practice Patterns Regarding Disclosure of Pre-referral Medical Errors.

Science.gov (United States)

Dossett, Lesly A; Kauffmann, Rondi M; Lee, Jay S; Singh, Harkamal; Lee, M Catherine; Morris, Arden M; Jagsi, Reshma; Quinn, Gwendolyn P; Dimick, Justin B

2018-06-01

Our objective was to determine specialist physicians' attitudes and practices regarding disclosure of pre-referral errors. Physicians are encouraged to disclose their own errors to patients. However, no clear professional norms exist regarding disclosure when physicians discover errors in diagnosis or treatment that occurred at other institutions before referral. We conducted semistructured interviews of cancer specialists from 2 National Cancer Institute-designated Cancer Centers. We purposively sampled specialists by discipline, sex, and experience-level who self-described a >50% reliance on external referrals (n = 30). Thematic analysis of verbatim interview transcripts was performed to determine physician attitudes regarding disclosure of pre-referral medical errors; whether and how physicians disclose these errors; and barriers to providing full disclosure. Participants described their experiences identifying different types of pre-referral errors including errors of diagnosis, staging and treatment resulting in adverse events ranging from decreased quality of life to premature death. The majority of specialists expressed the belief that disclosure provided no benefit to patients, and might unnecessarily add to their anxiety about their diagnoses or prognoses. Specialists had varying practices of disclosure including none, non-verbal, partial, event-dependent, and full disclosure. They identified a number of barriers to disclosure, including medicolegal implications and damage to referral relationships, the profession's reputation, and to patient-physician relationships. Specialist physicians identify pre-referral errors but struggle with whether and how to provide disclosure, even when clinical circumstances force disclosure. Education- or communication-based interventions that overcome barriers to disclosing pre-referral errors warrant development.

Protocol-based care: the standardisation of decision-making?

Science.gov (United States)

Rycroft-Malone, Jo; Fontenla, Marina; Seers, Kate; Bick, Debra

2009-05-01

To explore how protocol-based care affects clinical decision-making. In the context of evidence-based practice, protocol-based care is a mechanism for facilitating the standardisation of care and streamlining decision-making through rationalising the information with which to make judgements and ultimately decisions. However, whether protocol-based care does, in the reality of practice, standardise decision-making is unknown. This paper reports on a study that explored the impact of protocol-based care on nurses' decision-making. Theoretically informed by realistic evaluation and the promoting action on research implementation in health services framework, a case study design using ethnographic methods was used. Two sites were purposively sampled; a diabetic and endocrine unit and a cardiac medical unit. Within each site, data collection included observation, postobservation semi-structured interviews with staff and patients, field notes, feedback sessions and document review. Data were inductively and thematically analysed. Decisions made by nurses in both sites were varied according to many different and interacting factors. While several standardised care approaches were available for use, in reality, a variety of information sources informed decision-making. The primary approach to knowledge exchange and acquisition was person-to-person; decision-making was a social activity. Rarely were standardised care approaches obviously referred to; nurses described following a mental flowchart, not necessarily linked to a particular guideline or protocol. When standardised care approaches were used, it was reported that they were used flexibly and particularised. While the logic of protocol-based care is algorithmic, in the reality of clinical practice, other sources of information supported nurses' decision-making process. This has significant implications for the political goal of standardisation. The successful implementation and judicious use of tools such as

Motives and preferences of general practitioners for new collaboration models with medical specialists: a qualitative study

Directory of Open Access Journals (Sweden)

Klazinga Niek S

2007-01-01

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 GPs to initiate and continue participating with medical specialists in new collaborative care models. The following two questions are addressed in this study: What motivates GPs to initiate and sustain new models for collaborating with medical specialists? What kind of new collaboration models do GPs suggest? Methods A qualitative study design was used. Starting in 2003 and finishing in 2005, we conducted semi-structured interviews with a purposive sample of 21 Dutch GPs. The sampling criteria were age, gender, type of practice, and practice site. The interviews were recorded, fully transcribed, and analysed by two researchers working independently. The resulting motivational factors and preferences were grouped into categories. Results 'Developing personal relationships' and 'gaining mutual respect' appeared to dominate when the motivational factors were considered. Besides developing personal relationships with specialists, the GPs were also interested in familiarizing specialists with the competencies attached to the profession of family medicine. Additionally, they were eager to increase their medical knowledge to the benefit of their patients. The GPs stated a variety of preferences with respect to the design of new models of collaboration. Conclusion Developing personal relationships with specialists appeared to be one of the dominant motives for increased collaboration. Once the relationships have been formed, an informal network with occasional professional contact seemed sufficient. Although GPs are interested in increasing their knowledge, once they have reached a certain level of expertise, they shift their focus to another specialty. The preferences for new collaboration

Part-time and full-time medical specialists, are there differences in allocation of time?

NARCIS (Netherlands)

Jong, J.D. de; Heiligers, P.; Groenewegen, P.P.; Hingstman, L.

2006-01-01

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

Part-time and full-time medical specialists, are there differences in allocation of time?

NARCIS (Netherlands)

Jong, Judith D. de; Heiligers, Phil; Groenewegen, Peter P.; Hingstman, Lammert

2006-01-01

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

Encounters between medical specialists and patients with medically unexplained physical symptoms; influences of communication on patient outcomes and use of health care: a literature overview.

NARCIS (Netherlands)

Weiland, A.; Kraats, R.E. van de; Blankenstein, A.H.; Saase, J.L.C.M. van; Molen, H.T. van der; Bramer, W.M.; Dulmen, A.M. van; Arends, L.R.

2012-01-01

Medically unexplained physical symptoms (MUPS) burden patients and health services due to large quantities of consultations and medical interventions. The aim of this study is to determine which elements of communication in non-psychiatric specialist MUPS care influence health outcomes. Systematic

International comparison of systems to determine entitlements to medical specialist care: performance and organizational issues

NARCIS (Netherlands)

E.A. Stolk (Elly); A.A. de Bont (Antoinette); M.J. Poley (Marten); S. Jerak (Sonja); M. Stroet (Mary); F.F.H. Rutten (Frans)

2008-01-01

textabstractSummary Objective: CVZ has asked us to provide a comparison of criteria and procedures that different countries use to determine entitlements to medical specialist care. This question was asked within the context of the recent introduction of the DBC (diagnosis treatment combinations)

Training specialists to write appropriate reply letters to general practitioners about patients with medically unexplained physical symptoms; A cluster-randomized trial.

NARCIS (Netherlands)

A. Weiland (Anne); A.H. Blankenstein (Annette); M.H.A. Willems; J.L.C.M. van Saase (Jan); P.L.A. van Daele (Paul); H.T. van der Molen (Henk); G.B. Langbroek (Ginger B.); A. Bootsma (Aart); E.M. Vriens (Els M.); A. Oberndorff-Klein Woolthuis (Ardi); R. Vernhout (Rene); L.R. Arends (Lidia)

2015-01-01

textabstractObjective: To evaluate effects of a communication training for specialists on the quality of their reply letters to general practitioners (GPs) about patients with medically unexplained physical symptoms (MUPS). Methods: Before randomization, specialists included ≤3 MUPS patients in a

Evaluation of vocal acoustic and efficiency analysis parameters in medical students and academic teachers with use of iris and diagnoscope specialist software.

Science.gov (United States)

Zielińska-Bliźniewska, Hanna; Sułkowski, Wiesław J; Pietkiewicz, Piotr; Miłoński, Jarosław; Mazurek, Agnieszka; Olszewski, Jurek

2012-06-01

The aim of this study was to compare the parameters of vocal acoustic and vocal efficiency analyses in medical students and academic teachers with use of the IRIS and DiagnoScope Specialist software and to evaluate their usefulness in prevention and certification of occupational disease. The study group comprised 40 women, including students and employees of the Military Medical Faculty, Medical University of Łodź. After informed consent had been obtained from the participant women, the primary medical history was taken, videolaryngoscopic and stroboscopic examinations were performed and diagnostic vocal acoustic analysis was carried out with the use of the IRIS and Diagno-Scope Specialist software. Based on the results of the performed measurements, the statistical analysis evidenced the compatibility between two software programs, IRIS and DiagnoScope Specialist, with the only exception of the F4 formant. The mean values of vocal acoustic parameters in medical students and academic teachers, obtained by means of the IRIS software, can be used as standards for the female population not yet developed by the producer. When using the DiagnoScope Specialist software, some mean values were higher and some lower than the standards specified by the producer. The study evidenced the compatibility between two measurement software programs, IRIS and DiagnoScope Specialist, except for the F4 formant. It should be noted that the later has advantage over the former since the standard values of vocal acoustic parameters have been worked out by the producer. Moreover, they only slightly departed from the values obtained in our study and may be useful in diagnostics of occupational voice disorders.

The logic of Technical Standardisation

DEFF Research Database (Denmark)

Nedergaard, Peter

In this paper technical standardisation is understood and explained in a model where economic analysis is coupled with an analysis of the political system as proposed in rational choice theory. The aim is to answer both the question why various countries (e.g. the United States versus European...... countries) let either the market or public intervention determine the mode of technical standardisation and the possible implications of these two ways of organizing technical standardisation from an economic and a political point of view. Based upon the analysis of the paper a couple of general policy...... recommendations are made concerning the mode of technical standardisation....

Does electronic clinical microbiology results reporting influence medical decision making: a pre- and post-interview study of medical specialists.

Science.gov (United States)

Bruins, Marjan J; Ruijs, Gijs J H M; Wolfhagen, Maurice J H M; Bloembergen, Peter; Aarts, Jos E C M

2011-03-30

Clinicians view the accuracy of test results and the turnaround time as the two most important service aspects of the clinical microbiology laboratory. Because of the time needed for the culturing of infectious agents, final hardcopy culture results will often be available too late to have a significant impact on early antimicrobial therapy decisions, vital in infectious disease management. The clinical microbiologist therefore reports to the clinician clinically relevant preliminary results at any moment during the diagnostic process, mostly by telephone. Telephone reporting is error prone, however. Electronic reporting of culture results instead of reporting on paper may shorten the turnaround time and may ensure correct communication of results. The purpose of this study was to assess the impact of the implementation of electronic reporting of final microbiology results on medical decision making. In a pre- and post-interview study using a semi-structured design we asked medical specialists in our hospital about their use and appreciation of clinical microbiology results reporting before and after the implementation of an electronic reporting system. Electronic reporting was highly appreciated by all interviewed clinicians. Major advantages were reduction of hardcopy handling and the possibility to review results in relation to other patient data. Use and meaning of microbiology reports differ significantly between medical specialties. Most clinicians need preliminary results for therapy decisions quickly. Therefore, after the implementation of electronic reporting, telephone consultation between clinician and microbiologist remained the key means of communication. Overall, electronic reporting increased the workflow efficiency of the medical specialists, but did not have an impact on their decision-making. © 2011 Bruins et al; licensee BioMed Central Ltd.

Does electronic clinical microbiology results reporting influence medical decision making: a pre- and post-interview study of medical specialists

Directory of Open Access Journals (Sweden)

Bloembergen Peter

2011-03-01

Full Text Available Abstract Background Clinicians view the accuracy of test results and the turnaround time as the two most important service aspects of the clinical microbiology laboratory. Because of the time needed for the culturing of infectious agents, final hardcopy culture results will often be available too late to have a significant impact on early antimicrobial therapy decisions, vital in infectious disease management. The clinical microbiologist therefore reports to the clinician clinically relevant preliminary results at any moment during the diagnostic process, mostly by telephone. Telephone reporting is error prone, however. Electronic reporting of culture results instead of reporting on paper may shorten the turnaround time and may ensure correct communication of results. The purpose of this study was to assess the impact of the implementation of electronic reporting of final microbiology results on medical decision making. Methods In a pre- and post-interview study using a semi-structured design we asked medical specialists in our hospital about their use and appreciation of clinical microbiology results reporting before and after the implementation of an electronic reporting system. Results Electronic reporting was highly appreciated by all interviewed clinicians. Major advantages were reduction of hardcopy handling and the possibility to review results in relation to other patient data. Use and meaning of microbiology reports differ significantly between medical specialties. Most clinicians need preliminary results for therapy decisions quickly. Therefore, after the implementation of electronic reporting, telephone consultation between clinician and microbiologist remained the key means of communication. Conclusions Overall, electronic reporting increased the workflow efficiency of the medical specialists, but did not have an impact on their decision-making.

How do medical specialists value their own intercultural communication behaviour? A reflective practice study.

Science.gov (United States)

Paternotte, E; Scheele, F; van Rossum, T R; Seeleman, M C; Scherpbier, A J J A; van Dulmen, A M

2016-08-24

Intercultural communication behaviour of doctors with patients requires specific intercultural communication skills, which do not seem structurally implemented in medical education. It is unclear what motivates doctors to apply intercultural communication skills. We investigated how purposefully medical specialists think they practise intercultural communication and how they reflect on their own communication behaviour. Using reflective practice, 17 medical specialists independently watched two fragments of videotapes of their own outpatient consultations: one with a native patient and one with a non-native patient. They were asked to reflect on their own communication and on challenges they experience in intercultural communication. The interviews were open coded and analysed using thematic network analysis. The participants experienced only little differences in their communication with native and non-native patients. They mainly mentioned generic communication skills, such as listening and checking if the patient understood. Many participants experienced their communication with non-native patients positively. The participants mentioned critical incidences of intercultural communication: language barriers, cultural differences, the presence of an interpreter, the role of the family and the atmosphere. Despite extensive experience in intercultural communication, the participants of this study noticed hardly any differences between their own communication behaviour with native and non-native patients. This could mean that they are unaware that consultations with non-native patients might cause them to communicate differently than with native patients. The reason for this could be that medical specialists lack the skills to reflect on the process of the communication. The participants focused on their generic communication skills rather than on specific intercultural communication skills, which could either indicate their lack of awareness, or demonstrate that

Brazilian infectious diseases specialists: who and where are they?

Science.gov (United States)

Cassenote, Alex Jones Flores; Scheffer, Mario César; Segurado, Aluísio Augusto Cotrim

2016-01-01

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

CSHCN in Texas: meeting the need for specialist care.

Science.gov (United States)

Young, M Cherilyn; Drayton, Vonna L C; Menon, Ramdas; Walker, Lesa R; Parker, Colleen M; Cooper, Sam B; Bultman, Linda L

2005-06-01

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.

Is there a need for placement evaluations for specialist practice students? A proposal.

Science.gov (United States)

Sturge, Sally Anne

2014-10-01

This paper outlines a recent proposal justifying the initiation of standardised placement evaluations across specialist community public health nursing and specialist community nursing students while they undertake their educational programme. Within one approved education institute (AEI) it was identified that there was no standardised tool currently being used across the West Midlands, making the process of quality assurance extremely difficult. A clear rationale is provided for the use of such a tool, including supporting evidence from professional, statutory and regulatory bodies, health and education policies and quality assurance agencies. Placement evaluations are critical to students' learning, ensuring a safe and conducive environment, while providing a continuous cyclical process in conjunction with educational audits to allow the opportunity of regular assessment of the learning environment conforming to the Nursing Midwifery Council's risk-based approach. In light of the recent recommendations from the Francis report, it is pivotal that organisations such as the NHS and AEIs engage proactively together, fostering an open and transparent relationship to ensure standards of care are of the highest quality. Aspects of leadership theory are also discussed to enable the planned change to be successful.

[Part-time medical specialist training; experiences with job-sharing for trainee internists].

Science.gov (United States)

Bevers, K; Nauta, S; Stuyt, P M

2004-02-14

Due to various factors such as social changes, an increasing number of couples with two incomes, and a growing proportion of female doctors, there has been a growing demand for part-time work in recent years. This is also true for resident physicians. Objections such as a discontinuity in care and the decline in the quality of education frequently prevent resident physicians from working part-time. Over the past two years, the University Medical Centre Nijmegen, the Netherlands, has experimented with job-sharing on clinical wards for resident physicians in internal medicine. This approach works well in practice, as long as a number of conditions, including the proper transfer of medical information and good communication, are satisfied. Job-sharing is one means of satisfying the growing demand for part-time work among resident physicians and specialists.

Use of professional profiles in applications for specialist training positions.

Science.gov (United States)

Lundh, Andreas; Skjelsager, Karen; Wildgaard, Kim

2013-07-01

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.

Fewer specialists support using medical marijuana and CBD in treating epilepsy patients compared with other medical professionals and patients: result of Epilepsia's survey.

Science.gov (United States)

Mathern, Gary W; Beninsig, Laurie; Nehlig, Astrid

2015-01-01

From May 20 to September 1 2014, Epilepsia conducted an online survey seeking opinions about the use of medical marijuana and cannabidiol (CBD) for people with epilepsy. This study reports the findings of that poll. The survey consisted of eight questions. Four questions asked if there were sufficient safety and efficacy data, whether responders would advise trying medical marijuana in cases of severe refractory epilepsy, and if pharmacologic grade compounds containing CBD should be available. Four questions addressed occupation, geographic region of residence, if responders had read the paper, and if they were International League Against Epilepsy/International Bureau for Epilepsy (ILAE/IBE) members. Of 776 who started or completed the survey, 58% were patients from North America, and 22% were epileptologists and general neurologists from Europe and North America. A minority of epileptologists and general neurologists said that there were sufficient safety (34%) and efficacy (28%) data, and 48% would advise using medical marijuana in severe cases of epilepsy. By comparison, nearly all patients and the public said there were sufficient safety (96%) and efficacy (95%) data, and 98% would recommend medical marijuana in cases of severe epilepsy. General physicians, basic researchers, nurses, and allied health professions sided more with patients, saying that there were sufficient safety (70%) and efficacy (71%) data, and 83% would advise using marijuana in severe cases. A majority (78%) said there should be pharmacologic grade compounds containing CBD, and there were no differences between specialists, general medical personal, and patients and the public. This survey indicates that there is a wide disparity in opinion on the use of medical marijuana and CBD in the treatment of people with epilepsy, which varied substantially, with fewer medical specialists supporting its use compared with general medical personal, and patients and the public. Wiley Periodicals, Inc

A method for the prescription of inexpensive spectacles by non-specialist healthcare workers: S-Glasses.

LENUS (Irish Health Repository)

Treacy, M P

2013-04-01

Globally, 153 million people are visually impaired from uncorrected refractive error. The aim of this research was to verify a method whereby autorefractors could be used by non-specialist health-workers to prescribe spectacles, which used a small stock of preformed lenses that fit frames with standardised apertures. These spectacles were named S-Glasses (Smart Glasses).

Tourism Industry And Standardisation: An Impossible Task?

OpenAIRE

BOZKURT, Alper

2013-01-01

Standardisation of a tourism industry offering will be discussed with this article in two different ways First by reviewing previous studies on the topic definitions of standardisation tourism industry and differences between a service and a goods product will be presented Second by interviewing managers from different tourism industry sectors possibility of a tourism product’s standardisation will be outlined Key words: standardisation service product goods product tourism indust...

Quality management of medical specialist care in the Netherlands : an explorative study of its nature and development

NARCIS (Netherlands)

N.S. Klazinga (Niek)

1996-01-01

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

[Cooperation, Job Satisfaction and Burn Out - Sustainability in Outpatient Mental Health Care among Medical Specialists in Germany].

Science.gov (United States)

Baumgardt, Johanna; Moock, Jörn; Rössler, Wulf; Kawohl, Wolfram

2017-04-01

Objective Cooperation, job satisfaction, and burn out risk are indicators of sustainability in mental health services. Thus they were assessed among registered medical specialists in outpatient mental health care in Germany. Method A postal survey consisting of three questionnaires about cooperation, job satisfaction, and burnout was carried out among all registered medical specialists in outpatient mental health care in Germany (n = 4,430). Results 14.1 % (n = 626) of the specialists responded to the survey. Quality and quantity of cooperation regarding mental health care services were rated diverse, job satisfaction was assessed medium to high, and burnout risk was low to medium. Higher job satisfaction correlated with good quality of cooperation, fewer years of practice, fewer patients' chronically ill, more patients who as well seek psychotherapy, and less time spent on cooperation. Low burn out risk correlated with good quality of cooperation, higher age, single practice setting and a higher amount of patients who as well seek psychotherapy. Conclusion Quality and quantity of cooperation in outpatient mental health care - especially regarding community mental health care institutions - should be fostered. Aspects to be considered to reinforce job satisfaction and minimize burn out risk are age, years of practice, quality and quantity of cooperation, practice setting, and the mixture of patients. © Georg Thieme Verlag KG Stuttgart · New York.

Teaching musculoskeletal examination skills to UK medical students: a comparative survey of Rheumatology and Orthopaedic education practice.

Science.gov (United States)

Blake, Tim

2014-03-28

Specialists in Rheumatology and Orthopaedics are frequently involved in undergraduate teaching of musculoskeletal (MSK) examination skills. Students often report that specialty-led teaching is inconsistent, confusing and bears little resemblance to the curricula. The Gait, Arms, Legs and Spine (GALS) is a MSK screening tool that provides a standardised approach to examination despite it being fraught with disapproval and low uptake. Recent studies would appear to support innovative instructional methods of engaging learners such as patient educators and interactive small group teaching. This comparative cross-sectional survey evaluates the current state of undergraduate teaching in Rheumatology and Orthopaedics, including preferred teaching methods, attitudes towards GALS, and barriers to effective teaching. An electronic questionnaire was sent to specialist trainees and Consultants in the East and West Midlands region, representing 5 UK medical schools. Descriptive statistical data analysis was performed. There were 76 respondents representing 5 medical schools. There was a request for newer teaching methodologies to be used: multi-media computer-assisted learning (35.5%), audio-visual aids (31.6%), role-playing (19.7%), and social media (3.9%). It is evident that GALS is under-utilised with 50% of clinicians not using GALS in their teaching. There is a genuine desire for clinical educators to improve their teaching ability, collaborate more with curriculum planners, and feel valued by institutions. There remains a call for implementing a standardised approach to MSK clinical teaching to supersede GALS.

Dosimetry in medical specialist in procedures of interventionist radiology

International Nuclear Information System (INIS)

Gaona, E.; Vazquez V, J. A.; Rivera M, T.; Izeta G, A. C.; Azorin V, J. C.; Arreola, M.

2014-08-01

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)

Marketing and the medical specialist in the managed care environment.

Science.gov (United States)

Treister, N W

1997-01-01

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.

Situation of the medical physics in the Republic of Argentina. Regulatory problem linked to the requirement of physic specialists

International Nuclear Information System (INIS)

Arbor Gonzalez, A.; Larcher, A.; Blanco, S.

2001-01-01

This paper provides up-to-date data on the participation of medical physicists in current staffs for radiotherapy, nuclear medicine and diagnostic radiology in Argentina, and it presents projections on the academic education of specialists in the next five years. At the same time, the regulatory framework including the requirements for physicists staffing levels in medical practices is presented. This panorama permits to stick out the important role of the professional associations and the academic institutions in the development of Medical Physics in the country. (author)

General medical training in gastroenterology: views from specialist trainees on the challenges of dual accreditation.

Science.gov (United States)

Neale, James R; Basford, Peter J

2015-02-01

Higher specialist training in general internal medicine (GIM) and the medical specialties has been subject to many changes and increasing subspecialisation in recent years. The 'Shape of Training' review proposes 'broad-based specialty training', shortening of training by one year, and subspecialisation to be undertaken after the certificate of specialty training is obtained. All higher level gastroenterology trainees based in the UK were invited to complete an online survey between July and September 2012 to assess their experience of gastroenterology and GIM training. Overall, 72.7% of trainees expressed satisfaction with their training in gastroenterology but significantly fewer (43.5%) expressed satisfaction with their training in GIM. Satisfaction with gastroenterology training thus is good, but satisfaction with GIM training is lower and levels of dissatisfaction have increased significantly since 2008. Up to 50% of trainees are not achieving the minimum recommended number of colonoscopy procedures for their stage of training. Experience in GIM is seen as service orientated, with a lack of training opportunities. There is a worrying difficulty in gaining the minimum required experience in endoscopy. If the length of specialist training is shortened and generalised, training in key core specialist skills such as endoscopy may be compromised further. © 2015 Royal College of Physicians.

Race trouble: experiences of Black medical specialist trainees in South Africa.

Science.gov (United States)

Thackwell, Nicola; Swartz, Leslie; Dlamini, Sipho; Phahladira, Lebogang; Muloiwa, Rudzani; Chiliza, Bonginkosi

2016-12-03

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.

[Potential improvements in medical education as retrospectively evaluated by candidates for specialist examinations].

Science.gov (United States)

Hofer, M; Jansen, M; Soboll, S

2006-02-24

As part of the new regulations for licensing doctors there have been numerous attempts at reform by many medical faculties to consider interdisciplinary linkage of the curriculum with emphasis on teaching of small groups of students. This study was undertaken to help answer the question of how much weight should be given to the various subjects and what resources are needed for any reformed curriculum and what key areas of competence need to be given greater importance. 1029 candidates of specialist examinations of the Medical Council of North-Rhine in 2002 and 2003 filled in questionnaires to evaluate retrospectively the actual relevance of individual preclinical and clinical subjects, courses and areas of practical competence to their further medical education and related potentials for improvement in their studies. The participants were from 5 medical faculties in the North-Rhine area of Germany. They were also asked about methods of examination that were effective in aiding their learning behaviour. Those answering the questionnaire considered especially chemistry and physics as well as environmental, occupational and forensic medicine, bio-mathematics, radiotherapy and nuclear medicine among the less relevant subjects. On the other hand, anatomy, physiology, internal medicine, pharmacology and surgery were considered especially relevant. The greatest deficiencies in most of the medical curricula as taught in the North-Rhine medical courses are in the areas of competence in communication and practical clinical skills. Members of this group also pleaded for an increased use of standardized objective structured clinical examinations (OSCE).

A clinical nurse specialist-led intervention to enhance medication adherence using the plan-do-check-act cycle for continuous self-improvement.

Science.gov (United States)

Russell, Cynthia L

2010-01-01

A clinical nurse specialist-led intervention to improve medication adherence in chronically ill adults using renal transplant recipients as an exemplar population is proposed. Meta-analyses and systematic reviews of chronically ill and transplant patients indicate that patient-specific characteristics not only are poor and inconsistent predictors for medication nonadherence but also are not amenable to intervention. Adherence has not meaningfully improved, despite meta-analyses and systematic narrative reviews of randomized controlled trials (RCTs) dealing with medication nonadherence in acutely and chronically ill persons and RCTs dealing with transplant patients. Interventions with a superior potential to enhance medication adherence must be developed. Use of a clinical nurse specialist-led continuous self-improvement intervention with adult renal transplant recipients is proposed. Continuous self-improvement focuses on improving personal systems thinking and behavior using the plan-do-check-act process. Electronic medication monitoring reports, one of several objective measures of medication adherence, are used by the clinician to provide patient feedback during the check process on medication-taking patterns. Continuous self-improvement as an intervention holds promise in supporting patient self-management and diminishing the blame that clinicians place on patients for medication nonadherence. Using an objective measure of medication adherence such as an electronic monitoring report fosters collaborative patient-clinician discussions of daily medication-taking patterns. Through collaboration, ideas for improving medication taking can be explored. Changes can be followed and evaluated for effectiveness through the continuous self-improvement process. Future studies should include RCTs comparing educational and/or behavioral interventions to improve medication adherence.

Entrustable professional activity (EPA) reshapes the practice of specialist training.

Science.gov (United States)

Niemi-Murola, Leila

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.

Standardisation of digital human models.

Science.gov (United States)

Paul, Gunther; Wischniewski, Sascha

2012-01-01

Digital human models (DHM) have evolved as useful tools for ergonomic workplace design and product development, and found in various industries and education. DHM systems which dominate the market were developed for specific purposes and differ significantly, which is not only reflected in non-compatible results of DHM simulations, but also provoking misunderstanding of how DHM simulations relate to real world problems. While DHM developers are restricted by uncertainty about the user need and lack of model data related standards, users are confined to one specific product and cannot exchange results, or upgrade to another DHM system, as their previous results would be rendered worthless. Furthermore, origin and validity of anthropometric and biomechanical data is not transparent to the user. The lack of standardisation in DHM systems has become a major roadblock in further system development, affecting all stakeholders in the DHM industry. Evidently, a framework for standardising digital human models is necessary to overcome current obstructions. Practitioner Summary: This short communication addresses a standardisation issue for digital human models, which has been addressed at the International Ergonomics Association Technical Committee for Human Simulation and Virtual Environments. It is the outcome of a workshop at the DHM 2011 symposium in Lyon, which concluded steps towards DHM standardisation that need to be taken.

[Outpatient specialist medical care: what is possible, what will come?].

Science.gov (United States)

Tschuschke, C; Uhthoff, H

2013-08-01

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.

The effect of the computer-assisted interactive video training interact-cancer on the communication skills of medical specialists in oncology.

NARCIS (Netherlands)

Hulsman, R.L.; Ros, W.J.G.; Winnubst, J.A.M.; Bensing, J.M.

1998-01-01

Introduction. INTERACT-CANCER is an interactive course for training communication skills of medical specialists in oncology. The course aims at teaching patient-centred behaviour. It includes four main topics in doctor-patient communication: basic skills, communicating bad news, informing patients,

Use of standardised patients to assess quality of tuberculosis care: a pilot, cross-sectional study.

Science.gov (United States)

Das, Jishnu; Kwan, Ada; Daniels, Benjamin; Satyanarayana, Srinath; Subbaraman, Ramnath; Bergkvist, Sofi; Das, Ranendra K; Das, Veena; Pai, Madhukar

2015-11-01

Existing studies of the quality of tuberculosis care have relied on recall-based patient surveys, questionnaire surveys of knowledge, and prescription or medical record analysis, and the results mostly show the health-care provider's knowledge rather than actual practice. No study has used standardised patients to assess clinical practice. Therefore we aimed to assess quality of care for tuberculosis using such patients. We did a pilot, cross-sectional validation study of a convenience sample of consenting private health-care providers in low-income and middle-income areas of Delhi, India. We recruited standardised patients in apparently good health from the local community to present four cases (two of presumed tuberculosis and one each of confirmed tuberculosis and suspected multidrug-resistant tuberculosis) to a randomly allocated health-care provider. The key objective was to validate the standardised-patient method using three criteria: negligible risk and ability to avoid adverse events for providers and standardised patients, low detection rates of standardised patients by providers, and data accuracy across standardised patients and audio verification of standardised-patient recall. We also used medical vignettes to assess providers' knowledge of presumed tuberculosis. Correct case management was benchmarked using Standards for Tuberculosis Care in India (STCI). Between Feb 2, and March 28, 2014, we recruited and trained 17 standardised patients who had 250 interactions with 100 health-care providers, 29 of whom were qualified in allopathic medicine (ie, they had a Bachelor of Medicine & Surgery [MBBS] degree), 40 of whom practised alternative medicine, and 31 of whom were informal health-care providers with few or no qualifications. The interactions took place between April 1, and April 23, 2014. The proportion of detected standardised patients was low (11 [5%] detected out of 232 interactions among providers who completed the follow-up survey), and

Teaching evolution to psychiatrists in Venezuela: comparison with medical students and other medical specialists: a pilot study

Directory of Open Access Journals (Sweden)

Trino Baptista

2012-09-01

Full Text Available Introduction: The teaching of evolution theory (ET in medical programs has received scant attention in the literature. In this report, we first describe the main applications of ET in medicine. Second, we present the evaluation of an interactive seminar on ET given to groups of medical students, psychiatrists, and other medical specialists. Methods: A two-hour, four-module, interactive seminar was conducted with separate groups of 27 psychiatrists, 15 family doctors, 18 neurologists, 13 physiatrists, 12 internists, and 24 sixth-year medical students without formal training in ET. Their knowledge of ET before and after the seminar was rated on a validated analogical scale (0-12. In addition, the perceived relevance of the information for the participants’ professional activity was assessed. Results: Score averages and medians before the seminar were below 6, suggesting low to moderate knowledge. The students' scores did not differ significantly from those of the physicians except on the Hominization item, where they scored lower than the physicians (p = 0.02. The psychiatrists’ scores did not differ from those of the other groups before the seminar, but after the seminar the increase in their scores on a number of items was significantly smaller than that of the other groups. While all groups scored 10 or more when assessing the relevance of the information, the psychiatrists had the lowest score (p = 0.024. Discussion: The results show the adequacy of short programs to enhance knowledge on ET. This may assist medical educators to develop comprehensive and compulsory courses. Future studies must explore whether psychiatrists are relatively reluctant or ambivalent to accept evolution concepts and proposals.

[Surgical History Taking and Clinical Examination: Establishing a Standardised System by Means of a Nation-Wide Academic Teaching Project].

Science.gov (United States)

von Bernstorff, W; Irmer, H; Menges, P; Peters, S; Heidecke, C-D; Busemann, A

2017-02-01

Background: History taking and systematic clinical examination are central techniques of physicians. Medicine in general and surgery in particular frequently require immediate decisions and start of therapies. So far, a standardised surgical system for history taking and clinical examination in teaching has been lacking at our faculty. A consensus of all medical faculties on a standardised system could be a tool to improve the medical teaching and education at our teaching institutions. Methods: The established Anglo-Saxonian system of history taking and clinical examination was adapted to our own clinical needs. Thereafter, this system was sent out to all chairmen of general and visceral surgery departments in German University Hospitals asking for evaluation and improvements. We adapted the system according to the chairmen's comments and suggestions. Since winter semester 2011 this system has been integrated into the clinical course of history taking and examination. It is compulsory for all 5th semester students (first clinical year/graduate course) at the Universitätsmedizin Greifswald. In addition, a video was produced demonstrating all major techniques of clinical examination. This video is available for all students on a password blocked site of the World Wide Web. Results: Altogether, 89 % of all contacted chairmen returned their comments and suggestions for improvements. After implementation of the new system, positive evaluations of students increased significantly from 63.5 to 77.0 % in general and abdominal surgery (p history taking and clinical examination applicable for students as well as qualified surgeons in daily routine work. It has been approved by the majority of the departments of surgery of all German university hospitals. Furthermore, it can be applied by other medical specialties, in particular, internal medicine. Furthermore, the standardisation of history taking and clinical examination can contribute to improve patients' safety as

Struggling doctors in specialist training: a case control study

DEFF Research Database (Denmark)

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...

Semi-structured interview is a reliable and feasible tool for selection of doctors for general practice specialist training

DEFF Research Database (Denmark)

Isaksen, Jesper; Hertel, Niels Thomas; Kjær, Niels Kristian

2013-01-01

In order to optimise the selection process for admission to specialist training in family medicine, we developed a new design for structured applications and selection interviews. The design contains semi-structured interviews, which combine individualised elements from the applications...... with standardised behaviour-based questions. This paper describes the design of the tool, and offers reflections concerning its acceptability, reliability and feasibility....

Standardising Software Processes - An Obstacle for Innovation?

DEFF Research Database (Denmark)

Aaen, Ivan; Pries-Heje, Jan

2004-01-01

Over the last 10 years CMM has achieved widespread use as a model for improving software organisations. Often CMM is used to standardise software processes across projects. In this paper we discuss this standardisation of SPI in relation to innovation, organisational size and company growth. Our...... discussion is empirically based on years work and experience working with companies on SPI. In the concrete our discussion is enhanced by vignette stories taken from our experience. As a result we find that standardisation focussing on process, metrics, and controls may jeopardize innovative capabilities...

Brazilian infectious diseases specialists: who and where are they?

Directory of Open Access Journals (Sweden)

Alex Jones Flores Cassenote

2016-03-01

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.

Terminology standardisation in the nuclear engineering field

International Nuclear Information System (INIS)

Kraut, A.

1987-01-01

Terminological standardisation is made for the purpose of unambiguous understanding, at least among experts in a given field of knowledge. The author explains a number of criteria and aspects to be taken into account in the process of standardisation by referring to the work of the Terminology Committee on Nuclear Engineering. He discusses the word formation in a technical language and the features of standardised terminology. Accepted terminology is a main factor in all procedures concerning design, testing, and approval and licensing of nuclear facilities, and also is of importance in terms of economics. (HP) [de

Fostering a "Feeling of Worth" Among Vulnerable HIV Populations: The Role of Linkage to Care Specialists.

Science.gov (United States)

Broaddus, Michelle R; Owczarzak, Jill; Schumann, Casey; Koester, Kimberly A

2017-10-01

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.

Neutron Activation Analysis with k0-standardisation

International Nuclear Information System (INIS)

Pomme, S.

2001-01-01

SCK-CEN's programme on Neutron Activation Analysis with k 0 -standardisation concentrates on the improvement of the standardisation method and the characterisation of the neutron field as well as on the improvement of the statistical control on neutron activation analysis. Main achievements in 2000 are reported

Comorbidities and medications of patients with chronic hepatitis C under specialist care in the UK

Science.gov (United States)

Hudson, Benjamin; Walker, Alex J.

2017-01-01

Designing services with the capacity and expertise to meet the needs of the chronic hepatitis C (CHC) population in the era of direct acting antivirals (DAAs), and widening access to such treatments, requires detailed understanding of the characteristics and healthcare needs of the existing patient population. In this retrospective analysis of data from the National HCV Research UK Biobank between March 2012 and October 2014, the characteristics of the CHC population currently under specialist care in the UK were evaluated—with specific focus upon use of medications, adverse lifestyle choices, and comorbidities. Demographic data, risk factors for CHC acquisition, HCV genotype, liver disease status, lifestyle factors, comorbidities, and medication classes were collected. Data were analyzed by history of injecting drug use (IDU), age, and severity of liver disease. A total of 6278 patients (70.5% white; median age, 52 years) from 59 UK specialist centres were included; 59.1% of patients had acquired HCV through IDU. The prevalence of adverse lifestyle factors was significantly lower in non‐IDU compared with previous IDU or recent IDU patients. Depression was common in the previous (50.8%) and recent IDU (68.1%) groups, compared with 27.6% in non‐IDU patients. Cirrhosis was common (23.6%), and prevalence increased with age. We describe a heterogeneous, polymorbid, and aging population of CHC patients in secondary care, and demonstrate underrepresentation of injecting drug users within the current system. The implications of this present significant challenges to physicians and healthcare commissioners in designing services which are fit for purpose inthe DAA era. PMID:28480974

Commissioning of specialist palliative care services in England.

Science.gov (United States)

Lancaster, Harriet; Finlay, Ilora; Downman, Maxwell; Dumas, James

2018-03-01

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/.

Impact of a Clinical Pharmacy Specialist in an Emergency Department for Seniors.

Science.gov (United States)

Shaw, Paul B; Delate, Thomas; Lyman, Alfred; Adams, Jody; Kreutz, Heather; Sanchez, Julia K; Dowd, Mary Beth; Gozansky, Wendolyn

2016-02-01

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.

'Going private': a qualitative comparison of medical specialists' job satisfaction in the public and private sectors of South Africa.

Science.gov (United States)

Ashmore, John

2013-01-03

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

Medical specialist attendance in nursing homes [Beschreibung und Bewertung der fachärztlichen Versorgung von Pflegeheimbewohnern in Deutschland

Directory of Open Access Journals (Sweden)

Balzer, Katrin

2013-04-01

Full Text Available [english] The care in nursing homes was examined based on scientific studies. The analysis focuses on dementia and type II diabetes. There is evidence for deficits in the supply of medical specialist attendance to nursing home residents with these diseases in Germany. Compared with corresponding guidelines the medical care for nursing home residents may be too low or inadequate.[german] Es wird die Versorgung in Pflegeheimen auf Basis wissenschaftlicher Studien untersucht. Schwerpunkte der Analyse sind Demenz und Diabetes. Es gibt Hinweise auf fachärztliche Versorgungsmängel bei Pflegeheimbewohnern mit diesen Krankheiten in Deutschland. Verglichen mit entsprechenden Leitlinien bestehen mögliche Unter- bzw. Fehlversorgungen.

COgnitive behavioural therapy vs standardised medical care for adults with Dissociative non-Epileptic Seizures (CODES): a multicentre randomised controlled trial protocol.

Science.gov (United States)

Goldstein, Laura H; Mellers, John D C; Landau, Sabine; Stone, Jon; Carson, Alan; Medford, Nick; Reuber, Markus; Richardson, Mark; McCrone, Paul; Murray, Joanna; Chalder, Trudie

2015-06-27

The evidence base for the effectiveness of psychological interventions for patients with dissociative non-epileptic seizures (DS) is currently extremely limited, although data from two small pilot randomised controlled trials (RCTs), including from our group, suggest that Cognitive Behavioural Therapy (CBT) may be effective in reducing DS occurrence and may improve aspects of psychological status and psychosocial functioning. The study is a multicentre, pragmatic parallel group RCT to evaluate the clinical and cost-effectiveness of specifically-tailored CBT plus standardised medical care (SMC) vs SMC alone in reducing DS frequency and improving psychological and health-related outcomes. In the initial screening phase, patients with DS will receive their diagnosis from a neurologist/epilepsy specialist. If patients are eligible and interested following the provision of study information and a booklet about DS, they will consent to provide demographic information and fortnightly data about their seizures, and agree to see a psychiatrist three months later. We aim to recruit ~500 patients to this screening stage. After a review three months later by a psychiatrist, those patients who have continued to have DS in the previous eight weeks and who meet further eligibility criteria will be told about the trial comparing CBT + SMC vs SMC alone. If they are interested in participating, they will be given a further booklet on DS and study information. A research worker will see them to obtain their informed consent to take part in the RCT. We aim to randomise 298 people (149 to each arm). In addition to a baseline assessment, data will be collected at 6 and 12 months post randomisation. Our primary outcome is monthly seizure frequency in the preceding month. Secondary outcomes include seizure severity, measures of seizure freedom and reduction, psychological distress and psychosocial functioning, quality of life, health service use, cost effectiveness and adverse

Standardisation of costs: the Dutch Manual for Costing in economic evaluations.

Science.gov (United States)

Oostenbrink, Jan B; Koopmanschap, Marc A; Rutten, Frans F H

2002-01-01

The lack of a uniform costing methodology is often considered a weakness of economic evaluations that hinders the interpretation and comparison of studies. Standardisation is therefore an important topic within the methodology of economic evaluations and in national guidelines that formulate the formal requirements for studies to be considered when deciding on the reimbursement of new medical therapies. Recently, the Dutch Manual for Costing: Methods and Standard Costs for Economic Evaluations in Health Care (further referred to as "the manual") has been published, in addition to the Dutch guidelines for pharmacoeconomic research. The objectives of this article are to describe the main content of the manual and to discuss some key issues of the manual in relation to the standardisation of costs. The manual introduces a six-step procedure for costing. These steps concern: the scope of the study;the choice of cost categories;the identification of units;the measurement of resource use;the monetary valuation of units; andthe calculation of unit costs. Each step consists of a number of choices and these together define the approach taken. In addition to a description of the costing process, five key issues regarding the standardisation of costs are distinguished. These are the use of basic principles, methods for measurement and valuation, standard costs (average prices of healthcare services), standard values (values that can be used within unit cost calculations), and the reporting of outcomes. The use of the basic principles, standard values and minimal requirements for reporting outcomes, as defined in the manual, are obligatory in studies that support submissions to acquire reimbursement for new pharmaceuticals. Whether to use standard costs, and the choice of a particular method to measure or value costs, is left mainly to the investigator, depending on the specific study setting. In conclusion, several instruments are available to increase standardisation in

COgnitive behavioural therapy versus standardised medical care for adults with Dissociative non-Epileptic Seizures (CODES): statistical and economic analysis plan for a randomised controlled trial.

Science.gov (United States)

Robinson, Emily J; Goldstein, Laura H; McCrone, Paul; Perdue, Iain; Chalder, Trudie; Mellers, John D C; Richardson, Mark P; Murray, Joanna; Reuber, Markus; Medford, Nick; Stone, Jon; Carson, Alan; Landau, Sabine

2017-06-06

Dissociative seizures (DSs), also called psychogenic non-epileptic seizures, are a distressing and disabling problem for many patients in neurological settings with high and often unnecessary economic costs. The COgnitive behavioural therapy versus standardised medical care for adults with Dissociative non-Epileptic Seizures (CODES) trial is an evaluation of a specifically tailored psychological intervention with the aims of reducing seizure frequency and severity and improving psychological well-being in adults with DS. The aim of this paper is to report in detail the quantitative and economic analysis plan for the CODES trial, as agreed by the trial steering committee. The CODES trial is a multicentre, pragmatic, parallel group, randomised controlled trial performed to evaluate the clinical effectiveness and cost-effectiveness of 13 sessions of cognitive behavioural therapy (CBT) plus standardised medical care (SMC) compared with SMC alone for adult outpatients with DS. The objectives and design of the trial are summarised, and the aims and procedures of the planned analyses are illustrated. The proposed analysis plan addresses statistical considerations such as maintaining blinding, monitoring adherence with the protocol, describing aspects of treatment and dealing with missing data. The formal analysis approach for the primary and secondary outcomes is described, as are the descriptive statistics that will be reported. This paper provides transparency to the planned inferential analyses for the CODES trial prior to the extraction of outcome data. It also provides an update to the previously published trial protocol and guidance to those conducting similar trials. ISRCTN registry ISRCTN05681227 (registered on 5 March 2014); ClinicalTrials.gov NCT02325544 (registered on 15 December 2014).

Updated European core curriculum for radiotherapists (radiation oncologists). Recommended curriculum for the specialist training of medical practitioners in radiotherapy (radiation oncology) within Europe.

NARCIS (Netherlands)

Baumann, M.; Leer, J.W.H.; Dahl, O.; Neve, W. de; Hunter, R.; Rampling, R.; Verfaillie, C.

2004-01-01

AIM: To produce updated state-of-the-art recommendations for harmonised medical specialist training in radiotherapy within Europe. MATERIAL AND METHODS: The Minimum Curriculum for the Theoretical Education in Radiation Oncology in Europe from 1991 was updated under consideration of new developments

China and Global ICT standardisation and innovation

OpenAIRE

Williams, Robin; Graham, Ian; Jakobs, Kai; Lyytinen, Kalle

2011-01-01

The People's Republic of China has become remarkably active in the development of interoperability standards across many areas of information and communications technology (ICT). Such standards are crucial for the creation of newindustries and markets for novel ICT products and services. This engagement in standardisation is linked to the Chinese government's strategy to develop indigenous technologies and, in some cases through involvement in international standardisation bodies, to put Chin...

The rural pipeline to longer-term rural practice: General practitioners and specialists.

Directory of Open Access Journals (Sweden)

Marcella M S Kwan

Full Text Available Rural medical workforce shortage contributes to health disadvantage experienced by rural communities worldwide. This study aimed to determine the regional results of an Australian Government sponsored national program to enhance the Australian rural medical workforce by recruiting rural background students and establishing rural clinical schools (RCS. In particular, we wished to determine predictors of graduates' longer-term rural practice and whether the predictors differ between general practitioners (GPs and specialists.A cross-sectional cohort study, conducted in 2012, of 729 medical graduates of The University of Queensland 2002-2011. The outcome of interest was primary place of graduates' practice categorised as rural for at least 50% of time since graduation ('Longer-term Rural Practice', LTRP among GPs and medical specialists. The main exposures were rural background (RB or metropolitan background (MB, and attendance at a metropolitan clinical school (MCS or the Rural Clinical School for one year (RCS-1 or two years (RCS-2.Independent predictors of LTRP (odds ratio [95% confidence interval] were RB (2.10 [1.37-3.20], RCS-1 (2.85 [1.77-4.58], RCS-2 (5.38 [3.15-9.20], GP (3.40 [2.13-5.43], and bonded scholarship (2.11 [1.19-3.76]. Compared to being single, having a metropolitan background partner was a negative predictor (0.34 [0.21-0.57]. The effects of RB and RCS were additive-compared to MB and MCS (Reference group: RB and RCS-1 (6.58[3.32-13.04], RB and RCS-2 (10.36[4.89-21.93]. Although specialists were less likely than GPs to be in LTRP, the pattern of the effects of rural exposures was similar, although some significant differences in the effects of the duration of RCS attendance, bonded scholarships and partner's background were apparent.Among both specialists and GPs, rural background and rural clinical school attendance are independent, duration-dependent, and additive, predictors of longer-term rural practice. Metropolitan

Minority Language Standardisation and the Role of Users

Science.gov (United States)

Lane, Pia

2015-01-01

Developing a standard for a minority language is not a neutral process; this has consequences for the status of the language and how the language users relate to the new standard. A potential inherent problem with standardisation is whether the language users themselves will accept and identify with the standard. When standardising minority…

Estimating the 'consumer surplus' for branded versus standardised tobacco packaging.

Science.gov (United States)

Gendall, Philip; Eckert, Christine; Hoek, Janet; Farley, Tessa; Louviere, Jordan; Wilson, Nick; Edwards, Richard

2016-11-01

Tobacco companies question whether standardised (or 'plain') packaging will change smokers' behaviour. We addressed this question by estimating how standardised packaging compared to a proven tobacco control intervention, price increases through excise taxes, thus providing a quantitative measure of standardised packaging's likely effect. We conducted an online study of 311 New Zealand smokers aged 18 years and above that comprised a willingness-to-pay task comparing a branded and a standardised pack at four different price levels, and a choice experiment. The latter used an alternative-specific design, where the alternatives were a branded pack or a standardised pack, with warning theme and price varied for each pack. Respondents had higher purchase likelihoods for the branded pack (with a 30% warning) than the standardised pack (with a 75% warning) at each price level tested, and, on average, were willing to pay approximately 5% more for a branded pack. The choice experiment produced a very similar estimate of 'consumer surplus' for a branded pack. However, the size of the 'consumer surplus' varied between warning themes and by respondents' demographic characteristics. These two experiments suggest standardised packaging and larger warning labels could have a similar overall effect on adult New Zealand smokers as a 5% tobacco price increase. The findings provide further evidence for the efficacy of standardised packaging, which focuses primarily on reducing youth initiation, and suggest this measure will also bring notable benefits to adult smokers. 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/.

Managing IT infrastructure standardisation in the networked manufacturing firm

NARCIS (Netherlands)

Akkermans, H.A.; Horst, van der H.

2002-01-01

This paper discusses managerial aspects of information technology (IT) infrastructure standardisation in networked manufacturing firms. It shows that in these firms, where local initiative is very important and strict central hierarchical control is lacking, standardisation of IT infrastructure is

Scottish young people's perceptions of standardised packs - a qualitative study

Directory of Open Access Journals (Sweden)

Andy Macgregor

2018-03-01

Full Text Available Background Standardised cigarette packs were introduced into the UK in May 2016. Retailers could sell old stock until May 2017 after which only the sale of cigarettes and tobacco in standardised packs was allowed. As in Australia, pack shape, colour, opening mechanism and font are regulated, together with the size and position of health warnings and number of cigarettes in a pack. This paper explores Scottish young people's awareness of and views about standardised packs in Spring 2017. Methods The DISPLAY study is a five year study established to evaluate the national tobacco point-of sale (POS promotions ban in four communities in Scotland. This paper is based on the qualitative component, annual focus groups carried out with Secondary 2 (13 year olds and Secondary 4 (15 year olds students in four secondary schools. 16 groups (82 students convened in February - March 2017 explored students' perceptions of standardised packaging. Results There was a high level of awareness of standardised packs prior to their full implementation. Smokers had bought them, and they and other participants had seen them in possession of friends and family members, and in litter. Participants' views of the new packaging were generally negative, described as unappealing and depressing, particularly the pictorial health warnings. Packs were compared unfavourably with previous non-standardised versions. However, there was no consensus on their likely impact. Some participants argued that their impact would be widespread, while others thought that any impact would be confined to young non/occasional smokers and that established smokers would be unaffected. Conclusions In early 2017 young people in Scotland had high awareness and knowledge of standardised tobacco packs before their full implementation. Despite differing views about their likely impact on youth smoking, participants irrespective of smoking status overwhelmingly regarded them as unattractive and less

Standardised patient-simulated practice learning

African Journals Online (AJOL)

Teaching strategies must link theory to practice, foster critical thinking, be relevant and stimulate ... Standardised patient-simulated practice learning: A rich pedagogical .... relationship for them to grow and develop from novice to expert. They.

Recommendations for using standardised phenotypes in genetic association studies

Directory of Open Access Journals (Sweden)

Naylor Melissa G

2009-07-01

Full Text Available Abstract Genetic association studies of complex traits often rely on standardised quantitative phenotypes, such as percentage of predicted forced expiratory volume and body mass index to measure an underlying trait of interest (eg lung function, obesity. These phenotypes are appealing because they provide an easy mechanism for comparing subjects, although such standardisations may not be the best way to control for confounders and other covariates. We recommend adjusting raw or standardised phenotypes within the study population via regression. We illustrate through simulation that optimal power in both population- and family-based association tests is attained by using the residuals from within-study adjustment as the complex trait phenotype. An application of family-based association analysis of forced expiratory volume in one second, and obesity in the Childhood Asthma Management Program data, illustrates that power is maintained or increased when adjusted phenotype residuals are used instead of typical standardised quantitative phenotypes.

Standardisation of neonatal clinical practice.

Science.gov (United States)

Bhutta, Z A; Giuliani, F; Haroon, A; Knight, H E; Albernaz, E; Batra, M; Bhat, B; Bertino, E; McCormick, K; Ochieng, R; Rajan, V; Ruyan, P; Cheikh Ismail, L; Paul, V

2013-09-01

The International Fetal and Newborn Growth Consortium for the 21(st) Century (INTERGROWTH-21(st) ) is a large-scale, population-based, multicentre project involving health institutions from eight geographically diverse countries, which aims to assess fetal, newborn and preterm growth under optimal conditions. Given the multicentre nature of the project and the expected number of preterm births, it is vital that all centres follow the same standardised clinical care protocols to assess and manage preterm infants, so as to ensure maximum validity of the resulting standards as indicators of growth and nutrition with minimal confounding. Moreover, it is well known that evidence-based clinical practice guidelines can reduce the delivery of inappropriate care and support the introduction of new knowledge into clinical practice. The INTERGROWTH-21(st) Neonatal Group produced an operations manual, which reflects the consensus reached by members of the group regarding standardised definitions of neonatal morbidities and the minimum standards of care to be provided by all centres taking part in the project. The operational definitions and summary management protocols were developed by consensus through a Delphi process based on systematic reviews of relevant guidelines and management protocols by authoritative bodies. This paper describes the process of developing the Basic Neonatal Care Manual, as well as the morbidity definitions and standardised neonatal care protocols applied across all the INTERGROWTH-21(st) participating centres. Finally, thoughts about implementation strategies are presented. © 2013 Royal College of Obstetricians and Gynaecologists.

Complex care by multiple medical and dental specialists of a patient with aggressive Gorlin-Goltz syndrome.

Science.gov (United States)

Nagy, K; Kiss, E; Erdei, C; Oberna, F; Fejérdy, P; Márton, K; Vajo, Z

2008-06-01

Gorlin-Goltz syndrome is a genetically predisposed disease characterised by multiple basal cell carcinomas, odontogenic keratocysts and ectopic calcifications. The aim of this study was to show successful treatment of a 37-year-old male patient by cooperation between different dental and medical specialists. Because of the recurrence of a large basal cell carcinoma after multiple operations and a total dose telecobalt irradiation of 66 Gy, the patient's nose was ablated, with resection of the upper lip and part of the maxilla. The intraoral prosthetic treatment helped to restore the subtotal edentulousness. In order to enhance the application of the dental prosthesis, an Abbe plasty was performed at the second stage of surgery. As previous irradiation of the area precluded the use of facial implants immediately after the intraoral treatment, a temporary artificial nose prosthesis was created. The patient tolerated the procedures well and is completely disease-free 12 months after the surgery. Besides presenting a rare and complicated case of Gorlin-Goltz syndrome, the main purpose of this report is to show that, if different specialists in a dental-clinical team (maxillofacial surgeon, oncologist, radiation oncologist, prosthodontist and psychiatrist) combine their skills and expertise, successful management is possible even in a challenging complex case.

Flemish Sign Language Standardisation

Science.gov (United States)

Van Herreweghe, Mieke; Vermeerbergen, Myriam

2009-01-01

In 1997, the Flemish Deaf community officially rejected standardisation of Flemish Sign Language. It was a bold choice, which at the time was not in line with some of the decisions taken in the neighbouring countries. In this article, we shall discuss the choices the Flemish Deaf community has made in this respect and explore why the Flemish Deaf…

Use of professional profiles in applications for specialist training positions

DEFF Research Database (Denmark)

Lundh, Andreas; Skjelsager, Karen; Wildgaard, Kim

2013-01-01

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...

Achieving best practices in national standardisation. A benchmarking study of the national standardisation systems of Finland, Sweden, Denmark and Italy

International Nuclear Information System (INIS)

Bonner, P.; Potter, D.

2000-01-01

The national standardisation systems of Finland, Sweden, Denmark and Italy have been benchmarked in a study that has sought to identify best practices for improving the performance of all participating bodies. This study has been funded by the Ministry of Trade and Industry of Finland with some assistance from the European Commission. It has involved a series of 27 interviews of some 120 participants at different levels in the standardisation and wider stakeholder communities. This report details the features of each national system and describes more than 50 best practices identified during the course of the study, together with more than 25 recommendations for further improvements that are drawn from best practices in other organisations. The report starts by identifying best practices in the national standardisation systems and their structures and processes before moving onto the participation in European and international standardisation, with their challenges of influence, management and delivery. The relationship with government, at national level and within European programmes, is then addressed before moving onto the financing of standardisation activities within each of the national systems. The focus then starts moving more towards the national standards bodies (SFS,SIS,DS,UNI/CEI) by looking into issues relating to publications and onto customer services, sales and marketing. Management issues and the benefits of a long term strategic approach are then covered before moving on to the issues associated with communications and outreach, not only to those outside of the standards community but also those within it and on its edges. Moreover, trends during the last five years and those expected within the next two are dealt with briefly. A number of recommendations are common to all of the participating bodies. More detailed recommendations and suggested priorities have been made privately in a further set of reports delivered to the participating bodies

Senior physiotherapy students as standardised patients for junior students enhances self-efficacy and satisfaction in both junior and senior students.

Science.gov (United States)

Mandrusiak, Allison M; Isles, Rosemary; Chang, Angela T; Choy, Nancy L Low; Toppenberg, Rowena; McCook, Donna; Smith, Michelle D; O'Leary, Karina; Brauer, Sandra G

2014-05-23

Standardised patients are used in medical education to expose students to clinical contexts and facilitate transition to clinical practice, and this approach is gaining momentum in physiotherapy programs. Expense and availability of trained standardised patients are factors limiting widespread adoption, and accessing clinical visits with real patients can be challenging. This study addressed these issues by engaging senior students as standardised patients for junior students. It evaluated how this approach impacted self-reported constructs of both the junior and senior students. Learning activities for undergraduate physiotherapy students were developed in five courses (Neurology, Cardiorespiratory and three Musculoskeletal courses) so that junior students (Year 2 and 3) could develop skills and confidence in patient interview, physical examination and patient management through their interaction with standardised patients played by senior students (Year 4). Surveys were administered before and after the interactions to record junior students' self-reported confidence, communication, preparedness for clinic, and insight into their abilities; and senior students' confidence and insight into what it is like to be a patient. Satisfaction regarding this learning approach was surveyed in both the junior and senior students. A total of 253 students completed the surveys (mean 92.5% response rate). Across all courses, junior students reported a significant (all P Senior students demonstrated a significant improvement in their confidence in providing feedback and insight into their own learning (P senior students as standardised patients resulted in positive experiences for both junior and senior students across a variety of physiotherapy areas, activities, and stages within a physiotherapy program. These findings support the engagement of senior students as standardised patients to enhance learning within physiotherapy programs, and may have application across other

Trends and quality of care in outpatient visits to generalist and specialist physicians delivering primary care in the United States, 1997-2010.

Science.gov (United States)

Edwards, Samuel T; Mafi, John N; Landon, Bruce E

2014-06-01

Although many specialists serve as primary care physicians (PCPs), the type of patients they serve, the range of services they provide, and the quality of care they deliver is uncertain. To describe trends in patient, physician, and visit characteristics, and compare visit-based quality for visits to generalists and specialists self-identified as PCPs. Cross-sectional study and time trend analysis. Nationally representative sample of visits to office-based physicians from the National Ambulatory Medical Care Survey, 1997-2010. Proportions of primary care visits to generalist and specialists, patient characteristics, principal diagnoses, and quality. Among 84,041 visits to self-identified PCPs representing an estimated 4.0 billion visits, 91.5 % were to generalists, 5.9 % were to medical specialists and 2.6 % were to obstetrician/gynecologists. The proportion of PCP visits to generalists increased from 88.4 % in 1997 to 92.4 % in 2010, but decreased for medical specialists from 8.0 % to 4.8 %, p = 0.04). The proportion of medical specialist visits in which the physician self-identified as the patient's PCP decreased from 30.6 % in 1997 to 9.8 % in 2010 (p specialist PCPs take care of older patients (mean age 61 years), and dedicate most of their visits to chronic disease management (51.0 %), while generalist PCPs see younger patients (mean age 55.4 years) most commonly for new problems (40.5 %). Obstetrician/gynecologists self-identified as PCPs see younger patients (mean age 38.3 p specialists. Medical specialists are less frequently serving as PCPs for their patients over time. Generalist, medical specialist, and obstetrician/gynecologist PCPs serve different primary care roles for different populations. Delivery redesign efforts must account for the evolving role of generalist and specialist PCPs in the delivery of primary care.

Standardisation of the USGS Volcano Alert Level System (VALS): analysis and ramifications

Science.gov (United States)

Fearnley, C. J.; McGuire, W. J.; Davies, G.; Twigg, J.

2012-11-01

The standardisation of volcano early warning systems (VEWS) and volcano alert level systems (VALS) is becoming increasingly common at both the national and international level, most notably following UN endorsement of the development of globally comprehensive early warning systems. Yet, the impact on its effectiveness, of standardising an early warning system (EWS), in particular for volcanic hazards, remains largely unknown and little studied. This paper examines this and related issues through evaluation of the emergence and implementation, in 2006, of a standardised United States Geological Survey (USGS) VALS. Under this upper-management directive, all locally developed alert level systems or practices at individual volcano observatories were replaced with a common standard. Research conducted at five USGS-managed volcano observatories in Alaska, Cascades, Hawaii, Long Valley and Yellowstone explores the benefits and limitations this standardisation has brought to each observatory. The study concludes (1) that the process of standardisation was predominantly triggered and shaped by social, political, and economic factors, rather than in response to scientific needs specific to each volcanic region; and (2) that standardisation is difficult to implement for three main reasons: first, the diversity and uncertain nature of volcanic hazards at different temporal and spatial scales require specific VEWS to be developed to address this and to accommodate associated stakeholder needs. Second, the plural social contexts within which each VALS is embedded present challenges in relation to its applicability and responsiveness to local knowledge and context. Third, the contingencies of local institutional dynamics may hamper the ability of a standardised VALS to effectively communicate a warning. Notwithstanding these caveats, the concept of VALS standardisation clearly has continuing support. As a consequence, rather than advocating further commonality of a standardised

Management of Nonceliac Gluten Sensitivity by Gastroenterology Specialists: Data from an Italian Survey

Directory of Open Access Journals (Sweden)

Federica Branchi

2015-01-01

Full Text Available Background and Aim. Nonceliac gluten sensitivity is syndrome characterized by symptoms disappearing after a gluten-free diet. Its existence is still argument of discussion among specialists. Our aim was to evaluate the knowledge about nonceliac gluten sensitivity among gastroenterology specialists. Methods. During October 2013 a questionnaire was sent through a medical newsletter to Italian gastroenterologists. Twelve questions investigated their knowledge on nonceliac gluten sensitivity, including their diagnostic and therapeutic approach. Results. A total of 212 gastroenterologists filled in the questionnaire. The 98.6% were aware of the existence of a syndrome called “nonceliac gluten sensitivity” and 77% believe in its existence. However, only 56% gave a correct definition of the term. The majority of specialists diagnosed gluten sensitive patients and the number of diagnoses was not statistically different from that of celiac disease. Moreover, a gluten-free diet was prescribed by 64% of the specialists and among them the 73% noted an increase of gluten sensitive patients attending their outpatient services. Conclusions. Our study indicated that most of the specialists recognize nonceliac gluten sensitivity and prescribe gluten-free diet, although 44% of the specialists are not able to give its correct definition; underlining the necessity of medical education on this topic is needed.

Governance of electrotechnical standardisation in Europe

NARCIS (Netherlands)

H.J. de Vries (Henk)

2015-01-01

markdownabstract__Abstract__ This report provides recommendations about the governance of electrotechnical standardisation in Europe to seven independent National Committees: DKE (Germany), Electrosuisse (Switzerland), OVE (Austria), NEC (the Netherlands), NEK (Norway), SEK (Sweden), and SESKO

[Deontology in generalists-specialists relations in domestic emergencies].

Science.gov (United States)

Leemans, P

2000-09-01

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.

Standardisation roadmap for electromobility; Normungs-Fahrplan fuer die Elektromobilitaet

Energy Technology Data Exchange (ETDEWEB)

Heusinger, Stefan [DKE Deutsche Kommission Elektrotechnik Elektronik Informationstechnik im DIN und VDE, Frankfurt/Main (Germany). Bereich Standardisierung

2011-03-15

All internal combustion engines - even the most efficient ones - consume fossil fuels which are getting increasingly scarce. The future of power supply, also in the mobile sector, is in renewables and electromobility. In Germany, the NPE (National Platform for Electromobility) was founded in order to achieve standardisation in this field as early as possible. A standardisation roadmap was established which is to facilitate implementation of electromobility during the next few years.

Direct risk standardisation: a new method for comparing casemix adjusted event rates using complex models.

Science.gov (United States)

Nicholl, Jon; Jacques, Richard M; Campbell, Michael J

2013-10-29

Comparison of outcomes between populations or centres may be confounded by any casemix differences and standardisation is carried out to avoid this. However, when the casemix adjustment models are large and complex, direct standardisation has been described as "practically impossible", and indirect standardisation may lead to unfair comparisons. We propose a new method of directly standardising for risk rather than standardising for casemix which overcomes these problems. Using a casemix model which is the same model as would be used in indirect standardisation, the risk in individuals is estimated. Risk categories are defined, and event rates in each category for each centre to be compared are calculated. A weighted sum of the risk category specific event rates is then calculated. We have illustrated this method using data on 6 million admissions to 146 hospitals in England in 2007/8 and an existing model with over 5000 casemix combinations, and a second dataset of 18,668 adult emergency admissions to 9 centres in the UK and overseas and a published model with over 20,000 casemix combinations and a continuous covariate. Substantial differences between conventional directly casemix standardised rates and rates from direct risk standardisation (DRS) were found. Results based on DRS were very similar to Standardised Mortality Ratios (SMRs) obtained from indirect standardisation, with similar standard errors. Direct risk standardisation using our proposed method is as straightforward as using conventional direct or indirect standardisation, always enables fair comparisons of performance to be made, can use continuous casemix covariates, and was found in our examples to have similar standard errors to the SMR. It should be preferred when there is a risk that conventional direct or indirect standardisation will lead to unfair comparisons.

Respiratory rates measured by a standardised clinical approach, ward staff, and a wireless device

DEFF Research Database (Denmark)

Granholm, A; Pedersen, N E; Lippert, A.

2016-01-01

in a medical ward. Respiratory rate was measured by three methods: a standardised approach over 60 s while patients lay still and refrained from talking, by ward staff and by a wireless electronic patch (SensiumVitals). The Bland-Altman method was used to compare measurements and three breaths per minute (BPM......) was considered a clinically relevant difference. RESULTS: We included 50 patients. The mean difference between the standardised approach and the electronic measurement was 0.3 (95% CI: -1.4 to 2.0) BPM; 95% limits of agreement were -11.5 (95% CI: -14.5 to -8.6) and 12.1 (95% CI: 9.2 to 15.1) BPM. Removal...... of three outliers with huge differences lead to a mean difference of -0.1 (95% CI: -0.7 to 0.5) BPM and 95% limits of agreement of -4.2 (95% CI: -5.3 to -3.2) BPM and 4.0 (95% CI: 2.9 to 5.0) BPM. The mean difference between staff and electronic measurements was 1.7 (95% CI: -0.5 to 3.9) BPM; 95% limits...

Standardisation of spirometry | Stewart | South African Medical Journal

African Journals Online (AJOL)

South African Medical Journal. Journal Home · ABOUT · Advanced Search · Current Issue · Archives · Journal Home > Vol 79, No 4 (1991) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should load here if your ...

Medical Information Sources Used by Specialists and Residents in Mashhad, Iran

NARCIS (Netherlands)

Sarbaz, Masoumeh; Naderi, Hamid Reza; Aelami, Mohammad Hassan; Eslami, Saeid

2016-01-01

Background: Physicians continually need to update their knowledge to ensure appropriate decision making about patient care. Objectives: We aimed to identify and compare information sources used by specialists and residents, their reasons for choosing these sources, and the level of their confidence

Comparison of prescribing indicators of academic versus non-academic specialist physicians in Urmia, Iran

Science.gov (United States)

Sadigh-Rad, Laya; Majdi, Leila; Javaezi, Mehrnush; Delirrad, Mohammad

2015-01-01

Objective: As chief prescribers, physicians could have a key role in rational drug use. Core prescribing indicators of all physicians have been evaluated in the Islamic Republic of Iran for several years, but no study has assessed the effects of academic status of doctors on their prescribing behaviors. We aimed to compare prescribing indicators of two groups of academic and non-academic specialist physicians working in Urmia, Iran. Methods: In this cross-sectional study, prescribing indicators of the total number of 37 academic and 104 non-academic specialist physicians in six medical specialties (infectious diseases, psychiatry, otorhinolaryngology, gynecology, pediatrics and general surgery) were studied during 2012 using Rx-analyzer, a dedicated computer application. A set of five quality indicators was used based on the World Health Organization and International Network for Rational Use of Drugs recommendations. Findings: Totally, 709,771 medications in 269,660 prescriptions were studied. For academic and non-academic specialist physicians, the average number of medications per prescription was 2.26 and 2.65, respectively. Similarly, patients’ encounters with injectable pharmaceuticals were 17.37% and 26.76%, respectively. The corresponding figures for antimicrobial agents were 33.12% and 45.46%, respectively. The average costs of every prescription were 6.53 and 3.30 United States Dollar for academic and non-academic specialist physicians, respectively. All the above-mentioned differences were statistically significant. Conclusion: Better prescribing patterns were observed in academic specialist physicians. However, they prescribed medications that were more expensive, while the reason was not investigated in this study. Further studies may reveal the exact causes of these differences. PMID:25984540

Nurse's use of power to standardise nursing terminology in electronic health records.

Science.gov (United States)

Ali, Samira; Sieloff, Christina L

2017-07-01

To describe nurses' use of power to influence the incorporation of standardised nursing terminology within electronic health records. Little is known about nurses' potential use of power to influence the incorporation of standardised nursing terminology within electronic health records. The theory of group power within organisations informed the design of the descriptive, cross-sectional study used a survey method to assess nurses' use of power to influence the incorporation of standardised nursing terminology within electronic health records. The Sieloff-King Assessment of Group Power within Organizations © and Nursing Power Scale was used. A total of 232 nurses responded to the survey. The mean power capability score was moderately high at 134.22 (SD 18.49), suggesting that nurses could use power to achieve the incorporation of standardised nursing terminology within electronic health records. The nurses' power capacity was significantly correlated with their power capability (r = 0.96, P power to achieve their goals, such as the incorporation of standardised nursing terminology within electronic health records. Nurse administrators may use their power to influence the incorporation of standardised nursing terminology within electronic health records. If nurses lack power, this could decrease nurses' ability to achieve their goals and contribute to the achievement of effective patient outcomes. © 2017 John Wiley & Sons Ltd.

Standardisation of magnetic nanoparticles in liquid suspension

International Nuclear Information System (INIS)

Wells, James; Kazakova, Olga; Posth, Oliver; Steinhoff, Uwe; Petronis, Sarunas; Bogart, Lara K; Southern, Paul; Pankhurst, Quentin; Johansson, Christer

2017-01-01

Suspensions of magnetic nanoparticles offer diverse opportunities for technology innovation, spanning a large number of industry sectors from imaging and actuation based applications in biomedicine and biotechnology, through large-scale environmental remediation uses such as water purification, to engineering-based applications such as position-controlled lubricants and soaps. Continuous advances in their manufacture have produced an ever-growing range of products, each with their own unique properties. At the same time, the characterisation of magnetic nanoparticles is often complex, and expert knowledge is needed to correctly interpret the measurement data. In many cases, the stringent requirements of the end-user technologies dictate that magnetic nanoparticle products should be clearly defined, well characterised, consistent and safe; or to put it another way—standardised. The aims of this document are to outline the concepts and terminology necessary for discussion of magnetic nanoparticles, to examine the current state-of-the-art in characterisation methods necessary for the most prominent applications of magnetic nanoparticle suspensions, to suggest a possible structure for the future development of standardisation within the field, and to identify areas and topics which deserve to be the focus of future work items. We discuss potential roadmaps for the future standardisation of this developing industry, and the likely challenges to be encountered along the way. (topical review)

Standardisation of magnetic nanoparticles in liquid suspension

Science.gov (United States)

Wells, James; Kazakova, Olga; Posth, Oliver; Steinhoff, Uwe; Petronis, Sarunas; Bogart, Lara K.; Southern, Paul; Pankhurst, Quentin; Johansson, Christer

2017-09-01

Suspensions of magnetic nanoparticles offer diverse opportunities for technology innovation, spanning a large number of industry sectors from imaging and actuation based applications in biomedicine and biotechnology, through large-scale environmental remediation uses such as water purification, to engineering-based applications such as position-controlled lubricants and soaps. Continuous advances in their manufacture have produced an ever-growing range of products, each with their own unique properties. At the same time, the characterisation of magnetic nanoparticles is often complex, and expert knowledge is needed to correctly interpret the measurement data. In many cases, the stringent requirements of the end-user technologies dictate that magnetic nanoparticle products should be clearly defined, well characterised, consistent and safe; or to put it another way—standardised. The aims of this document are to outline the concepts and terminology necessary for discussion of magnetic nanoparticles, to examine the current state-of-the-art in characterisation methods necessary for the most prominent applications of magnetic nanoparticle suspensions, to suggest a possible structure for the future development of standardisation within the field, and to identify areas and topics which deserve to be the focus of future work items. We discuss potential roadmaps for the future standardisation of this developing industry, and the likely challenges to be encountered along the way.

Using the computer to optimize human performance in health care delivery. The pathologist as medical information specialist.

Science.gov (United States)

Korpman, R A

1987-07-01

The demands for information retrieval, processing, and synthesis placed on all providers of health care have increased dramatically in the last several decades. Although systems have been developed to capture charge-related data in support of cost reimbursement, there has been a conspicuous lack of attention paid to information tools to directly enhance the delivery of patient care. The termination of cost reimbursement, together with an increasing recognition of the problems inherent in current manual record-keeping systems, is creating a significant new focus on medical information. This change in focus requires a shift in systems orientation away from financial and departmentally centered systems and toward patient-centered approaches. There is thus increasing recognition of the need for a physician-level medical information specialist to serve as an institution's chief information officer, assuming responsibility for the collection, manipulation, and availability of all patient care-related data. By virtue of training, typical experience, hospital presence, and a noncompetitive position with the hospital's medical staff, the pathologist is uniquely suited for this position. To effectively perform this role, a variety of new specialized data management tools are becoming available. Integrated information systems, patient care management by exception, decision support tools, and, in the future, "artificial intelligence" assists can all be expected to become staples of pathology practice, especially impacting those pathologists who choose to be responsive to the new practice milieu of medical information science.

Attitudes toward people with HIV/AIDS among medical practitioners and nonmedical specialists in Ukraine

Directory of Open Access Journals (Sweden)

Zhabenko, Nataliya

2012-07-01

Full Text Available INTRODUCTION: AIDS is the disease that has been stigmatized since its development; stigmatization of people living with HIV is an important barrier to using HIV testing and treatment. It is well known, that stigma is associated with mental disorders including depression and anxiety. Ukraine is a country with one of the highest number of annual HIV infection cases. GOALS: The goal of this study was to evaluate medical practitioners’ (surgeons, psychiatrists, therapists and students and nonmedical specialists’ attitude toward people with HIV/AIDS.METHODS: A total of 180 individuals participated in the study. Acceptance of people who have AIDS or are infected with HIV was assessed with the help of the “Attitudes toward people with HIV or AIDS”. Total scores range from 50 to 10, higher scores indicate high acceptance of persons with HIV/AIDS.RESULTS: Younger participants reported higher acceptance of persons with HIV or AIDS (p.05. Medical practitioners showed greater total score, compare to nonmedical specialists (38.0 ± 6.0 vs. 34.0 ± 5.5, respectively, p<.05. A one-way between-groups analysis of variance was conducted to explore the impact of medical specialty on levels of positive attitudes toward people with HIV or AIDS. The actual difference in mean scores between the 4 groups was moderate (.06. Students and psychiatrists reported more positive attitudes (higher acceptance toward people with HIV and AIDS, but analyses showed, that there was not a statistically significant difference at the level in total score for the groups.CONCLUSION: In this study we evaluated the level of attitudes toward people with HIV or AIDS in Ukraine. Young age and medical education were significantly associated with the positive attitudes toward people with HIV and AIDS. Our findings are important for the programs reducing the stigma and discrimination that should be addressed to the wide layers of the society.

Motives that head and neck cancer patients have for contacting a specialist nurse - an empirical study.

Science.gov (United States)

Salander, Pär; Isaksson, Joakim; Granström, Brith; Laurell, Göran

2016-11-01

The purpose of this study is to systematically explore the motives for patients with head and neck cancer to contact a specialist nurse during two years postdiagnosis. Research focusing on the role of specialist nurses in cancer care almost exclusively concern cancers other than head and neck cancer. Qualitative, descriptive study based on the contacts between patients with head and neck cancer and a specialist nurse. Patients were invited to contact a specialist nurse by telephone. The specialist nurse took systematic field notes, that is, she registered who contacted her, the nature of the call and the outcome. Sixty patients were included. In descending order, the motives for contact were questions about practical and uncomplicated matters, consultations about medical troubles/worries, presenting a report of the patient's situation, requests for additional information about the treatment plan and requests for medical information. The pattern of the patients' motivations for calling was not related to medical or social factors, suggesting that the initiative to make contact is very much a question of the complexity of individual life circumstances. Very few referrals were sent from the specialist nurse to other professionals. The specialist nurse turned out to be more than just a coordinator of health-care resources. The findings bring up questions about the potential of the nurse's function as a coordinator, but also as a potential attachment figure, and questions about the nurse's relationships to other professionals. When implementing a specialist nurse function, it is important to decide whether the function should be inspired by a broader relational perspective. In addition to the indispensible competence and experience in the clinical field of head and neck cancer, training in counselling and acquaintance with object-relational psychology will then be desirable. © 2016 John Wiley & Sons Ltd.

Safeguards and Physics Measurements: Neutron Activation Analysis with k0-standardisation

International Nuclear Information System (INIS)

Pomme, S.

2000-01-01

SCK-CEN's programme on Neutron Activation Analysis with k 0 -standardisation concentrates on the improvement of the standardisation method and the characterisation of the neutron field as well as on the improvement of the statistical control on neutron activation analysis. Main achievements in 2000 are reported

Epidemiology of chronic pain in the office of a pain specialist neurologist

Directory of Open Access Journals (Sweden)

Karen dos Santos Ferreira

2015-07-01

Full Text Available Objective The objective of the present report was to describe the working experience of a pain specialist neurologist after concluding a medical residency program on neurology, area of concentration pain. Method A retrospective study was conducted for one year in the office of a pain specialist neurologist. Patients older than 18 years with chronic pain according to the criteria of the International Association for the Study of Pain, were included. Demographic data, chronic pain data and the treatments instituted were investigated. Results A total of 241 medical records were reviewed, mean patient age was 52.4 years and 79 (66.9% were women, and the mean score on a numeric pain scale was 8.69. The diagnoses were headaches (74.6%, neuropathic pain (17% and ostheomuscular pain (8.2%. We did not detect cancer pain. Patients received medication and procedures of anesthetic blockade. Conclusion This data can guide new medical residency programs on Neurology, area of concentration pain, to plan activities and studies.

Understanding practice patterns of glaucoma sub-specialists in India

Directory of Open Access Journals (Sweden)

Nikhil S. Choudhari

2017-10-01

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.

Occupational medicine specialist referral triggers: Mixed-methods analysis of teleconsult cases.

Science.gov (United States)

Eaton, J L; Mohammad, A; Mohr, D C; Brustein, D J; Kirkhorn, S R

2017-12-30

Qualitative analyses can yield critical lessons for learning organizations in healthcare. Few studies have applied these techniques in the field of occupational and environmental medicine (OEM). To describe the characteristics of complex cases referred for OEM subspecialty evaluation and variation by referring provider's training. Using a mixed methods approach, we conducted a content analysis of clinical cases submitted to a national OEM teleconsult service. Consecutive cases entered between April 2014 and July 2015 were screened, coded and analysed. 108 cases were available for analysis. Local Veterans Health Administration (VHA) non-specialist providers entered a primary medical diagnosis in 96% of cases at the time of intake. OEM speciality physicians coded significant medical conditions based on free text comments. Coder inter-rater reliability was 84%. The most frequent medical diagnosis types associated with tertiary OEM referral by non-specialists were endocrine (19%), cardiovascular (18%) and mental health (16%). Concern for usage of controlled and/or sedating medications was cited in 1% of cases. Compared to referring non-specialists, OEM physicians were more likely to attribute case complexity to musculoskeletal (OR: 2.3, 1.68-3.14) or neurological (OR: 1.69, 1.28-2.24) conditions. Medication usage (OR: 2.2, 1.49-2.26) was more likely to be a source of clinical concern among referring providers. The findings highlight the range of triggers for OEM physician subspecialty referral in clinical practice with employee patients. The results of this study can be used to inform development of provider education, standardized clinical practice pathways, and quality review activities for occupational medicine practitioners. Published by Oxford University Press on behalf of The Society of Occupational Medicine 2017.

[Changing to a career in general practice - a qualitative study reveals motives of specialists].

Science.gov (United States)

Schwill, Simon; Magez, Julia; Jäger, Cornelia; von Meißner, Wolfgang Cg; Szecsenyi, Joachim; Flum, Elisabeth

2016-12-01

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

Cost-efficiency of specialist hyperacute in-patient rehabilitation services for medically unstable patients with complex rehabilitation needs: a prospective cohort analysis.

Science.gov (United States)

Turner-Stokes, Lynne; Bavikatte, Ganesh; Williams, Heather; Bill, Alan; Sephton, Keith

2016-09-08

To evaluate functional outcomes, care needs and cost-efficiency of hyperacute (HA) rehabilitation for a cohort of in-patients with complex neurological disability and unstable medical/surgical conditions. A multicentre cohort analysis of prospectively collected clinical data from the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database, 2012-2015. Two HA specialist rehabilitation services in England, providing different service models for HA rehabilitation. All patients admitted to each of the units with an admission rehabilitation complexity M score of ≥3 (N=190; mean age 46 (SD16) years; males:females 63:37%). Diagnoses were acquired brain injury (n=166; 87%), spinal cord injury (n=9; 5%), peripheral neurological conditions (n=9; 5%) and other (n=6; 3%). Specialist in-patient multidisciplinary rehabilitation combined with management and stabilisation of intercurrent medical and surgical problems. Rehabilitation complexity and medical acuity: Rehabilitation Complexity Scale-version 13. Dependency and care costs: Northwick Park Dependency Scale/Care Needs Assessment (NPDS/NPCNA). Functional independence: UK Functional Assessment Measure (UK FIM+FAM). (1) reduction in dependency and (2) cost-efficiency, measured as the time taken to offset rehabilitation costs by savings in NPCNA-estimated costs of on-going care in the community. The mean length of stay was 103 (SD66) days. Some differences were observed between the two units, which were in keeping with the different service models. However, both units showed a significant reduction in dependency and acuity between admission and discharge on all measures (Wilcoxon: pspecialist HA rehabilitation can be highly cost-efficient, producing substantial savings in on-going care costs, and relieving pressure in the acute care services. 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/

De determination for young samples using the standardised OSL response of coarse-grain quartz

International Nuclear Information System (INIS)

Burbidge, C.I.; Duller, G.A.T.; Roberts, H.M.

2006-01-01

It has recently been shown that it is possible to construct standardised curves of the sensitivity corrected growth in optically stimulated luminescence (OSL) with exposure to ionising radiation, and that they may be used in the dating of quartz and polymineral samples. Standardised growth curves are particularly advantageous where measurement time is limited, as once they have been defined, only the natural signal and the response to a subsequent test dose are required in order to determine the equivalent dose of a sub-sample. The present study is concerned with the application of the standardised growth curve approach to OSL dating of Holocene age samples. Systematic changes in the shape of the standardised growth curve of coarse-grain quartz are identified as the size of the test dose is varied, because of non-proportionality between the test dose and the luminescence test response. The effect is characterised by fitting the change in gradient of the standardised growth curve as test dose is varied. An equation is defined to describe standardised growth as a function of regenerative dose and test dose. Regenerative dose responses of other samples in this study are treated as unknowns and recovered through different growth curves to compare precision and accuracy of various methods of D e determination. The standardised growth curve is found to yield similar precision to conventional fits of single aliquot regenerative data, but slightly poorer accuracy. The standardised growth curve approach was refined by incorporating the measurement of one regenerative response for each aliquot as well as its natural signal. Measurements of this additional data point for aliquots of 22 samples were used to adjust the standardised growth equation, improving its accuracy. The incorporation of this additional data point also indicated a systematic uncertainty of 2.4% in the estimates of D e

The relationship between standardised test performance and ...

African Journals Online (AJOL)

The English language proficiency of South African learners is integral to ... in standardised reading/writing tests in English Second Language (ESL) and (2) the use of ... and their relationship with the ESL learner's language learning strategies.

Specialist participation in healthcare delivery transformation: influence of patient self-referral.

Science.gov (United States)

Aliu, Oluseyi; Sun, Gordon; Burke, James; Chung, Kevin C; Davis, Matthew M

2014-01-01

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.

Standardised metrics for global surgical surveillance.

Science.gov (United States)

Weiser, Thomas G; Makary, Martin A; Haynes, Alex B; Dziekan, Gerald; Berry, William R; Gawande, Atul A

2009-09-26

Public health surveillance relies on standardised metrics to evaluate disease burden and health system performance. Such metrics have not been developed for surgical services despite increasing volume, substantial cost, and high rates of death and disability associated with surgery. The Safe Surgery Saves Lives initiative of WHO's Patient Safety Programme has developed standardised public health metrics for surgical care that are applicable worldwide. We assembled an international panel of experts to develop and define metrics for measuring the magnitude and effect of surgical care in a population, while taking into account economic feasibility and practicability. This panel recommended six measures for assessing surgical services at a national level: number of operating rooms, number of operations, number of accredited surgeons, number of accredited anaesthesia professionals, day-of-surgery death ratio, and postoperative in-hospital death ratio. We assessed the feasibility of gathering such statistics at eight diverse hospitals in eight countries and incorporated them into the WHO Guidelines for Safe Surgery, in which methods for data collection, analysis, and reporting are outlined.

Coordination of cancer care between family physicians and cancer specialists: Importance of communication.

Science.gov (United States)

Easley, Julie; Miedema, Baukje; Carroll, June C; Manca, Donna P; O'Brien, Mary Ann; Webster, Fiona; Grunfeld, Eva

2016-10-01

To explore health care provider (HCP) perspectives on the coordination of cancer care between FPs and cancer specialists. Qualitative study using semistructured telephone interviews. Canada. A total of 58 HCPs, comprising 21 FPs, 15 surgeons, 12 medical oncologists, 6 radiation oncologists, and 4 GPs in oncology. This qualitative study is nested within a larger mixed-methods program of research, CanIMPACT (Canadian Team to Improve Community-Based Cancer Care along the Continuum), focused on improving the coordination of cancer care between FPs and cancer specialists. Using a constructivist grounded theory approach, telephone interviews were conducted with HCPs involved in cancer care. Invitations to participate were sent to a purposive sample of HCPs based on medical specialty, sex, province or territory, and geographic location (urban or rural). A coding schema was developed by 4 team members; subsequently, 1 team member coded the remaining transcripts. The resulting themes were reviewed by the entire team and a summary of results was mailed to participants for review. Communication challenges emerged as the most prominent theme. Five key related subthemes were identified around this core concept that occurred at both system and individual levels. System-level issues included delays in medical transcription, difficulties accessing patient information, and physicians not being copied on all reports. Individual-level issues included the lack of rapport between FPs and cancer specialists, and the lack of clearly defined and broadly communicated roles. Effective and timely communication of medical information, as well as clearly defined roles for each provider, are essential to good coordination of care along the cancer care trajectory, particularly during transitions of care between cancer specialist and FP care. Despite advances in technology, substantial communication challenges still exist. This can lead to serious consequences that affect clinical decision making

AWARENESS OF MEDICAL SPECIALISTS AND PATIENTS IN BULGARIA OF ETHICS COMMITTEES AND THE BENEFITS OF THEIR WORK

Directory of Open Access Journals (Sweden)

Neli Gradinarova

2018-02-01

Full Text Available In today’s healthcare, the role of morality emerges to the forefront as a result of the high degree of uncertainty in our modern environment. Ethically responsible behaviour is therefore perceived as a prerequisite for preventing and counteracting a number of moral risks in society. With regard to moral hazard and responsibility, ethical codes represent a rational control mechanism, lowering the extent of the probability of moral peril. Ethics committees are also founded based on such ethical codes, the purpose of such committees being the proclamation and observation of the principles and norms set forth. At the healthcare institutions of the Republic of Bulgaria, ethics committees are established that are based on the principles of medical ethics and medical law. The significance with which ethics committees are charged regarding the sustainable development of the healthcare system consists of protecting the patients, the medical professionals and the institution itself. Awareness of the significance, functions and benefits of ethics committees and their impact on the medical practice and patients in Bulgaria is, however, insufficiently low. In a questionnaire survey conducted among 149 medical specialists employed at three medical establishments for hospital care in the country, and 269 patients under treatment at them, at being asked “Do you think that ethics committees contribute to protecting and respecting patients’ rights?”, 26.2% of the respondents among the medical professionals replied that they are not sure, while 25.7% of did not provide an answer to the question thus asked due to being unfamiliar with ethics committees as an institutionalized body and their functions. The analysis of the results of the abovementioned survey among medical professionals and patients evidences a low level of awareness of the ethics committees and their work on the territory of the Republic of Bulgaria. It is essential for healthcare

The management of chronic pain in Switzerland: a comparative survey of Swiss medical specialists treating chronic pain.

NARCIS (Netherlands)

Wilder-Smith, O.H.G.; Mohrle, J.J.; Dolin, P.J.; Martin, N.C.

2001-01-01

Chronic pain management by Swiss specialist physicians with the primary hypothesis that pain clinic practitioners conform better to good practice (interdisciplinarity, diagnostic/therapeutic routines, quality control, education) than other specialists treating chronic pain was surveyed. Management

Expectations of medical specialists about image-based teleconsultation - A qualitative study on acute burns in South Africa.

Science.gov (United States)

Blom, Lisa; Laflamme, Lucie; Mölsted Alvesson, Helle

2018-01-01

Image-based teleconsultation between medical experts and healthcare staff at remote emergency centres can improve the diagnosis of conditions which are challenging to assess. One such condition is burns. Knowledge is scarce regarding how medical experts perceive the influence of such teleconsultation on their roles and relations to colleagues at point of care. In this qualitative study, semi-structured interviews were conducted with 15 medical experts to explore their expectations of a newly developed App for burns diagnostics and care prior to its implementation. Purposive sampling included male and female physicians at different stages of their career, employed at different referral hospitals and all potential future tele-experts in remote teleconsultation using the App. Positioning theory was used to analyse the data. The experts are already facing changes in their diagnostic practices due to the informal use of open access applications like WhatsApp. Additional changes are expected when the new App is launched. Four positions of medical experts were identified in situations of diagnostic advice, two related to patient flow-clinical specialist and gatekeeper-and two to point of care staff-educator and mentor. The experts move flexibly between the positions during diagnostic practices with remote colleagues. A new position in relation to previous research on medical roles-the mentor-came to light in this setting. The App is expected to have an important educational impact, streamline the diagnostic process, improve both triage and referrals and be a more secure option for remote diagnosis compared to current practices. Verbal communication is however expected to remain important for certain situations, in particular those related to the mentor position. The quality and security of referrals are expected to be improved through the App but the medical experts see less potential for conveying moral support via the App during remote consultations. Experts

Expectations of medical specialists about image-based teleconsultation - A qualitative study on acute burns in South Africa.

Directory of Open Access Journals (Sweden)

Lisa Blom

Full Text Available Image-based teleconsultation between medical experts and healthcare staff at remote emergency centres can improve the diagnosis of conditions which are challenging to assess. One such condition is burns. Knowledge is scarce regarding how medical experts perceive the influence of such teleconsultation on their roles and relations to colleagues at point of care.In this qualitative study, semi-structured interviews were conducted with 15 medical experts to explore their expectations of a newly developed App for burns diagnostics and care prior to its implementation. Purposive sampling included male and female physicians at different stages of their career, employed at different referral hospitals and all potential future tele-experts in remote teleconsultation using the App. Positioning theory was used to analyse the data.The experts are already facing changes in their diagnostic practices due to the informal use of open access applications like WhatsApp. Additional changes are expected when the new App is launched. Four positions of medical experts were identified in situations of diagnostic advice, two related to patient flow-clinical specialist and gatekeeper-and two to point of care staff-educator and mentor. The experts move flexibly between the positions during diagnostic practices with remote colleagues. A new position in relation to previous research on medical roles-the mentor-came to light in this setting. The App is expected to have an important educational impact, streamline the diagnostic process, improve both triage and referrals and be a more secure option for remote diagnosis compared to current practices. Verbal communication is however expected to remain important for certain situations, in particular those related to the mentor position.The quality and security of referrals are expected to be improved through the App but the medical experts see less potential for conveying moral support via the App during remote consultations

Specialist Bibliographic Databases

OpenAIRE

Gasparyan, Armen Yuri; Yessirkepov, Marlen; Voronov, Alexander A.; Trukhachev, Vladimir I.; Kostyukova, Elena I.; Gerasimov, Alexey N.; Kitas, George D.

2016-01-01

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...

“Caint na ndaoine”. The Irish Language as a Precedent for Standardisation

Directory of Open Access Journals (Sweden)

Carlo James Waskowski Ritchie

2016-12-01

Full Text Available “Caint na ndaoine”. The Irish Language as a Precedent for Standardisation Critics of the standardisation of the Irish language argue that the “modernisation” of the Irish orthography has been detrimental to the preservation of the various dialects that form native spoken Irish. The effects of standardisation on Irish consequently form an important precedent for language standardisation. The potential alienation of a language’s native speakers is an outcome of standardisation that is obviously destructive for a language community that exists in a minority. The issues that surround the movement for a standardised Plattdeutsch are similar to those faced in the standardisation of Modern Irish. Since the recognition by the European Union of Low German (Plattdeutsch as a regional language in 1998, there has been newfound momentum in the movement for its reestablishment as a unified language of Northern Germany. One of the great difficulties of this movement however is the lack of any universal orthography due to the separate nature of the language’s dialects. Given the sociolinguistic similarities of these two (albeit unrelated languages, a study of the effects of the standardisation of Irish is useful for an assessment of the possibility of a standardised Plattdeutsch.   “Caint na ndaoine”. Język irlandzki jako precedens standaryzacji Krytycy procesu standaryzacji języka irlandzkiego uważają, że „modernizacja” irlandzkiej ortografii zaszkodziła ochronie wielu dialektów składających się na oralny język natywnych Irlandczyków. Skutki standaryzacji irlandzkiego stanowią więc ważny precedens standaryzacji języków. Możliwe wyobcowanie natywnych użytkowników języka jest w oczywisty sposób destrukcyjnym dla trwania wspólnoty mniejszościowej rezultatem procesu standaryzacji. Zagadnienia towarzyszące ruchowi na rzecz standaryzacji języka dolnoniemieckiego są podobne do problemów standaryzacji, wobec kt

Standardisation of haemoglobinometry : History and new challenges

NARCIS (Netherlands)

Zijlstra, WG

1997-01-01

During the 1950s several attempts were made to standardise the measurement of the haemoglobin concentration in human blood, for which numerous different methods were in use giving widely different results. In 1966, a consensus was reached on the general use of a photometric determination after

Dissuasive cigarette sticks: the next step in standardised ('plain') packaging?

Science.gov (United States)

Hoek, Janet; Gendall, Philip; Eckert, Christine; Louviere, Jordan

2016-11-01

Standardised (or 'plain') packaging has reduced the appeal of smoking by removing imagery that smokers use to affiliate themselves with the brand they smoke. We examined whether changing the appearance of cigarette sticks could further denormalise smoking and enhance the negative impact of standardised packaging. We conducted an online study of 313 New Zealand smokers who comprised a Best-Worst Choice experiment and a rating task. The Best-Worst experiment used a 2×3×3×6 orthogonal design to test the following attributes: on-pack warning message, branding level, warning size and stick appearance. We identified three segments whose members' choice patterns were strongly influenced by the stick design, warning theme and size, and warning theme, respectively. Each of the dissuasive sticks tested was less preferred and rated as less appealing than the most common stick in use; a 'minutes of life lost' stick was the most aversive of the stimuli tested. Dissuasive sticks could enhance the effect of standardised packaging, particularly among older smokers who are often more heavily addicted and resistant to change. Countries introducing standardised packaging legislation should take the opportunity to denormalise the appearance of cigarette sticks, in addition to removing external tobacco branding from packs and increasing the warning size. 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/.

Can medical students calculate drug doses? | Harries | Southern ...

African Journals Online (AJOL)

... with calculations when the drug concentration was expressed either as a ratio or a percentage. Conclusion: Our findings support calls for the standardised labelling of drugs in solution and for dosage calculation training in the medical curriculum. Keywords: drug dosage calculations, clinical competence, medication errors

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.

Science.gov (United States)

Hoshina, T; Yamamoto, N; Ogawa, M; Nakamoto, T; Kusuhara, K

2017-08-01

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.

Public or private care: where do specialists spend their time?

Science.gov (United States)

Freed, Gary L; Turbitt, Erin; Allen, Amy

2017-10-01

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

Assessment framework for standardisation activities ResiStand

NARCIS (Netherlands)

Stolk, D.J.; Lee, M.D.E. van der; Petiet, P.J.; Liedtke, C.; Lindner, R.; Zetten, J. van; Karppinen, A.; Anson, S.; Kroener, I.

2017-01-01

Standardisation is a powerful tool to achieve better interoperability. However, it needs to overcome a lack of interest and modest participation from stakeholders. Also, promising research results are not always used as the basis for new standards. The overall goal of ResiStand is to find new ways

Specialist Bibliographic Databases.

Science.gov (United States)

Gasparyan, Armen Yuri; Yessirkepov, Marlen; Voronov, Alexander A; Trukhachev, Vladimir I; Kostyukova, Elena I; Gerasimov, Alexey N; Kitas, George D

2016-05-01

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

Science.gov (United States)

2016-01-01

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

The Impact of Microlensing on the Standardisation of Strongly Lensed Type Ia Supernovae

Science.gov (United States)

Foxley-Marrable, Max; Collett, Thomas E.; Vernardos, Georgios; Goldstein, Daniel A.; Bacon, David

2018-05-01

We investigate the effect of microlensing on the standardisation of strongly lensed Type Ia supernovae (GLSNe Ia). We present predictions for the amount of scatter induced by microlensing across a range of plausible strong lens macromodels. We find that lensed images in regions of low convergence, shear and stellar density are standardisable, where the microlensing scatter is ≲ 0.15 magnitudes, comparable to the intrinsic dispersion of for a typical SN Ia. These standardisable configurations correspond to asymmetric lenses with an image located far outside the Einstein radius of the lens. Symmetric and small Einstein radius lenses (≲ 0.5 arcsec) are not standardisable. We apply our model to the recently discovered GLSN Ia iPTF16geu and find that the large discrepancy between the observed flux and the macromodel predictions from More et al. (2017) cannot be explained by microlensing alone. Using the mock GLSNe Ia catalogue of Goldstein et al. (2017), we predict that ˜ 22% of GLSNe Ia discovered by LSST will be standardisable, with a median Einstein radius of 0.9 arcseconds and a median time-delay of 41 days. By breaking the mass-sheet degeneracy the full LSST GLSNe Ia sample will be able to detect systematics in H0 at the 0.5% level.

Conflict Management Strategies in the ICU Differ Between Palliative Care Specialists and Intensivists.

Science.gov (United States)

Chiarchiaro, Jared; White, Douglas B; Ernecoff, Natalie C; Buddadhumaruk, Praewpannarai; Schuster, Rachel A; Arnold, Robert M

2016-05-01

Conflict is common between physicians and surrogate decision makers around end-of-life care in ICU. Involving experts in conflict management improve outcomes, but little is known about what differences in conflict management styles may explain the benefit. We used simulation to examine potential differences in how palliative care specialists manage conflict with surrogates about end-of-life treatment decisions in ICUs compared with intensivists. Subjects participated in a high-fidelity simulation of conflict with a surrogate in an ICU. In this simulation, a medical actor portrayed a surrogate decision maker during an ICU family meeting who refuses to follow an advance directive that clearly declines advanced life-sustaining therapies. We audiorecorded the simulation encounters and applied a coding framework to quantify conflict management behaviors, which was organized into two categories: task-focused communication and relationship building. We used negative binomial modeling to determine whether there were differences between palliative care specialists' and intensivists' use of task-focused communication and relationship building. Single academic medical center ICU. Palliative care specialists and intensivists. None. We enrolled 11 palliative care specialists and 25 intensivists. The palliative care specialists were all attending physicians. The intensivist group consisted of 11 attending physicians, 9 pulmonary and critical care fellows, and 5 internal medicine residents rotating in the ICU. We excluded five residents from the primary analysis in order to reduce confounding due to training level. Physicians' mean age was 37 years with a mean of 8 years in practice. Palliative care specialists used 55% fewer task-focused communication statements (incidence rate ratio, 0.55; 95% CI, 0.36-0.83; p = 0.005) and 48% more relationship-building statements (incidence rate ratio, 1.48; 95% CI, 0.89-2.46; p = 0.13) compared with intensivists. We found that palliative care

Knowledge of the law about withholding or withdrawing life-sustaining treatment by intensivists and other specialists.

Science.gov (United States)

White, Ben; Willmott, Lindy; Cartwright, Colleen; Parker, Malcolm H; Williams, Gail

2016-06-01

Decisions about withholding or withdrawing life-sustaining treatment (WWLST) from adults who lack capacity are an integral part of intensive care (IC) practice. We compare the knowledge, attitudes and practice of intensivists in relation to the law about WWLST with six other specialties most often involved in end-of-life care. We used a cross-sectional postal survey of medical specialists in the three most populous Australian states, and analysed responses from 867 medical specialists from the seven specialties most likely to be involved in WWLST decisions in the acute-care setting (emergency, geriatric, palliative, renal and respiratory medicine, medical oncology and IC). Attitudes to, and knowledge and practice of, the law relating to end-of-life care. Of 2702 surveys sent to eligible practitioners, 867 completed questionnaires were returned. There was an overall response rate of 32% and an IC response rate also of 32% (125/388). Intensivists performed better than average in legal knowledge but important knowledge gaps remain. Intensivists had a more negative attitude to the role of law in this area than other specialty groups but reported being seen as a leading source of information about legal issues by other medical specialists and nurses. Intensivists also reported being the specialists most frequently making decisions about end-of-life treatment. Improved legal knowledge and open engagement with the law can help manage the risk of harm to patients and protect intensivists from liability. IC guidelines and continuing professional development are important strategies to address these issues.

Standardised patient-simulated practice learning: A rich ...

African Journals Online (AJOL)

This study investigates the use of standardised patients (SPs) in a simulated patient interview as a learning strategy to bridge the theory-practice gap. Simulation helps students to develop skills such as communication, higher cognitive thinking, decision-making and problem-solving. There is evidence to support the use of ...

Treatment Outcomes From a Specialist Model for Treating Tobacco Use Disorder in a Medical Center.

Science.gov (United States)

Burke, Michael V; Ebbert, Jon O; Schroeder, Darrell R; McFadden, David D; Hays, J Taylor

2015-11-01

Cigarette smoking causes premature mortality and multiple morbidity; stop smoking improves health. Higher rates of smoking cessation can be achieved through more intensive treatment, consisting of medication and extended counseling of patients, but there are challenges to integrating these interventions into healthcare delivery systems. A care model using a master-level counselor trained as a tobacco treatment specialist (TTS) to deliver behavioral intervention, teamed with a supervising physician/prescriber, affords an opportunity to integrate more intensive tobacco dependence treatment into hospitals, clinics, and other medical systems. This article analyzes treatment outcomes and predictors of abstinence for cigarette smokers being treated using the TTS-physician team in a large outpatient clinic over a 7-year period.This is an observational study of a large cohort of cigarette smokers treated for tobacco dependence at a medical center. Patients referred by the primary healthcare team for a TTS consult received a standard assessment and personalized treatment planning guided by a workbook. Medication and behavioral plans were developed collaboratively with each patient. Six months after the initial assessment, a telephone call was made to ascertain a 7-day period of self-reported abstinence. The univariate association of each baseline patient characteristic with self-reported tobacco abstinence at 6 months was evaluated using the chi-squared test. In addition, a multiple logistic regression analysis was performed with self-reported tobacco abstinence as the dependent variable and all baseline characteristics included as explanatory variables.Over a period of 7 years (2005-2011), 6824 cigarette smokers who provided general research authorization were seen for treatment. The 6-month self-reported abstinence rate was 28.1% (95% confidence interval: 27.7-30.1). The patients most likely to report abstinence were less dependent, more motivated to quit, and did not

Neutron activation analysis with k0-standardisation : general formalism and procedure

International Nuclear Information System (INIS)

Pomme, S.; Hardeman, F.; Robouch, P.; Etxebarria, N.; Arana, G.

1997-09-01

Instrumental neutron activation analysis (INAA) with k 0 -standardisation is a powerful tool for multi-element analysis at a broad range of trace element concentrations. An overview is given of the basic principles, fundamental equations, and general procedure of this method. Different aspects of the description of the neutron activation reaction rate are discussed, applying the Hogdahl convention. A general activation-decay formula is derived and its application to INAA is demonstrated. Relevant k 0 -definitions for different activation decay schemes are summarised and upgraded to cases of extremely high fluxes. The main standardisation techniques for INAA are discussed, emphasizing the k 0 -standardisation. Some general aspects of the basic equipment and its calibration are discussed, such as the characterisation of the neutron field and the tuning of the spectrometry part. A method for the prediction and optimisation of the analytical performance of INAA is presented

The clinical nurse specialist as resuscitation process manager.

Science.gov (United States)

Schneiderhahn, Mary Elizabeth; Fish, Anne Folta

2014-01-01

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

Expectations of medical specialists about image-based teleconsultation – A qualitative study on acute burns in South Africa

Science.gov (United States)

Laflamme, Lucie; Mölsted Alvesson, Helle

2018-01-01

Background Image-based teleconsultation between medical experts and healthcare staff at remote emergency centres can improve the diagnosis of conditions which are challenging to assess. One such condition is burns. Knowledge is scarce regarding how medical experts perceive the influence of such teleconsultation on their roles and relations to colleagues at point of care. Methods In this qualitative study, semi-structured interviews were conducted with 15 medical experts to explore their expectations of a newly developed App for burns diagnostics and care prior to its implementation. Purposive sampling included male and female physicians at different stages of their career, employed at different referral hospitals and all potential future tele-experts in remote teleconsultation using the App. Positioning theory was used to analyse the data. Results The experts are already facing changes in their diagnostic practices due to the informal use of open access applications like WhatsApp. Additional changes are expected when the new App is launched. Four positions of medical experts were identified in situations of diagnostic advice, two related to patient flow–clinical specialist and gatekeeper–and two to point of care staff–educator and mentor. The experts move flexibly between the positions during diagnostic practices with remote colleagues. A new position in relation to previous research on medical roles–the mentor–came to light in this setting. The App is expected to have an important educational impact, streamline the diagnostic process, improve both triage and referrals and be a more secure option for remote diagnosis compared to current practices. Verbal communication is however expected to remain important for certain situations, in particular those related to the mentor position. Conclusion The quality and security of referrals are expected to be improved through the App but the medical experts see less potential for conveying moral support via the App

A Comparison of Selected Supervisory Skills of Content Specialist and Non-Content Specialist University Supervisors

Science.gov (United States)

Hunt, Kevin; Mitchell, Murray; Maina, Michael; Griffin, Lisa

2015-01-01

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…

The law, economics and politics of international standardisation

NARCIS (Netherlands)

Delimatsis, Panagiotis

2015-01-01

In an era of increased reliance on private regulatory bodies and globalised economic activity, standardisation is the field where politics, technical expertise and strategic behaviour meet and interact. International standard-setting bodies exemplify the rise of transnational governance and the

Admission rates in a general practitioner-based versus a hospital specialist based, hospital-at-home model

DEFF Research Database (Denmark)

Mogensen, Christian Backer; Ankersen, Ejnar Skytte; Lindberg, Mats J

2018-01-01

. 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...

The predictability of phytophagous insect communities: host specialists as habitat specialists.

Directory of Open Access Journals (Sweden)

Jörg Müller

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

Adolescents and mothers value referral to a specialist service for chronic fatigue syndrome or myalgic encephalopathy (CFS/ME).

Science.gov (United States)

Beasant, Lucy; Mills, Nicola; Crawley, Esther

2014-04-01

Paediatric chronic fatigue syndrome or myalgic encephalopathy (CFS/ME) is relatively common and disabling. Current guidance recommends referral to specialist services, although some general practitioners believe the label of CFS/ME is harmful and many are not confident about diagnosing CFS/ME. Aim Explore whether or not adolescents and their mothers value referral to a specialist service for young people with CFS/ME. A qualitative study nested within a feasibility study of interventions for CFS/ME [Specialist Medical Intervention and Lightning Evaluation (SMILE)]. In-depth interviews were undertaken with 13 mothers and 12 adolescents participating in the SMILE study. Transcripts were systematically assigned codes using the qualitative data organisation package NVivo and analysed thematically using techniques of constant comparison. Gaining access to the specialist service was difficult and took a long time. Mothers felt that they needed to be proactive and persistent, partly because of a lack of knowledge in primary and secondary care. Having gained access, mothers felt the CFS/ME service was useful because it recognised and acknowledged their child's condition and opened channels of dialogue between health-care professionals and education providers. Adolescents reported that specialist medical care resulted in better symptom management, although some adolescents did not like the fact that the treatment approach limited activity. Adolescents and their mothers value receiving a diagnosis from a specialist service and making progress in managing CFS/ME. General practitioners should support adolescents with CFS/ME in accessing CFS/ME specialist services, consistent with current guidance.

Biomedical laboratory science education: standardising teaching content in resource-limited countries

Directory of Open Access Journals (Sweden)

Wendy Arneson

2013-06-01

Full Text Available Background: There is a worldwide shortage of qualified laboratory personnel to provide adequate testing for the detection and monitoring of diseases. In an effort to increase laboratory capacity in developing countries, new skills have been introduced into laboratory services. Curriculum revision with a focus on good laboratory practice is an important aspect of supplying entry-level graduates with the competencies needed to meet the current needs. Objectives: Gaps in application and problem-solving competencies of newly graduated laboratory personnel were discovered in Ethiopia, Tanzania and Kenya. New medical laboratory teaching content was developed in Ethiopia, Tanzania and Kenya using national instructors, tutors, and experts and consulting medical laboratory educators from the United States of America (USA. Method: Workshops were held in Ethiopia to create standardised biomedical laboratory science (BMLS lessons based on recently-revised course objectives with an emphasis on application of skills. In Tanzania, course-module teaching guides with objectives were developed based on established competency outcomes and tasks. In Kenya, example interactive presentations and lesson plans were developed by the USA medical laboratory educators prior to the workshop to serve as resources and templates for the development of lessons within the country itself. Results: The new teaching materials were implemented and faculty, students and other stakeholders reported successful outcomes. Conclusions: These approaches to updating curricula may be helpful as biomedical laboratory schools in other countries address gaps in the competencies of entry-level graduates.

Bioboxes: standardised containers for interchangeable bioinformatics software.

Science.gov (United States)

Belmann, Peter; Dröge, Johannes; Bremges, Andreas; McHardy, Alice C; Sczyrba, Alexander; Barton, Michael D

2015-01-01

Software is now both central and essential to modern biology, yet lack of availability, difficult installations, and complex user interfaces make software hard to obtain and use. Containerisation, as exemplified by the Docker platform, has the potential to solve the problems associated with sharing software. We propose bioboxes: containers with standardised interfaces to make bioinformatics software interchangeable.

Rural specialists: The nature of their work and professional satisfaction by geographical location of work.

Science.gov (United States)

O'Sullivan, Belinda; McGrail, Matthew; Russell, Deborah

2017-12-01

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.

[Accreditation of medical laboratories].

Science.gov (United States)

Horváth, Andrea Rita; Ring, Rózsa; Fehér, Miklós; Mikó, Tivadar

2003-07-27

In Hungary, the National Accreditation Body was established by government in 1995 as an independent, non-profit organization, and has exclusive rights to accredit, amongst others, medical laboratories. The National Accreditation Body has two Specialist Advisory Committees in the health care sector. One is the Health Care Specialist Advisory Committee that accredits certifying bodies, which deal with certification of hospitals. The other Specialist Advisory Committee for Medical Laboratories is directly involved in accrediting medical laboratory services of health care institutions. The Specialist Advisory Committee for Medical Laboratories is a multidisciplinary peer review group of experts from all disciplines of in vitro diagnostics, i.e. laboratory medicine, microbiology, histopathology and blood banking. At present, the only published International Standard applicable to laboratories is ISO/IEC 17025:1999. Work has been in progress on the official approval of the new ISO 15189 standard, specific to medical laboratories. Until the official approval of the International Standard ISO 15189, as accreditation standard, the Hungarian National Accreditation Body has decided to progress with accreditation by formulating explanatory notes to the ISO/IEC 17025:1999 document, using ISO/FDIS 15189:2000, the European EC4 criteria and CPA (UK) Ltd accreditation standards as guidelines. This harmonized guideline provides 'explanations' that facilitate the application of ISO/IEC 17025:1999 to medical laboratories, and can be used as a checklist for the verification of compliance during the onsite assessment of the laboratory. The harmonized guideline adapted the process model of ISO 9001:2000 to rearrange the main clauses of ISO/IEC 17025:1999. This rearrangement does not only make the guideline compliant with ISO 9001:2000 but also improves understanding for those working in medical laboratories, and facilitates the training and education of laboratory staff. With the

A standardised questionnaire for evaluating hospital-based rotations in general practice vocational training.

Science.gov (United States)

Viniol, Annika; Lommler-Thamer, Martina; Baum, Erika; Banzhoff, Norbert Donner

2015-05-01

The residency period of vocational training is a fundamental component for a general practitioner's (GP's) qualification. During the residency, teaching is given by consultants and staff from different medical disciplines who do not necessarily know the GP registrar's training objectives. To develop a standardised feedback questionnaire to evaluate residency attachments and enable GP registrars and their supervisors to discuss the actual training environment and areas for improvement. A cross-sectional study was carried out to assess GP registrars' ratings of items preselected by an expert group to reflect important elements in high-quality vocational training. We recruited GP registrars in Germany via mailing lists and online discussion forums and used the importance-severity-score method to score the content and importance of the selected items. On the basis of these ratings, we eliminated 74 items. This version of the questionnaire then underwent an intra-observer-reliability evaluation by the same GP registrars after eight weeks. Items with a correlation of less than 0.4 (Pearson correlation coefficient) were dropped or rephrased. Our initial questionnaire featured 117 potential items. We reduced this to 43 items after the first study; two additional items were dropped following the reliability test. To our knowledge, this is the first standardised feedback questionnaire evaluating the residency period of vocational training. We hope our work will improve the quality of GPs' vocational training. The importance-severity-score method is a fast and efficient method for developing instruments using personal judgement to evaluate constructs.

Traumatic brain injury in England and Wales: prospective audit of epidemiology, complications and standardised mortality

Science.gov (United States)

Lawrence, T; Bouamra, O; Woodford, M; Lecky, F; Hutchinson, P J

2016-01-01

Objectives To provide a comprehensive assessment of the management of traumatic brain injury (TBI) relating to epidemiology, complications and standardised mortality across specialist units. Design The Trauma Audit and Research Network collects data prospectively on patients suffering trauma across England and Wales. We analysed all data collected on patients with TBI between April 2014 and June 2015. Setting Data were collected on patients presenting to emergency departments across 187 hospitals including 26 with specialist neurosurgical services, incorporating factors previously identified in the Ps14 multivariate logistic regression (Ps14n) model multivariate TBI outcome prediction model. The frequency and timing of secondary transfer to neurosurgical centres was assessed. Results We identified 15 820 patients with TBI presenting to neurosurgical centres directly (6258), transferred from a district hospital to a neurosurgical centre (3682) and remaining in a district general hospital (5880). The commonest mechanisms of injury were falls in the elderly and road traffic collisions in the young, which were more likely to present in coma. In severe TBI (Glasgow Coma Score (GCS) ≤8), the median time from admission to imaging with CT scan is 0.5 hours. Median time to craniotomy from admission is 2.6 hours and median time to intracranial pressure monitoring is 3 hours. The most frequently documented complication of severe TBI is bronchopneumonia in 5% of patients. Risk-adjusted W scores derived from the Ps14n model indicate that no neurosurgical unit fell outside the 3 SD limits on a funnel plot. Conclusions We provide the first comprehensive report of the management of TBI in England and Wales, including data from all neurosurgical units. These data provide transparency and suggests equity of access to high-quality TBI management provided in England and Wales. PMID:27884843

Differences in quality standards when prescribing nutritional support: Differences between specialist and non-specialist physicians.

Science.gov (United States)

Morán López, Jesús Manuel; Piedra León, María; Enciso Izquierdo, Fidel Jesús; Luengo Pérez, Luis Miguel; Amado Señaris, José Antonio

2016-01-01

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.

[Medical technology and medical education].

Science.gov (United States)

von Mallek, D; Biersack, H-J; Mull, R; Wilhelm, K; Heinz, B; Mellert, F

2010-08-01

The education of medical professionals is divided into medical studies, postgraduate training leading to the qualification as a specialist, and continuing professional development. During education, all scientific knowledge and practical skills are to be acquired, which enable the physician to practice responsibly in a specialized medical area. In the present article, relevant curricula are analyzed regarding the consideration of medical device-related topics, as the clinical application of medical technology has reached a central position in modern patient care. Due to the enormous scientific and technical progress, this area has become as important as pharmacotherapy. Our evaluation shows that medical device-related topics are currently underrepresented in the course of medical education and training and should be given greater consideration in all areas of medical education. Possible solutions are presented.

BIM Anatomy II: Standardisation Needs & Support Systems

OpenAIRE

Hooper, Martin

2015-01-01

This thesis presents the results of an investigation into BIM standardisation needs and procedural supporting mechanisms that may enable design, construction and operating (DCO) organisations to advance their deployment of Building Information Modelling (BIM) technology, and improve construction project outcomes. To achieve sustainable development requires effective information management. Building Information Modelling is of strategic importance for the development of effi...

Current standardisation for nanotechnology

International Nuclear Information System (INIS)

Bard, Delphine; Mark, David; Moehlmann, Carsten

2009-01-01

Standardisation and standards provide an important mechanism to support both innovation and the application of regulations. There is currently no specific regulation for any nanomaterials. Health, safety and environmental protection aspects associated with nanomaterials are however in principle covered to different levels by current EU regulatory framework. There are a number of national, European and international organisations developing standards associated with the development, description and use of nanomaterials as well as the protection of human health and the environment from the production and use of chemicals and consumer products, including nanomaterials. These organisations have also established specific committees on nanotechnology. This paper outlines the different relevant regulations and standards. This paper will mainly be focused on a European health and safety perspective.

National aspects of nuclear standardisation

International Nuclear Information System (INIS)

Becker, K.

1984-01-01

The article first introduces the German Standards Institute (DIN) in figures and in its work, and gives details of the Nuclear Technology Committee (NK) which works with the Nuclear Committee. The German regulations consist of a total of about 220 documents, which cost about 18 million DM per annum. The use of nuclear standardisation can be seen in 1) a standardized, high safety level; 2) speeding up and simplifying the authorisation process; 3) improved acceptance; 4) means of technology transfer; 5) simplified trace across borders and 6) standardized requirements for plant near the border. (HSCH) [de

Turning the Big Mac Index into the Medical MAC Index | Wilson ...

African Journals Online (AJOL)

Objective: The purpose of this study was to create a global medical earnings index, called the Medical MAC Index, to enable a comparison of what medical specialists earn in the countries included in the study. Design: The study gathered data on the earnings of specialist anaesthetists employed in state hospitals with five ...

What's 'difficult'? A multi-stage qualitative analysis of secondary care specialists' experiences with medically unexplained symptoms.

Science.gov (United States)

Maatz, Anke; Wainwright, Megan; Russell, Andrew J; Macnaughton, Jane; Yiannakou, Yan

2016-11-01

The term 'difficult' is pervasively used in relation to medically unexplained symptoms (MUS) and patients with MUS. This article scrutinises the use of the term by analysing interview data from a study of secondary care specialists' experiences with and attitudes towards patients suffering from MUS. Qualitative design employing semi-structured open-ended interviews systematically analysed in three stages: first, data were analysed according to the principles of content analysis. The analysis subsequently focused on the use of the term 'difficult'. Iterations of the term were extracted by summative analysis and thematic coding revealed its different meanings. Finally, alternative expressions were explored. Three NHS trust secondary care hospitals in North-East England. 17 senior clinicians from seven medical and two surgical specialities. Unsolicited use of the term 'difficult' was common. 'Difficult' was rarely used as a patient characteristic or to describe the therapeutic relationship. Participants used 'difficult' to describe their experience of diagnosing, explaining, communicating and managing these conditions and their own emotional reactions. Health care system deficits and the conceptual basis for MUS were other facets of 'difficult'. Participants also reported experiences that were rewarding and positive. This study shows that blanket statements such as 'difficult patients' mask the complexity of doctors' experiences in the context of MUS. Our nuanced analysis of the use of 'difficult' challenges preconceived attitudes. This can help counter the unreflexive perpetuation of negative evaluations that stigmatize patients with MUS, encourage greater acknowledgement of doctors' emotions, and lead to more appropriate conceptualizations and management of MUS. Copyright © 2016 Elsevier Inc. All rights reserved.

Neutron activation analysis with k{sub 0}-standardisation : general formalism and procedure

Energy Technology Data Exchange (ETDEWEB)

Pomme, S.; Hardeman, F. [Centre de l`Etude de l`Energie Nucleaire, Mol (Belgium); Robouch, P.; Etxebarria, N.; Arana, G. [European Commission, Joint Research Centre, Institute for Reference Materials and Measurements, Geel (Belgium)

1997-09-01

Instrumental neutron activation analysis (INAA) with k{sub 0}-standardisation is a powerful tool for multi-element analysis at a broad range of trace element concentrations. An overview is given of the basic principles, fundamental equations, and general procedure of this method. Different aspects of the description of the neutron activation reaction rate are discussed, applying the Hogdahl convention. A general activation-decay formula is derived and its application to INAA is demonstrated. Relevant k{sub 0}-definitions for different activation decay schemes are summarised and upgraded to cases of extremely high fluxes. The main standardisation techniques for INAA are discussed, emphasizing the k{sub 0}-standardisation. Some general aspects of the basic equipment and its calibration are discussed, such as the characterisation of the neutron field and the tuning of the spectrometry part. A method for the prediction and optimisation of the analytical performance of INAA is presented.

XML-based clinical data standardisation in the National Health Service Scotland

Directory of Open Access Journals (Sweden)

Raluca Bunduchi

2006-12-01

Full Text Available The objective of this paper is to clarify the role that socio-economic factors played in shaping the development of XML-based clinical data standards in the National Health Service in Scotland from 2000 to 2004. The paper discusses the NHS Scotland approach to clinical data standardisation, emphasising the actors involved, their choices during the standard development process and the factors that have shaped these choices. The case suggests that the NHS Scotland approach to clinical data standardisation is shaped by strong political pressures for fast development of an integrated electronic patient care system, economic pressures for high efficiency and cost reductions, and organisational requirements for strong clinical support. Such economic, political and organisational pressures explain the informal approach to standard development, the emphasis on fast system development and strong clinical involvement. At the same time, market factors explain the low commitment of the IT vendors, which might have otherwise put significant pressure onNHSScotland to pursue a more formalised standardisation approach within an internationally recognised standard-setting body.

Factors influencing general practitioner referral of patients developing end-stage renal failure: a standardised case-analysis study.

LENUS (Irish Health Repository)

Montgomery, Anthony J

2006-01-01

BACKGROUND: To understand why treatment referral rates for ESRF are lower in Ireland than in other European countries, an investigation of factors influencing general practitioner referral of patients developing ESRF was conducted. METHOD: Randomly selected general practitioners (N = 51) were interviewed using 32 standardised written patient scenarios to elicit referral strategies. Main outcome measures: General practitioner referral levels and thresholds for patients developing end-stage renal disease; referral routes (nephrologist vs other physicians); influence of patient age, marital status and co-morbidity on referral. RESULTS: Referral levels varied widely with the full range of cases (0-32; median = 15) referred by different doctors after consideration of first laboratory results. Less than half (44%) of cases were referred to a nephrologist. Patient age (40 vs 70 years), marital status, co-morbidity (none vs rheumatoid arthritis) and general practitioner prior specialist renal training (yes or no) did not influence referral rates. Many patients were not referred to a specialist at creatinine levels of 129 micromol\\/l (47% not referred) or 250 micromol\\/l (45%). While all patients were referred at higher levels (350 and 480 micromol\\/l), referral to a nephrologist decreased in likelihood as scenarios became more complex; 28% at 129 micromol\\/l creatinine; 28% at 250 micromol\\/l; 18% at 350 micromol\\/l and 14% at 480 micromol\\/l. Referral levels and routes were not influenced by general practitioner age, sex or practice location. Most general practitioners had little current contact with chronic renal patients (mean number in practice = 0.7, s.d. = 1.3). CONCLUSION: The very divergent management patterns identified highlight the need for guidance to general practitioners on appropriate management of this serious condition.

Standardised neonatal parenteral nutrition formulations – an Australasian group consensus 2012

Science.gov (United States)

2014-01-01

Standardised parenteral nutrition formulations are routinely used in the neonatal intensive care units in Australia and New Zealand. In 2010, a multidisciplinary group was formed to achieve a consensus on the formulations acceptable to majority of the neonatal intensive care units. Literature review was undertaken for each nutrient and recommendations were developed in a series of meetings held between November 2010 and April 2011. Three standard and 2 optional amino acid/dextrose formulations and one lipid emulsion were agreed by majority participants in the consensus. This has a potential to standardise neonatal parenteral nutrition guidelines, reduce costs and prescription errors. PMID:24548745

48 CFR 552.236-72 - Specialist.

Science.gov (United States)

2010-10-01

... 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...

[Acute care of critically ill children in general hospitals: organisation and training].

Science.gov (United States)

van Sambeeck, S J L; Janssen, E J M; Hundscheid, T; Martens, S J L; Vos, G D

2013-01-01

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

Creation and Initial Validation of the International Dysphagia Diet Standardisation Initiative Functional Diet Scale.

Science.gov (United States)

Steele, Catriona M; Namasivayam-MacDonald, Ashwini M; Guida, Brittany T; Cichero, Julie A; Duivestein, Janice; Hanson, Ben; Lam, Peter; Riquelme, Luis F

2018-05-01

To assess consensual validity, interrater reliability, and criterion validity of the International Dysphagia Diet Standardisation Initiative Functional Diet Scale, a new functional outcome scale intended to capture the severity of oropharyngeal dysphagia, as represented by the degree of diet texture restriction recommended for the patient. Participants assigned International Dysphagia Diet Standardisation Initiative Functional Diet Scale scores to 16 clinical cases. Consensual validity was measured against reference scores determined by an author reference panel. Interrater reliability was measured overall and across quartile subsets of the dataset. Criterion validity was evaluated versus Functional Oral Intake Scale (FOIS) scores assigned by survey respondents to the same case scenarios. Feedback was requested regarding ease and likelihood of use. Web-based survey. Respondents (N=170) from 29 countries. Not applicable. Consensual validity (percent agreement and Kendall τ), criterion validity (Spearman rank correlation), and interrater reliability (Kendall concordance and intraclass coefficients). The International Dysphagia Diet Standardisation Initiative Functional Diet Scale showed strong consensual validity, criterion validity, and interrater reliability. Scenarios involving liquid-only diets, transition from nonoral feeding, or trial diet advances in therapy showed the poorest consensus, indicating a need for clear instructions on how to score these situations. The International Dysphagia Diet Standardisation Initiative Functional Diet Scale showed greater sensitivity than the FOIS to specific changes in diet. Most (>70%) respondents indicated enthusiasm for implementing the International Dysphagia Diet Standardisation Initiative Functional Diet Scale. This initial validation study suggests that the International Dysphagia Diet Standardisation Initiative Functional Diet Scale has strong consensual and criterion validity and can be used reliably by clinicians

Does a specialist unit improve outcomes for hospitalized patients with Parkinson's disease?

Science.gov (United States)

Skelly, Rob; Brown, Lisa; Fakis, Apostolos; Kimber, Lindsey; Downes, Charlotte; Lindop, Fiona; Johnson, Clare; Bartliff, Caroline; Bajaj, Nin

2014-01-01

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

Decommissioning costing approach based on the standardised list of costing items. Lessons learnt by the OMEGA computer code

International Nuclear Information System (INIS)

Daniska, Vladimir; Rehak, Ivan; Vasko, Marek; Ondra, Frantisek; Bezak, Peter; Pritrsky, Jozef; Zachar, Matej; Necas, Vladimir

2011-01-01

The document 'A Proposed Standardised List of Items for Costing Purposes' was issues in 1999 by OECD/NEA, IAEA and European Commission (EC) for promoting the harmonisation in decommissioning costing. It is a systematic list of decommissioning activities classified in chapters 01 to 11 with three numbered levels. Four cost group are defined for cost at each level. Document constitutes the standardised matrix of decommissioning activities and cost groups with definition of content of items. Knowing what is behind the items makes the comparison of cost for decommissioning projects transparent. Two approaches are identified for use of the standardised cost structure. First approach converts the cost data from existing specific cost structures into the standardised cost structure for the purpose of cost presentation. Second approach uses the standardised cost structure as the base for the cost calculation structure; the calculated cost data are formatted in the standardised cost format directly; several additional advantages may be identified in this approach. The paper presents the costing methodology based on the standardised cost structure and lessons learnt from last ten years of the implementation of the standardised cost structure as the cost calculation structure in the computer code OMEGA. Code include also on-line management of decommissioning waste, decay of radioactively, evaluation of exposure, generation and optimisation of the Gantt chart of a decommissioning project, which makes the OMEGA code an effective tool for planning and optimisation of decommissioning processes. (author)

Australia's rural medical workforce: Supply from its medical schools against career stage, gender and rural-origin.

Science.gov (United States)

McGrail, Matthew R; Russell, Deborah J

2017-10-01

The aim of this study was to explore the association between career stage and rural medical workforce supply among Australian-trained medical graduates. Descriptive analysis using the national Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal study. Australian-trained GPs and other specialists who participated in the MABEL study, 2008-2013. Proportions of GPs and specialists working in rural locations, according to career stage (establishing, early, mid and late), gender and childhood-origin type (rural versus metropolitan). Logistic regression models revealed that establishing- and early-career GPs had significantly higher likelihood (OR 1.67 and 1.38, respectively) of working rurally, but establishing and early-career doctors were significantly less likely (OR 0.34 and 0.43, respectively) to choose general practice, contributing proportionally fewer rural GPs overall (OR 0.77 and 0.75, respectively) compared to late-career doctors. For specialists, there were no significant associations between career cohorts and rural practice. Overall, there was a significantly lower likelihood (OR 0.83) of establishing-career doctors practising rurally. Women were similarly likely to be rural GPs but less likely to be rural specialists, while rural-origin was consistently associated with higher odds of rural practice. The supply of Australia's rural medical workforce from its medical schools continues to be challenging, with these data highlighting both their source and associations with doctors at different career stages. Despite large investments through rural medical training and rural workforce recruitment and retention policies, these data confirm continued reliance on internationally trained medical graduates for large proportions of rural supply is likely. © 2016 National Rural Health Alliance Inc.

IT-supported skill-mix change and standardisation in integrated eyecare: lessons from two screening projects in The Netherlands

Directory of Open Access Journals (Sweden)

Marleen de Mul

2007-05-01

Full Text Available Introduction: Information Technology (IT has the potential to significantly support skill-mix change and, thereby, to improve the efficiency and effectiveness of integrated care. Theory and methods: IT and skill-mix change share an important precondition: the standardisation of work processes. Standardisation plays a crucial role in IT-supported skill-mix change. It is not a matter of more or less standardisation than in the ‘old’ situation, but about creating an optimal fit. We used qualitative data from our evaluation of two integrated-care projects in Dutch eyecare to identify domains where this fit is important. Results: While standardisation was needed to delegate screening tasks from physicians to non-physicians, and to assure the quality of the integrated-care process as a whole, tensions arose in three domains: the performance of clinical tasks, the documentation, and the communication between professionals. Unfunctional standardisation led to dissatisfaction and distrust between the professionals involved in screening. Discussion and conclusion: Although the integration seems promising, much work is needed to ensure a synergistic relationship between skill-mix change and IT. Developing IT-supported skill-mix change by means of standardisation is a matter of tailoring standardisation to fit the situation at hand, while dealing with the local constraints of available technology and organisational context.

Sources of satisfaction and dissatisfaction among specialists within the public and private health sectors.

Science.gov (United States)

Ashton, Toni; Brown, Paul; Sopina, Elizaveta; Cameron, Linda; Tenbensel, Timothy; Windsor, John

2013-09-27

As in many countries, medical and surgical specialists in New Zealand have the opportunity of working in the public sector, the private sector or both. This study aimed to explore the level and sources of satisfaction and dissatisfaction of specialists in New Zealand with working in the two sectors. Such information can assist workforce planning, management and policy and may inform the wider debate about the relationship between the two sectors. A postal survey was conducted of 1983 registered specialists throughout New Zealand. Respondents were asked to assess 14 sources of satisfaction and 9 sources of dissatisfaction according to a 5-point Likert scale. Means and standard deviations were calculated for the total sample, and for procedural and non-procedural specialties. Differences between the means of each source of satisfaction and dissatisfaction were also calculated. Completed surveys were received from 943 specialists (47% response rate). Overall mean levels of satisfaction were higher in the private sector than the public sector while levels of dissatisfaction were lower. While the public system is valued for its opportunities for further education 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. 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.

Validation of core medical knowledge by postgraduates and specialists.

NARCIS (Netherlands)

Koens, F.; Rademakers, J.J.; Cate, O.T.J. ten

2005-01-01

BACKGROUND: Curriculum constructors and teachers must decide on the content and level of objectives and materials included in the medical curriculum. At University Medical Centre Utrecht it was decided to test relatively detailed knowledge at a regular level in study blocks and to design a progress

Standardisation of 64Cu using a software coincidence counting system

International Nuclear Information System (INIS)

Havelka, Miroslav; Sochorová, Jana

2014-01-01

The activity of the radionuclide 64 Cu was determined by the efficiency extrapolation method applied to 4π(PC)−γ coincidence counting. The standardisation was performed by software coincidence counting—a digital method for primary activity measurement that simplifies the setting of optimal coincidence parameters. The γ-ray-energy window, characterised by identical gamma detection efficiency related to the sum of EC and to the sum of beta decay branches, was found. This setting ensured a linear and zero slope extrapolation curve. - Highlights: • Standardisation realised by extrapolation method applied to 4π(PC)−γ coincidence. • Digital method for optimal setting of coincidence parameters was used. • Result with total standard uncertainty of 0.74% was obtained

Integrated palliative care is about professional networking rather than standardisation of care: A qualitative study with healthcare professionals in 19 integrated palliative care initiatives in five European countries.

Science.gov (United States)

den Herder-van der Eerden, Marlieke; van Wijngaarden, Jeroen; Payne, Sheila; Preston, Nancy; Linge-Dahl, Lisa; Radbruch, Lukas; Van Beek, Karen; Menten, Johan; Busa, Csilla; Csikos, Agnes; Vissers, Kris; van Gurp, Jelle; Hasselaar, Jeroen

2018-06-01

Integrated palliative care aims at improving coordination of palliative care services around patients' anticipated needs. However, international comparisons of how integrated palliative care is implemented across four key domains of integrated care (content of care, patient flow, information logistics and availability of (human) resources and material) are lacking. To examine how integrated palliative care takes shape in practice across abovementioned key domains within several integrated palliative care initiatives in Europe. Qualitative group interview design. A total of 19 group interviews were conducted (2 in Belgium, 4 in the Netherlands, 4 in the United Kingdom, 4 in Germany and 5 in Hungary) with 142 healthcare professionals from several integrated palliative care initiatives in five European countries. The majority were nurses ( n = 66; 46%) and physicians ( n = 50; 35%). The dominant strategy for fostering integrated palliative care is building core teams of palliative care specialists and extended professional networks based on personal relationships, shared norms, values and mutual trust, rather than developing standardised information exchange and referral pathways. Providing integrated palliative care with healthcare professionals in the wider professional community appears difficult, as a shared proactive multidisciplinary palliative care approach is lacking, and healthcare professionals often do not know palliative care professionals or services. Achieving better palliative care integration into regular healthcare and convincing the wider professional community is a difficult task that will take time and effort. Enhancing standardisation of palliative care into education, referral pathways and guidelines and standardised information exchange may be necessary. External authority (policy makers, insurance companies and professional bodies) may be needed to support integrated palliative care practices across settings.

Standardisation of Bull's Mental Skills Questionnaire in South Africa ...

African Journals Online (AJOL)

The contemporary science of sport and exercise psychology requires the standardisation of mental skills questionnaires to facilitate accurate assessment of and intervention for individuals and groups in various health and sport related contexts. The study presents international research findings regarding the ...

Activity standardisation of 18F and ionisation chamber calibration for nuclear medicine

International Nuclear Information System (INIS)

Schrader, H.; Klein, R.; Kossert, K.

2007-01-01

Primary activity standardisations were performed on solutions of 18 F using 4πβ-γ coincidence counting and liquid scintillation counting (LSC) according to the CIEMAT/NIST method. A β + -emission probability of 96.86% was used for both methods. The various standardised 18 F solutions were measured in ionisation chambers of the Physikalisch-Technische Bundesanstalt (PTB) and compared by determining radionuclide calibration factors. Already in 2001 an 18 F solution had been standardised at the PTB and compared with the results of nine national metrology institutes (NMIs), using the ISOCAL IV secondary radionuclide calibrators of the National Physical Laboratory (NPL) as transfer instruments and a 68 Ge check source solution. These results were linked to the International Reference System (SIR) at the Bureau International des Poids et Mesures (BIPM) by aliquots of solutions sent by the Laboratoire National Henri Becquerel (BNM-LNHB) and the NPL. Further on, in 2005, PTB sent an aliquot of an 18 F solution to the SIR for ionisation chamber measurements. A value of the equivalent activity was determined and included in the key comparison database (KCDB). The recent PTB value of the equivalent activity of the SIR is in good agreement with the key comparison reference value determined from five NMIs. These results confirm that the standardisation of 18 F solutions can be achieved with the accuracy required for use in nuclear medicine and, in particular, for applications in positron emission tomography (PET)

Multicentre chest computed tomography standardisation in children and adolescents with cystic fibrosis

DEFF Research Database (Denmark)

Kuo, Wieying; Kemner-van de Corput, Mariette P. C.; Perez-Rovira, Adria

2016-01-01

Progressive cystic fibrosis (CF) lung disease is the main cause of mortality in CF patients. CF lung disease starts in early childhood. With current standards of care, respiratory function remains largely normal in children and more sensitive outcome measures are needed to monitor early CF lung...... disease. Chest CT is currently the most sensitive imaging modality to monitor pulmonary structural changes in children and adolescents with CF. To quantify structural lung disease reliably among multiple centres, standardisation of chest CT protocols is needed. SCIFI CF (Standardised Chest Imaging...

The Role of the Environmental Health Specialist in the Penal and Correctional System

Science.gov (United States)

Walker, Bailus, Jr.; Gordon, Theodore J.

1976-01-01

Implementing a health and hygiene program in penal systems necessitates coordinating the entire staff. Health specialists could participate in facility planning and management, policy formation, and evaluation of medical care, housekeeping, and food services. They could also serve as liaisons between correctional staff and governmental or…

Comparing specialist medical care with specialist medical care plus the Lightning Process® for chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME): study protocol for a randomised controlled trial (SMILE Trial)

OpenAIRE

Crawley, Esther; Mills, Nicola; Hollingworth, Will; Deans, Zuzana; Sterne, Jonathan A; Donovan, Jenny L; Beasant, Lucy; Montgomery, Alan

2013-01-01

Background Chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a relatively common and potentially serious condition with a limited evidence base for treatment. Specialist treatment for paediatric CFS/ME uses interventions recommended by National Institute for Health and Clinical Excellence (NICE) including cognitive behavioural therapy, graded exercise therapy and activity management. The Lightning Process® (LP) is a trademarked intervention derived from osteopathy, life-coachi...

A Survey of Headache Medicine Specialists on Career Satisfaction and Burnout.

Science.gov (United States)

Evans, Randolph W; Ghosh, Kamalika

2015-01-01

Physicians report increasing rates of career dissatisfaction and professional burnout, which may be related to the practice environment and subspecialty. There has never been a survey of professional burnout among headache medicine specialists. The aim of the present survey was to learn more about how headache medicine physicians are affected by these issues. An email survey was sent to 749 physician members of the American Headache Society with questions or statements about demographics, professional quality of life and satisfaction, future practice plans, and professional burnout using the Maslach Burnout Inventory. In a sample of 127 headache medicine specialists, 66 (57.4%) physicians reported symptoms of professional burnout reflected by high Emotional Exhaustion and/or high Depersonalization. There is widespread dissatisfaction with work schedules, government regulations, implementation of the Affordable Care Act, insurance company policies, malpractice concerns, patient telephone calls, and compensation. Sixty-two percent of respondents concur that headache medicine is becoming more complicated without patient benefit, 14% concur that headache medicine specialists are fairly compensated, and 59% would go into headache medicine again if they were fourth year medical students. In the next 1 to 3 years, 21.3% plan to cut back on hours, 14.2% plan to cut back on patients seen, and 12.6% plan to switch to a cash practice. Medicine and healthcare are changing in such a way that 33.9% concur that they will accelerate their retirement plans. Headache medicine specialists have one of the highest rates of burnout compared to other physician specialists, which is twice the rate of working adults. Physicians' age and practice environment and experience are related with their career satisfaction and professional burnout. Some attributes of career satisfaction can decrease burnout by reducing emotional exhaustion and depersonalization and by enhancing personal

Standardised imaging technique for guided M-mode and Doppler echocardiography in the horse.

Science.gov (United States)

Long, K J; Bonagura, J D; Darke, P G

1992-05-01

Eighteen echocardiographic images useful for diagnostic imaging, M-mode echocardiography, and Doppler echocardiography of the equine heart were standardised by relating the position of the axial beam to various intracardiac landmarks. The transducer orientation required for each image was recorded in 14 adult horses by describing the degree of sector rotation and the orientation of the axial beam relative to the thorax. Repeatable images could be obtained within narrow limits of angulation and rotation for 14 of the 18 standardised images evaluated. Twenty-seven National Hunt horses were subsequently examined using this standardised technique. Selected cardiac dimensions were measured from two-dimensional and guided M-mode studies. Satisfactory results were achieved in 26 of the 27 horses. There was no linear correlation between any of the measured cardiac values and bodyweight. There was no significant difference between measurements taken from the left and the right hemithorax. Six horses were imaged on three consecutive days to assess the repeatability of the measurements. No significant difference was found between measurements obtained on different days. This study demonstrates a method for standardised echocardiographic evaluation of the equine heart that is repeatable, valuable for teaching techniques of equine echocardiography, applicable for diagnostic imaging and quantification of cardiac size, and useful for the evaluation of blood-flow patterns by Doppler ultrasound.

Impact of the Pharmacy Practice Model Initiative on Clinical Pharmacy Specialist Practice.

Science.gov (United States)

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

2016-05-01

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.

Dosimetry in medical specialist in procedures of interventionist radiology; Dosimetria en medico especialista en procedimientos de radiologia intervencionista

Energy Technology Data Exchange (ETDEWEB)

Gaona, E. [Universidad Autonoma Metropolitana, Unidad Xochimilco, Calz. del Hueso 1100, Col. Villa Quietud, 04960 Mexico D. F. (Mexico); Vazquez V, J. A.; Rivera M, T. [IPN, Centro de Investigacion en Ciencia Aplicada y Tecnologia Avanzada, Av. Legaria 694, 11500 Mexico D. F. (Mexico); Izeta G, A. C. [Hospital Central Militar, Periferico y Av. Ejercito Nacional s/n, 11200 Mexico D. F. (Mexico); Azorin V, J. C. [Universidad de Guanajuato, Instituto de Fisica, Loma del Bosque 103, 37150 Leon, Guanajuato (Mexico); Arreola, M., E-mail: gaen1310@correo.xoc.uam.mx [Shands Hospital at University of Florida, Department of Radiology, PO Box 100374, Gainesville, FL 32610-0374 (United States)

2014-08-15

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)

What motivates senior clinicians to teach medical students?

Directory of Open Access Journals (Sweden)

Owen Cathy

2005-07-01

Full Text Available Abstract Background This study was designed to assess the motivations of senior medical clinicians to teach medical students. This understanding could improve the recruitment and retention of important clinical teachers. Methods The study group was 101 senior medical clinicians registered on a teaching list for a medical school teaching hospital (The Canberra Hospital, ACT, Australia. Their motivations to teach medical students were assessed applying Q methodology. Results Of the 75 participants, 18 (24% were female and 57 (76% were male. The age distribution was as follows: 30–40 years = 16 participants (21.3%, 41–55 years = 46 participants (61.3% and >55 years = 13 participants (17.3%. Most participants (n = 48, 64% were staff specialists and 27 (36% were visiting medical officers. Half of the participants were internists (n = 39, 52%, 12 (16% were surgeons, and 24 (32% were other sub-specialists. Of the 26 senior clinicians that did not participate, two were women; 15 were visiting medical officers and 11 were staff specialists; 16 were internists, 9 were surgeons and there was one other sub-specialist. The majority of these non-participating clinicians fell in the 41–55 year age group. The participating clinicians were moderately homogenous in their responses. Factor analysis produced 4 factors: one summarising positive motivations for teaching and three capturing impediments for teaching. The main factors influencing motivation to teach medical students were intrinsic issues such as altruism, intellectual satisfaction, personal skills and truth seeking. The reasons for not teaching included no strong involvement in course design, a heavy clinical load or feeling it was a waste of time. Conclusion This study provides some insights into factors that may be utilised in the design of teaching programs that meet teacher motivations and ultimately enhance the effectiveness of the medical teaching workforce.

14 CFR 1214.305 - Payload specialist responsibilities.

Science.gov (United States)

2010-01-01

... 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...

Internal medicine specialists' attitudes towards working part-time: a comparison between 1996 and 2004.

NARCIS (Netherlands)

Lugtenberg, M.; Heiligers, P.J.M.; Jong, J.D. de; Hingstman, L.

2006-01-01

Background: Although medical specialists traditionally hold negative views towards working parttime, the practice of medicine has evolved. Given the trend towards more part-time work and that there is no evidence that it compromises the quality of care, attitudes towards part-time work may have

Assessment of acrylamide toxicity using a battery of standardised bioassays.

Science.gov (United States)

Zovko, Mira; Vidaković-Cifrek, Željka; Cvetković, Želimira; Bošnir, Jasna; Šikić, Sandra

2015-12-01

Acrylamide is a monomer widely used as an intermediate in the production of organic chemicals, e.g. polyacrylamides (PAMs). Since PAMs are low cost chemicals with applications in various industries and waste- and drinking water treatment, a certain amount of non-polymerised acrylamide is expected to end up in waterways. PAMs are non-toxic but acrylamide induces neurotoxic effects in humans and genotoxic, reproductive, and carcinogenic effects in laboratory animals. In order to evaluate the effect of acrylamide on freshwater organisms, bioassays were conducted on four species: algae Desmodesmus subspicatus and Pseudokirchneriella subcapitata, duckweed Lemna minor and water flea Daphnia magna according to ISO (International Organization for Standardisation) standardised methods. This approach ensures the evaluation of acrylamide toxicity on organisms with different levels of organisation and the comparability of results, and it examines the value of using a battery of low-cost standardised bioassays in the monitoring of pollution and contamination of aquatic ecosystems. These results showed that EC50 values were lower for Desmodesmus subspicatus and Pseudokirchneriella subcapitata than for Daphnia magna and Lemna minor, which suggests an increased sensitivity of algae to acrylamide. According to the toxic unit approach, the values estimated by the Lemna minor and Daphnia magna bioassays, classify acrylamide as slightly toxic (TU=0-1; Class 1). The results obtained from algal bioassays (Desmodesmus subspicatus and Pseudokirchneriella subcapitata) revealed the toxic effect of acrylamide (TU=1-10; Class 2) on these organisms.

An empirical analysis of public and private medical practice in Australia.

Science.gov (United States)

Cheng, Terence C; Joyce, Catherine M; Scott, Anthony

2013-06-01

The combination of public and private medical practice is widespread in many health systems and has important consequences for health care cost and quality. However, its forms and prevalence vary widely and are poorly understood. This paper examines factors associated with public and private sector work by medical specialists using a nationally representative sample of Australian doctors. We find considerable variations in the practice patterns, remuneration contracts and professional arrangements across doctors in different work sectors. Both specialists in mixed practice and private practice differ from public sector specialists with regard to their annual earnings, sources of income, maternity and other leave taken and number of practice locations. Public sector specialists are likely to be younger, to be international medical graduates, devote a higher percentage of time to education and research, and are more likely to do after hours and on-call work compared with private sector specialists. Gender and total hours worked do not differ between doctors across the different practice types. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Lessons from Small-scale Standardised Testing of English Reading ...

African Journals Online (AJOL)

The superior performance by the public school can partly be explained by teachers teaching experience, most of them have been teaching for more than ten years and greater community support for the school. It is recommended that data produced through small-scale standardised testing should be used by school ...

Traumatic brain injury in England and Wales: prospective audit of epidemiology, complications and standardised mortality.

Science.gov (United States)

Lawrence, T; Helmy, A; Bouamra, O; Woodford, M; Lecky, F; Hutchinson, P J

2016-11-24

To provide a comprehensive assessment of the management of traumatic brain injury (TBI) relating to epidemiology, complications and standardised mortality across specialist units. The Trauma Audit and Research Network collects data prospectively on patients suffering trauma across England and Wales. We analysed all data collected on patients with TBI between April 2014 and June 2015. Data were collected on patients presenting to emergency departments across 187 hospitals including 26 with specialist neurosurgical services, incorporating factors previously identified in the Ps14 multivariate logistic regression (Ps14 n ) model multivariate TBI outcome prediction model. The frequency and timing of secondary transfer to neurosurgical centres was assessed. We identified 15 820 patients with TBI presenting to neurosurgical centres directly (6258), transferred from a district hospital to a neurosurgical centre (3682) and remaining in a district general hospital (5880). The commonest mechanisms of injury were falls in the elderly and road traffic collisions in the young, which were more likely to present in coma. In severe TBI (Glasgow Coma Score (GCS) ≤8), the median time from admission to imaging with CT scan is 0.5 hours. Median time to craniotomy from admission is 2.6 hours and median time to intracranial pressure monitoring is 3 hours. The most frequently documented complication of severe TBI is bronchopneumonia in 5% of patients. Risk-adjusted W scores derived from the Ps14 n model indicate that no neurosurgical unit fell outside the 3 SD limits on a funnel plot. We provide the first comprehensive report of the management of TBI in England and Wales, including data from all neurosurgical units. These data provide transparency and suggests equity of access to high-quality TBI management provided in England and Wales. 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/.

An in vitro study of anti-inflammatory activity of standardised Andrographis paniculata extracts and pure andrographolide.

Science.gov (United States)

Low, Mitchell; Khoo, Cheang S; Münch, Gerald; Govindaraghavan, Suresh; Sucher, Nikolaus J

2015-02-07

The anti-inflammatory activity of Andrographis paniculata (Acanthaceae), a traditional medicine widely used in Asia, is commonly attributed to andrographolide, its main secondary metabolite. Commercial A. paniculata extracts are standardised to andrographolide content. We undertook the present study to investigate 1) how selective enrichment of andrographolide in commercial A. paniculata extracts affects the variability of non-standardised phytochemical components and 2) if variability in the non-standardised components of the extract affects the pharmacological activity of andrographolide itself. We characterized 12 commercial, standardised (≥30% andrographolide) batches of A. paniculata extracts from India by HPLC profiling. We determined the antioxidant capacity of the extracts using 2,2-diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging, oxygen radical antioxidant capacity (ORAC) and a Folin-Ciocalteu (FC) antioxidant assays. Their anti-inflammatory activity was assessed by assaying their inhibitory effect on the release of tumor necrosis factor alpha (TNF-α) in the human monocytic cell line THP-1. The andrographolide content in the samples was close to the claimed value (32.2 ± 2.1%, range 27.5 to 35.9%). Twenty-one non-standardised constituents exhibited more than 2-fold variation in HPLC peak intensities in the tested batches. The chlorogenic acid content of the batches varied more than 30-fold. The DPPH free radical scavenging activity varied ~3-fold, the ORAC and FC antioxidant capacity varied ~1.5 fold among batches. In contrast, the TNF-α inhibitory activity of the extracts exhibited little variation and comparison with pure andrographolide indicated that it was mostly due to their andrographolide content. Standardised A. paniculata extracts contained the claimed amount of andrographolide but exhibited considerable phytochemical background variation. DPPH radical scavenging activity of the extracts was mostly due to the flavonoid

48 CFR 536.570-3 - Specialist.

Science.gov (United States)

2010-10-01

... 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...

Internal medicine specialists' attitudes towards working part-time: a comparison between 1996 and 2004

NARCIS (Netherlands)

Lugtenberg, Marjolein; Heiligers, P.J.M.; Jong, Judith de; Hingstman, Lammert

2006-01-01

Although medical specialists traditionally hold negative views towards working parttime, the practice of medicine has evolved. Given the trend towards more part-time work and that there is no evidence that it compromises the quality of care, attitudes towards part-time work may have changed as

Definition of Specific Functions and Procedural Skills Required by Cuban Specialists in Intensive Care and Emergency Medicine.

Science.gov (United States)

Véliz, Pedro L; Berra, Esperanza M; Jorna, Ana R

2015-07-01

INTRODUCTION Medical specialties' core curricula should take into account functions to be carried out, positions to be filled and populations to be served. The functions in the professional profile for specialty training of Cuban intensive care and emergency medicine specialists do not include all the activities that they actually perform in professional practice. OBJECTIVE Define the specific functions and procedural skills required of Cuban specialists in intensive care and emergency medicine. METHODS The study was conducted from April 2011 to September 2013. A three-stage methodological strategy was designed using qualitative techniques. By purposive maximum variation sampling, 82 professionals were selected. Documentary analysis and key informant criteria were used in the first stage. Two expert groups were formed in the second stage: one used various group techniques (focus group, oral and written brainstorming) and the second used a three-round Delphi method. In the final stage, a third group of experts was questioned in semistructured in-depth interviews, and a two-round Delphi method was employed to assess priorities. RESULTS Ultimately, 78 specific functions were defined: 47 (60.3%) patient care, 16 (20.5%) managerial, 6 (7.7%) teaching, and 9 (11.5%) research. Thirty-one procedural skills were identified. The specific functions and procedural skills defined relate to the profession's requirements in clinical care of the critically ill, management of patient services, teaching and research at the specialist's different occupational levels. CONCLUSIONS The specific functions and procedural skills required of intensive care and emergency medicine specialists were precisely identified by a scientific method. This product is key to improving the quality of teaching, research, administration and patient care in this specialty in Cuba. The specific functions and procedural skills identified are theoretical, practical, methodological and social contributions to

Medical Specialist Preferences and Reasons among Fresh Nigerian ...

African Journals Online (AJOL)

The feminization of the workforce and demand for a better work/ life balance by both genders are leading to predicted shortages of ... the following study is to determine the choices of career and reasons for those choices among young medical ...

Use of professional profiles in applications for specialist training positions

DEFF Research Database (Denmark)

Lundh, Andreas; Skjelsager, Karen; Wildgaard, Kim

2013-01-01

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...

Requirements for the special examination of isotope diagnostic specialists

International Nuclear Information System (INIS)

Csakany, Gyoergy

1986-01-01

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.)

Avoiding costly hospitalisation at end of life: findings from a specialist palliative care pilot in residential care for older adults.

Science.gov (United States)

Chapman, Michael; Johnston, Nikki; Lovell, Clare; Forbat, Liz; Liu, Wai-Man

2018-03-01

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/.

Service innovation in glaucoma management: using a Web-based electronic patient record to facilitate virtual specialist supervision of a shared care glaucoma programme.

Science.gov (United States)

Wright, Heathcote R; Diamond, Jeremy P

2015-03-01

To assess the importance of specialist supervision in a new model of glaucoma service delivery. An optometrist supported by three technicians managed each glaucoma clinic. Patients underwent testing and clinical examination before the optometrist triaged them into one of five groups: 'normal', 'stable', 'low risk', 'unstable' and 'high risk'. Patient data were uploaded to an electronic medical record to facilitate virtual review by a glaucoma specialist. 24 257 glaucoma reviews at three glaucoma clinics during a 31-month period were analysed. The clinic optometrists and glaucoma specialists had substantial agreement (κ 0.69). 13 patients were identified to be high risk by the glaucoma specialist that had not been identified as such by the optometrist. Glaucoma specialists amended 13% of the optometrists' interim decisions resulting in an overall reduction in review appointments by 2.4%. Employing technicians and optometrists to triage glaucoma patients into groups defined by risk of blindness allows higher risk patients to be directed to a glaucoma specialist. Virtual review allows the glaucoma specialist to remain in overall control while reducing the risk that patients are treated or followed-up unnecessarily. Demand for glaucoma appointments can be reduced allowing scarce medical resources to be directed to patients most in need. 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.

The internal medicine specialist and neurosurgery

Directory of Open Access Journals (Sweden)

A. Pizzini

2013-05-01

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.

Use of standardised patients to assess antibiotic dispensing for tuberculosis by pharmacies in urban India: a cross-sectional study.

Science.gov (United States)

Satyanarayana, Srinath; Kwan, Ada; Daniels, Benjamin; Subbaraman, Ramnath; McDowell, Andrew; Bergkvist, Sofi; Das, Ranendra K; Das, Veena; Das, Jishnu; Pai, Madhukar

2016-11-01

India's total antibiotic use is the highest of any country. Patients often receive prescription-only drugs directly from pharmacies. Here we aimed to assess the medical advice and drug dispensing practices of pharmacies for standardised patients with presumed and confirmed tuberculosis in India. In this cross-sectional study in the three Indian cities Delhi, Mumbai, and Patna, we developed two standardised patient cases: first, a patient presenting with 2-3 weeks of pulmonary tuberculosis symptoms (Case 1); and second, a patient with microbiologically confirmed pulmonary tuberculosis (Case 2). Standardised patients were scheduled to present each case once to sampled pharmacies. We defined ideal management for both cases a priori as referral to a health-care provider without dispensing antibiotics or steroids or both. Between April 1, 2014, and Nov 29, 2015, we sampled 622 pharmacies in Delhi, Mumbai, and Patna. Standardised patients completed 1200 (96%) of 1244 interactions. We recorded ideal management (defined as referrals without the use of antibiotics or steroids) in 80 (13%) of 599 Case 1 interactions (95% CI 11-16) and 372 (62%) of 601 Case 2 interactions (95% CI 58-66). Antibiotic use was significantly lower in Case 2 interactions (98 [16%] of 601, 95% CI 13-19) than in Case 1 (221 [37%] of 599, 95% CI 33-41). First-line anti-tuberculosis drugs were not dispensed in any city. The differences in antibiotic or steroid use and number of medicines dispensed between Case 1 and Case 2 were almost entirely attributable to the difference in referral behaviour. Only some urban Indian pharmacies correctly managed patients with presumed tuberculosis, but most correctly managed a case of confirmed tuberculosis. No pharmacy dispensed anti-tuberculosis drugs for either case. Absence of a confirmed diagnosis is a key driver of antibiotic misuse and could inform antimicrobial stewardship interventions. Grand Challenges Canada, Bill & Melinda Gates Foundation, Knowledge for

Systematic screening for unsafe driving due to medical conditions: Still debatable

Directory of Open Access Journals (Sweden)

Lagarde Emmanuel

2008-01-01

Full Text Available Abstract Background Assessing people's ability to drive has become a public health concern in most industrialized countries. Although age itself is not a predictive factor of an increased risk for dangerous driving, the prevalence of medical conditions that may impair driving increases with age. Because the implementation of a screening for unsafe driving due to medical conditions is a public health issue, its usefulness should be judged using standardised criteria already proposed for screening for chronic disease. The aim of this paper is to propose standardised criteria suitable to assess the scientific validity of screening for unsafe driving due to medical conditions, and identify potential issues to be clarified before screening can be implemented and effective. Discussion Using criteria developed for screening for chronic diseases and published studies on driving with medical conditions, we specify six criteria to judge the opportunity of screening for unsafe driving due to medical conditions. This adaptation was needed because of the complexity of the natural history of medical conditions and their potential consequences on driving and road safety. We then illustrate that published studies pleading for or against screening for unsafe driving due to medical conditions fail to provide the needed documentation. Individual criteria were mentioned in 3 to 72% of 36 papers pleading for or against screening. Quantitative estimates of relevant indicators were provided in at most 42% of papers, and some data, such as the definition of an appropriate unsafe driving period were never provided. Summary The standardised framework described in this paper provides a template for assessing the effectiveness (or lack of effectiveness of proposed measures for screening for unsafe driving due to medical conditions. Even if most criteria were mentioned in the published literature pleading for or against such a screening, the failure to find quantitative and

Consequences of lack of specialists in radiation protection in health services and the different ways to overcome it

International Nuclear Information System (INIS)

Isoardi, Roberto; Acosta, Norma B.; Velez, Graciela

2013-01-01

In Argentina, most medical physicists are almost exclusive dedicated to radiotherapy and nuclear medicine to a lesser extent, due to standards where is required the physicist presence. The behavior is not the same in the area of diagnostic radiology where there is no standard to regulate it. The proposal elements to achieve sustainable development in the Medical Physics can be resumed like this: 1) the acceptance of the physicist as the health professional; 2)the request of it incorporation in the control of the Health Ministry (X-ray and ionizing radiations); 3) definition of the professional profiles to have the accreditation and certification of the specialists; 4) effort on the training of specialists in the areas where there is not this human resource

Subsidies to target specialist outreach services into more remote locations: a national cross-sectional study.

Science.gov (United States)

O'Sullivan, Belinda G; McGrail, Matthew R; Stoelwinder, Johannes U

2017-07-01

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

What Is a Pediatric Infectious Diseases Specialist?

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... 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 ...

What Is a Pediatric Critical Care Specialist?

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... Text Size Email Print Share What is a Pediatric Critical Care Specialist? Page Content Article Body If ... in the PICU. What Kind of Training Do Pediatric Critical Care Specialists Have? Pediatric critical care specialists ...

Specialist mental health consultation for depression in Australian aged care residents with dementia: a cluster randomized trial.

Science.gov (United States)

McSweeney, Kate; Jeffreys, Aimee; Griffith, Joanne; Plakiotis, Chris; Kharsas, Renee; O'Connor, Daniel W

2012-11-01

This cluster randomized controlled trial sought to determine whether multidisciplinary specialist mental health consultation was more effective than care as usual in treating the depression of aged care residents with dementia. Three hundred and eighty nine aged care residents were screened for dementia and major depression. Forty four were ultimately included in the intervention sample, selected from 20 aged care facilities located in Melbourne, Australia. Facilities were randomly allocated to an intervention condition involving the provision of multidisciplinary specialist consultation regarding the best-practice management of depression in dementia, or to a care as usual condition. Consultations involved individually tailored medical and psychosocial recommendations provided to care staff and general practitioners. All residents participated in a comprehensive pre-intervention diagnostic assessment, including the administration of the Cornell Scale for Depression in Dementia. This assessment was repeated approximately 15 weeks post-intervention by a rater blind to study condition. Multidisciplinary specialist mental health consultation was significantly more effective than care as usual in treating the clinical depression of aged care residents with dementia (p Depression in Dementia score for the intervention group was 9.47, compared with 14.23 for the control group. In addition, 77% of the intervention group no longer met criteria for major depression. The results of this study suggest that the psychosocial and medical management of depressed aged care residents can be improved by increasing access to specialist mental health consultation. Copyright © 2012 John Wiley & Sons, Ltd.

Senior medical students' appraisal of CanMEDS competencies.

NARCIS (Netherlands)

Rademakers, J.; Rooy, N. de; Cate, O.T.J. ten

2007-01-01

CONTEXT: In 2003 the Dutch Central College of Medical Specialties presented guidelines for the modernisation of all medical specialty training programmes in the Netherlands. These guidelines are based to a large extent on the CanMEDS (Canadian Medical Education Directives for Specialists) 2000

A process-stakeholder analysis of B2B industry standardisation

NARCIS (Netherlands)

Rodon, J.; Ramis-Pujol, J.; Christiaanse, E.

2007-01-01

Purpose - Interoperability standards are a crucial aspect in the development of B2B e-business. The aim of this paper is to understand how standardisation evolves by analysing the interplay between activities and stakeholders within the process. Unlike most of the IS research that focuses on the

Inequalities in mortality: study rates, not standardised mortality ratios [Letter

NARCIS (Netherlands)

Bonneux, L.G.A.

2010-01-01

In their study from 1921 to 2007 Thomas and colleagues conclude on the basis of standardised mortality ratios that inequalities in mortality continue to rise and are now almost as high as in the 1930s. Relative ratios are, however, misleading when absolute rates change strongly. I calculated the

[Trends among medical students towards general practice or specialization].

Science.gov (United States)

Breinbauer K, Hayo; Fromm R, Germán; Fleck L, Daniela; Araya C, Luis

2009-07-01

A 60/40 ratio has been estimated as a country's ideal proportion between general practitioners and specialists. In Chile this proportion was 36/ 64 in 2004, exactly the opposite of the ideal. Trends towards specialization or general practice among medical students have not been thoughtfully studied. To assess trends among medical students towards becoming general practitioners or specialists, exploring associated factors. Descriptive survey of 822 first to seventh year medical students at the University of Chile, School of Medicine. Desired activity to pursue (general practice or specialization) after graduation and general orientations within clinical practice were explored. Fifty three percent of students desired to enter a specialization program. Only 20% would work as a general practitioner (27% were still indecisive). Furthermore, a trend in early years of medical training towards an integral medicine is gradually reversed within later years. Seventh year students give significantly more importance to specialization than to integral medicine (p specialized medicine in the teaching environment. Most students prefer to enter a specialization program immediately after finishing medical school. Moreover, there is a social trend, at least within the teacher-attending environment, promoting not only the desire to specialize, but a pro-specialist culture.

Guideline-based survey of outpatient COPD management by pulmonary specialists in Germany

Directory of Open Access Journals (Sweden)

Buhl R

2012-02-01

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

Motives and preferences of general practitioners for new collaboration models with medical specialists : a qualitative study

NARCIS (Netherlands)

Berendsen, Annette J.; Benneker, Wim H. G. M.; Jong, Betty Meyboom-de; Klazinga, Niek S.; Schuling, Jan

2007-01-01

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 GPs to initiate and continue participating

Motives and preferences of general practitioners for new collaboration models with medical specialists: a qualitative study

NARCIS (Netherlands)

Berendsen, Annette J.; Benneker, Wim H. G. M.; Jong, Betty Meyboom-de; Klazinga, Niek S.; Schuling, Jan

2007-01-01

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 GPs to initiate and continue participating

Effects of standardised cigarette packaging on craving, motivation to stop and perceptions of cigarettes and packs.

Science.gov (United States)

Brose, Leonie S; Chong, Chwen B; Aspinall, Emily; Michie, Susan; McEwen, Andy

2014-01-01

To assess whether standardised packs of the form introduced in Australia are associated with a reduction in acute craving and/or an increase in motivation to stop, and to replicate previous findings on perceptions of packaging, perceptions of smokers using it and perceived effects on behaviour. Following abstinence of at least 12 h, 98 regular and occasional smokers were randomised to exposure to their own cigarette package, another branded package or a standardised package. Craving (QSU-brief), motivation to stop, both at baseline and post-exposure. Ratings of 10 attributes concerning package design, perceived smoker characteristics and effects on behaviour, post-exposure only. For craving, a mixed model ANCOVA showed a significant interaction of packaging and time of measurement (F(2,94) = 8.77, p interaction for motivation to stop smoking (p = .9). The standardised pack was perceived to be significantly less appealing and less motivating to buy cigarettes, smokers using them were perceived as less popular and cigarettes from them expected to taste worse. Standardised cigarette packaging may reduce acute (hedonic) craving and is associated with more negative perceptions than branded packaging with less prominent health warnings.

Management of multinodular goiter in Germany (Papillon 2005). Do the approaches of thyroid specialists and primary care practitioners differ?

Energy Technology Data Exchange (ETDEWEB)

Dietlein, M.; Schmidt, M.; Schicha, H. [Koeln Univ. (Germany). Dept. of Nuclear Medicine; Wegscheider, K. [Hamburg Univ. (Germany). Inst. of Statistics and Econometrics; Vaupel, R. [Sanofi-Aventis Deutschland GmbH, Berlin (Germany)

2007-07-01

Aim: Large-scale survey to focus on management of multinodular goiter and to compare the approaches of practitioners in primary care and thyroid specialists in Germany. Methods: Replies to a questionnaire were received from 2,191 practitioners and 297 thyroid specialists between June 1 and September 30, 2005. The hypothetical cases and their modifications described multinodular goiters of different sizes with and without toxic nodules. Results: In the workup, TSH determination and thyroid sonography were found to be standard procedures. Scintigraphy was selected by 80.2% of practitioners and 92.9% of specialists (p <0.001), in preference to fine needle aspiration cytology (17.9% of practitioners and 34.5% of the specialists, p <0.001). Only 6.1% of practitioners and 24.4% of specialists (p <0.001) advocated calcitonin screening. Euthyroid multinodular goiter (50-80 ml) was treated medically by 67.1% of practitioners and 65.6% of specialists, the combination of levothyroxine with iodine being clearly preferred (54.5% of practitioners, 52.3% of specialists). For toxic nodular goiter the preference for radioiodine therapy was significantly higher (p <0.001) among specialists (67.7%) than among practitioners (47.5%). Referral to surgery was recommended for cold nodules with negative cytology by 64.9% of practitioners and 73.5% of specialists (p = 0.004). Conclusions: Treatment and diagnostic procedures are used to nearly the same extent in primary care and specialist institutions, but the opinions diverge over the issues of calcitonin screening and referral for radioiodine therapy. (orig.)

Management of multinodular goiter in Germany (Papillon 2005). Do the approaches of thyroid specialists and primary care practitioners differ?

International Nuclear Information System (INIS)

Dietlein, M.; Schmidt, M.; Schicha, H.

2007-01-01

Aim: Large-scale survey to focus on management of multinodular goiter and to compare the approaches of practitioners in primary care and thyroid specialists in Germany. Methods: Replies to a questionnaire were received from 2,191 practitioners and 297 thyroid specialists between June 1 and September 30, 2005. The hypothetical cases and their modifications described multinodular goiters of different sizes with and without toxic nodules. Results: In the workup, TSH determination and thyroid sonography were found to be standard procedures. Scintigraphy was selected by 80.2% of practitioners and 92.9% of specialists (p <0.001), in preference to fine needle aspiration cytology (17.9% of practitioners and 34.5% of the specialists, p <0.001). Only 6.1% of practitioners and 24.4% of specialists (p <0.001) advocated calcitonin screening. Euthyroid multinodular goiter (50-80 ml) was treated medically by 67.1% of practitioners and 65.6% of specialists, the combination of levothyroxine with iodine being clearly preferred (54.5% of practitioners, 52.3% of specialists). For toxic nodular goiter the preference for radioiodine therapy was significantly higher (p <0.001) among specialists (67.7%) than among practitioners (47.5%). Referral to surgery was recommended for cold nodules with negative cytology by 64.9% of practitioners and 73.5% of specialists (p 0.004). Conclusions: Treatment and diagnostic procedures are used to nearly the same extent in primary care and specialist institutions, but the opinions diverge over the issues of calcitonin screening and referral for radioiodine therapy. (orig.)

Clarifying the role of the mental health peer specialist in Massachusetts, USA: insights from peer specialists, supervisors and clients.

Science.gov (United States)

Cabral, Linda; Strother, Heather; Muhr, Kathy; Sefton, Laura; Savageau, Judith

2014-01-01

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

29 CFR 42.9 - Farm Labor Specialist (ESA).

Science.gov (United States)

2010-07-01

... 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...

Consultation with specialist palliative care services in palliative sedation: considerations of Dutch physicians.

Science.gov (United States)

Koper, Ian; van der Heide, Agnes; Janssens, Rien; Swart, Siebe; Perez, Roberto; Rietjens, Judith

2014-01-01

Palliative sedation is considered a normal medical practice by the Royal Dutch Medical Association. Therefore, consultation of an expert is not considered mandatory. The European Association of Palliative Care (EAPC) framework for palliative sedation, however, is more stringent: it considers the use of palliative sedation without consulting an expert as injudicious and insists on input from a multi-professional palliative care team. This study investigates the considerations of Dutch physicians concerning consultation about palliative sedation with specialist palliative care services. Fifty-four physicians were interviewed on their most recent case of palliative sedation. Reasons to consult were a lack of expertise and the view that consultation was generally supportive. Reasons not to consult were sufficient expertise, the view that palliative sedation is a normal medical procedure, time pressure, fear of disagreement with the service and regarding consultation as having little added value. Arguments in favour of mandatory consultation were that many physicians lack expertise and that palliative sedation is an exceptional intervention. Arguments against mandatory consultation were practical obstacles that may preclude fulfilling such an obligation (i.e. lack of time), palliative sedation being a standard medical procedure, corroding a physician's responsibility and deterring physicians from applying palliative sedation. Consultation about palliative sedation with specialist palliative care services is regarded as supportive and helpful when physicians lack expertise. However, Dutch physicians have both practical and theoretical objections against mandatory consultation. Based on the findings in this study, there seems to be little support among Dutch physicians for the EAPC recommendations on obligatory consultation.

A method for developing standardised interactive education for complex clinical guidelines

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Vaughan Janet I

2012-11-01

Full Text Available Abstract Background Although systematic use of the Perinatal Society of Australia and New Zealand internationally endorsed Clinical Practice Guideline for Perinatal Mortality (PSANZ-CPG improves health outcomes, implementation is inadequate. Its complexity is a feature known to be associated with non-compliance. Interactive education is effective as a guideline implementation strategy, but lacks an agreed definition. SCORPIO is an educational framework containing interactive and didactic teaching, but has not previously been used to implement guidelines. Our aim was to transform the PSANZ-CPG into an education workshop to develop quality standardised interactive education acceptable to participants for learning skills in collaborative interprofessional care. Methods The workshop was developed using the construct of an educational framework (SCORPIO, the PSANZ-CPG, a transformation process and tutor training. After a pilot workshop with key target and stakeholder groups, modifications were made to this and subsequent workshops based on multisource written observations from interprofessional participants, tutors and an independent educator. This participatory action research process was used to monitor acceptability and educational standards. Standardised interactive education was defined as the attainment of content and teaching standards. Quantitative analysis of positive expressed as a percentage of total feedback was used to derive a total quality score. Results Eight workshops were held with 181 participants and 15 different tutors. Five versions resulted from the action research methodology. Thematic analysis of multisource observations identified eight recurring education themes or quality domains used for standardisation. The two content domains were curriculum and alignment with the guideline and the six teaching domains; overload, timing, didacticism, relevance, reproducibility and participant engagement. Engagement was the most

Standardised tumour, node and metastasis reporting of oncology CT scans

International Nuclear Information System (INIS)

Gormly, K. L. M.

2009-01-01

Full text: The oncology CT report is a vital piece of communication between the radiologist and the treating clinician and often determines patient management. The use of a standardised report that follows the tumour, node and metastasis (TNM) structure makes it easier for the radiologist to include all of the necessary information in an easy-to-read format. Presenting the results under the headings of primary tumour, lymph nodes, metastases, and other findings follows a similar pattern to that used by pathologists and also follows the thought process of the treating clinician. Standardised templates for TNM-based oncology CT reports were introduced into public and private institutions. An audit of 199 reports demonstrated a significant increase in the presence of measurements and conclusions in the template reports. While there was a non-significant increase in the use of correct Response Evaluation Criteria In Solid Tumours terminology for template reports, there was an improved attempt to describe the disease response. Saving measurements as a summary series on PACS also assists follow-up reporting

Education of nuclear energy specialists

International Nuclear Information System (INIS)

Paulikas, V.

1999-01-01

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

The use of standardised short-term and working memory tests in aphasia research: a systematic review.

Science.gov (United States)

Murray, Laura; Salis, Christos; Martin, Nadine; Dralle, Jenny

2018-04-01

Impairments of short-term and working memory (STM, WM), both verbal and non-verbal, are ubiquitous in aphasia. Increasing interest in assessing STM and WM in aphasia research and clinical practice as well as a growing evidence base of STM/WM treatments for aphasia warrant an understanding of the range of standardised STM/WM measures that have been utilised in aphasia. To date, however, no previous systematic review has focused on aphasia. Accordingly, the goals of this systematic review were: (1) to identify standardised tests of STM and WM utilised in the aphasia literature, (2) to evaluate critically the psychometric strength of these tests, and (3) to appraise critically the quality of the investigations utilising these tests. Results revealed that a very limited number of standardised tests, in the verbal and non-verbal domains, had robust psychometric properties. Standardisation samples to elicit normative data were often small, and most measures exhibited poor validity and reliability properties. Studies using these tests inconsistently documented demographic and aphasia variables essential to interpreting STM/WM test outcomes. In light of these findings, recommendations are provided to foster, in the future, consistency across aphasia studies and confidence in STM/WM tests as assessment and treatment outcome measures.

Organisational aspects of the qualification and involvement of Medical Physicists in Radiology

International Nuclear Information System (INIS)

Vassileva, J.

2004-01-01

The specialist in Medical Physics has a key position in Quality Assurance process at diagnostic and therapeutic process and in Radiation Protection at medical use of ionizing radiation. The International Basic Safety Standards for protection against ionizing radiation of IAEA recommend and the EURATOM Directives 96/23 and 97/43 require qualified expert in medical physics to be involved in all the activities with ionizing radiation. In radiotherapeutic process this expert shall be closely involved and in nuclear medicine and diagnostic radiology this specialist shall be available. The International Organization for Medical Physics (IOMP), the European Federation of Organizations for Medical Physics (EFOMP) as well as a number of national organizations for Medical Physics in different countries have a clear concept for the qualification levels of the medical physics specialists, for the recognition scheme of their qualification and for the organization of the medical physics activities in a clinical environment. The legal requirements for medical physics expert's involvement in medicine is introducing in Bulgaria with the new Ordinance for Radiation Protection of Individuals at Medical Exposure that is expected to come into force in the beginning of next year. Some problems for discussion are submitted here finding necessary changes in the existing system for education and training of Medical physicists as well as in the organization of their involvement in health centers in the country. (author)

Shiraz Medical Tourism Industry: Development Strategies

OpenAIRE

Mohammad Kazem RahimiZarchi; Tahereh Shafaghat; Nahid Hatam

2017-01-01

Background: Medical tourism industry with global revenue of around 20 billion dollars in 2005 is one of the largest industries in the world. Absorbing a percentage of this amount can have a significant impact on medical tourism economy of Asian countries, including Iran. The aim of this study was to provide solutions for attracting medical tourists in Shiraz. Methods: This qualitative study was carried out on health care management specialists, hospital administrators, statistics and medic...

[Was the current surplus of neurosurgeons predictable in 2009? Analysis of the situation based on the Report of supply and demand of medical specialists in Spain (2008-2025)].

Science.gov (United States)

Martín-Láez, Rubén; Ibáñez, Javier; Lagares, Alfonso; Fernández-Alén, José; Díez-Lobato, Ramiro

2012-11-01

In 2009 the Spanish Ministry of Health (SMH) published the report of supply and demand of medical specialists in Spain (2008-2025), in which our specialty was considered as presenting a moderate deficit of consultants. However, Spanish neurosurgery is currently in a situation of having a surplus of neurosurgeons. To determine whether it was possible to predict the current excess of neurosurgeons in 2009 and to forecast the most likely perspective of supply and demand in 2017. Raw data extracted from the SMH report, information on the ages of the Spanish neurosurgeons obtained from the study performed by our Board of Directors in 2001, and annual mortality rates for different age ranges provided by the National Institute of Statistics, were used to predict the evolution of supply and demand of neurosurgeons for the periods 2008-2012 and 2013-2017. The current situation of an excess of specialists was predictable in 2009, and if appropriate measures are not taken, a surplus of more than 100 neurosurgeons is likely in 2017, with an unemployment rate above 26% in the worst scenario. In order to match the actual and future demand of specialists, it is necessary and urgent to reduce the number of neurosurgical in-training positions. To achieve this goal, it is essential to obtain periodical and up-to-date structural information of the different Neurosurgery Departments and Units, and to revisit the accreditation terms of the more than fifty current teaching units. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

Attitudes regarding specialist referrals in periodontics.

Science.gov (United States)

Sharpe, G; Durham, J A; Preshaw, P M

2007-02-24

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.

Mission Specialist Scott Parazynski arrives at KSC

Science.gov (United States)

1998-01-01

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.

Proceedings of the third specialists` meeting on high energy nuclear data

Energy Technology Data Exchange (ETDEWEB)

Fukahori, Tokio [ed.

1998-11-01

This report is the Proceedings of the Third Specialists` Meeting on High Energy Nuclear Data. The meeting was held on March 30-31, 1998, at the Tokai Research Establishment of Japan Atomic Energy Research Institute with the participation of forty-odd specialists, who were the evaluators, theorists, experimentalists and users of high energy nuclear data including the members of the Japanese Nuclear Data Committee. The need of the high energy nuclear data up to a few Gev has been stressed in the meeting for many applications, such as spallation neutron sources for radioactive waste treatment, accelerator shielding design, medical isotope production, radiation therapy, the effects of space radiation on astronauts and their equipments, and the cosmic history of meteorites and other galactic substances. Since the Second Specialists` Meeting in 1995, such an evaluation activity in Japan has been grown and the results are accumulated. Foreign activities of high energy nuclear data evaluation are also being increased. According to the above situation, with the view point of reviewing and validating an evaluated high energy nuclear data file, project of high energy nuclear data file production, differential and integral experiments, status of evaluation and reviewing methods, processing and transport calculation methods, benchmark tests, international trends, etc. were discussed. The 16 of the presented papers are indexed individually. (J.P.N.)

The training and professional expectations of medical students in Angola, Guinea-Bissau and Mozambique

Directory of Open Access Journals (Sweden)

Fronteira Inês

2011-04-01

Full Text Available Abstract Background The purpose of this paper is to describe and analyze the professional expectations of medical students during the 2007-2008 academic year at the public medical schools of Angola, Guinea-Bissau and Mozambique, and to identify their social and geographical origins, their professional expectations and difficulties relating to their education and professional future. Methods Data were collected through a standardised questionnaire applied to all medical students registered during the 2007-2008 academic year. Results Students decide to study medicine at an early age. Relatives and friends seem to have an especially important influence in encouraging, reinforcing and promoting the desire to be a doctor. The degree of feminization of the student population differs among the different countries. Although most medical students are from outside the capital cities, expectations of getting into medical school are already associated with migration from the periphery to the capital city, even before entering medical education. Academic performance is poor. This seems to be related to difficulties in accessing materials, finances and insufficient high school preparation. Medical students recognize the public sector demand but their expectations are to combine public sector practice with private work, in order to improve their earnings. Salary expectations of students vary between the three countries. Approximately 75% want to train as hospital specialists and to follow a hospital-based career. A significant proportion is unsure about their future area of specialization, which for many students is equated with migration to study abroad. Conclusions Medical education is an important national investment, but the returns obtained are not as efficient as expected. Investments in high-school preparation, tutoring, and infrastructure are likely to have a significant impact on the success rate of medical schools. Special attention should be given

[Adverse events in neonatology, contribution of a standardised register].

Science.gov (United States)

Normand, Marie-Madeleine; Ejarque Albuquerque, Margarida; Grouazel, Anne-Laure; Cottereau, Marie-Noëlle

Despite the recommendation to report all adverse events to the risk management unit, such reporting is far from consistent. An internal, standardised register of adverse events, was put in place in a neonatology unit for six months. An analysis of the reports has led to the reorganisation of the unit and practices as part of a drive to improve the quality of care. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Factors associated with differences in quit rates between "specialist" and "community" stop-smoking practitioners in the english stop-smoking services.

Science.gov (United States)

McDermott, Máirtín S; Beard, Emma; Brose, Leonie S; West, Robert; McEwen, Andy

2013-07-01

Behavioral support improves smokers' chances of quitting, but quit rates are typically lower for smokers supported by "community practitioners" for whom smoking cessation is a small part of their job than for those supported by "specialist practitioners" for whom it is the main role. This article examined the factors that might contribute to this. A total of 573 specialist practitioners and 466 community practitioners completed a 42-item online survey that covered demographic and employment information, current practices, levels of training, and 4-week CO-verified quit rates. Responses were compared for community and specialist practitioners. Mediation analysis was undertaken to assess how far "structural" and "modifiable" variables account for the difference in quit rates. Specialist practitioners reported higher 4-week CO-verified quit rates than community practitioners (63.6% versus 50.4%, p Specialist" practitioners in the English stop-smoking services report higher success rates than "community" practitioners and this is at least in part attributable to more extensive training and supervision and greater adherence to evidence-based practice including advising on medication usage and promoting abrupt rather than gradual quitting.

Telemedicine in the acute health setting: A disruptive innovation for specialists (an example from stroke).

Science.gov (United States)

Bagot, Kathleen L; Cadilhac, Dominique A; Vu, Michelle; Moss, Karen; Bladin, Christopher F

2015-12-01

Telemedicine is a disruptive innovation within health care settings as consultations take place via audio-visual technology rather than traditional face-to-face. Specialist perceptions and experiences of providing audio-visual consultations in emergency situations, however, are not well understood. The aim of this exploratory study was to describe the experience of medical specialists providing acute stroke decision-making support via telemedicine. Data from the Victorian Stroke Telemedicine (VST) programme were used. The experiences of specialists providing an acute clinical telemedicine service to rural emergency departments were explored, drawing on disruptive innovation theory. Document analysis of programme consultation records, meeting minutes and in-depth individual interviews with three neurologists were analysed using triangulation. Since February 2014, 269 stroke telemedicine consultations with 12 neurologists have occurred. Retention on the roster has varied between 1 and >4 years. Overall, neurologists reported benefits of participation, as they were addressing health equity gaps for rural patients. Negative effects were the unpredictability of consultations impacting on their personal life, the mixed level of experience of colleagues initiating the consult and not knowing patient outcomes since follow-up communication was not routine. Insights into workforce experience and satisfaction were identified to inform strategies to support specialists to adapt to the disruptive innovation of telemedicine. © The Author(s) 2015.

INTERPERSONAL COMMUNICATION IN MEDICAL UNITS

Directory of Open Access Journals (Sweden)

Irina Ionela ROTARIU

2015-12-01

Full Text Available Over the last few years there has been noticed an increase of the general interest in proper communication between medical specialists, on one hand, and the patients and their families, on the other. The benefits of properly performed communication certainly lead to an increase of public confidence in the medical system and therefore to the patients' improved satisfaction and contentment.

What they think of us: A study of teaching medical specialists’ attitude towards psychiatry in India

Science.gov (United States)

Patra, Suravi; Patro, Binod Kumar

2017-01-01

Context: Attitudes of teaching medical specialists are important in shaping medical students’ attitudes toward psychiatry. Data on attitudes of teaching medical specialists of India toward psychiatry are limited. Aims: The aim was to study the attitude of teaching medical specialists of an academic medical center in East India toward psychiatry. Settings and Design: This was a cross-sectional descriptive study. Materials and Methods: We administered attitude toward psychiatry-30 (ATP 30) scale to teaching medical specialists of the All India Institute of Medical Sciences, Bhubaneswar, based on convenience sampling. Of 104 specialists contacted, 88 returned the completed questionnaire. Statistical Analysis: We carried out descriptive statistical analysis and expressed results in mean and standard deviation. We analyzed the association of demographic characteristics, specialization, and duration of professional experience with total ATP scores using Chi-square test. We used subgroup analysis to compare mean ATP scores in different demographic and professional groups. We used independent t-test and ANOVA for between group comparisons. Results: The response rate was 84.62% with a mean ATP score of 88.60. Female gender and having a family member with mental illness was significantly associated with favorable ATP. Notable findings were that 97% of participants were favorable toward patients with psychiatric illness, 90% felt psychiatric interventions as effective whereas 87% found psychiatry unappealing and 52% said that they would not have liked to be a psychiatrist. Conclusions: While favorable attitudes toward patients with psychiatric illness and psychiatric interventions may mean better patient care; unfavorable attitudes toward psychiatry as a career choice may adversely affect postgraduate recruitment rates. PMID:28529368

Are peer specialists happy on the job?

Science.gov (United States)

Jenkins, Sarah; Chenneville, Tiffany; Salnaitis, Christina

2018-03-01

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).

Russian family physicians try to develop an identity in specialist-oriented country.

OpenAIRE

Stewart, J

1995-01-01

Russia is in the process of reforming its medical system to place more emphasis on family medicine. Currently, most of the emphasis is on specialization and family doctors are considered little more than referral agents to specialists. Last fall, three Russian doctors with an interest in family medicine attended a conference in Winnipeg. Although they hope to learn from Canadian colleagues, they also think that Canada might be able to learn from Russian experience in the health-promotion field.

The role of the internal medicine specialist in the management of infective complications in general surgical wards

Directory of Open Access Journals (Sweden)

Patrizia Zoboli

2013-05-01

Full Text Available BACKGROUND Internal medicine specialists are often asked to evaluate a patient before surgery. Perioperative risk evaluation for elderly patients is important, because complications increase with age. The increasing age of the general population increases the probabilities of surgery in the older patients. The manifestation of a surgical problem, is more likely to be severe and complicated in the elderly patients. In fact, emergency surgery treatment occurs more frequently in the elderly (e.g., it is much more common to see intestinal obstruction complicating colorectal cancer in the elderly compared with a younger population. Old age is an independent factor for long hospital stay after surgery. The role of the preoperative medical consultant is to identify and evaluate a patient’s current medical status and provide a clinical risk profile, in order to decide whether further tests are indicated prior to surgery, and to optimise the patient’s medical condition in the attempt of reducing the risk of complications. The medical consultant must know which medical condition could eventually influence the surgery, achieve a good contact and communication between the medical and surgical team, in order to obtain the best management planning. AIM OF THE STUDY This paper focuses on the rational use of antibiotic prophylaxis and on the treatment of the complications of post-surgery infections (e.g., pulmonary complication, peritonitis, intra-abdominal infection. Specific aspects of pre-operative risk evaluation and peri and post-operative management are discussed. CONCLUSIONS The internal medicin specialist in collaboration with the surgical team is necessary in the peri and post-surgery management.

Effect of Early Referral to Specialist in Dementia on Institutionalization and Functional Decline: Findings from a Population-Based Study.

Science.gov (United States)

Pimouguet, Clément; Le-Goff, Mélanie; Rizzuto, Debora; Berr, Claudine; Leffondré, Karen; Pérès, Karine; Dartigues, Jean FranÇois; Helmer, Catherine

2016-01-01

Although early diagnosis has been hypothesized to benefit both patients and caregivers, until now studies evaluating the effect of early dementia diagnosis are lacking. To investigate the influence of early specialist referral for dementia on the risk of institutionalization and functional decline in Activity of Daily Living (ADL). Incident dementia cases were screened in a prospective population-based cohort, the Three-City Study, and initial specialist consultation for cognitive complaint was assessed at dementia diagnosis. Proportional hazard regression and illness-death models were used to test the association between specialist referral and, respectively, institutionalization and functional decline. Only one third of the incident individuals with dementia had consulted a specialist for cognitive problems early (36%). After adjustment on potential confounders (including cognitive and functional decline) and competing risk of death, participants who had consulted a specialist early in the disease course presented a higher rate of being institutionalized than those who did not (Hazard Ratio = 2.00, 95% Confidence Interval (CI): 1.09- 3.64). But early specialist referral was not associated with further functional decline (HR = 1.09, 95% CI: 0.71- 1.67). Early specialist referral in dementia is associated with increased risk of institutionalization but not with functional decline in ADL. These findings suggest that early care referral in dementia may be a marker of concern for patients and/or caregivers; subsequent medical and social care could be suboptimal or inappropriate to allow patients to stay longer at home.

The understanding of plastic and reconstructive surgery amongst Queensland medical students

Directory of Open Access Journals (Sweden)

Christopher Conyard

2016-06-01

This study has highlighted the gap between a medical student's perception and reality of the scope of Plastic and Reconstructive Surgery. It has emphasised the need for greater exposure and education in this surgical subspeciality if future medical practitioners are to better match the requirements of their patients to the skills of the specialist. If plastic surgeons wish to continue to be recognised as specialists in hand, craniofacial and reconstructive surgery, this gap between perception and reality needs to be addressed.

Setting the standard: Medical Education's first 50 years.

Science.gov (United States)

Rangel, Jaime C; Cartmill, Carrie; Kuper, Ayelet; Martimianakis, Maria A; Whitehead, Cynthia R

2016-01-01

By understanding its history, the medical education community gains insight into why it thinks and acts as it does. This piece provides a Foucauldian archaeological critical discourse analysis (CDA) of the journal Medical Education on the publication of its 50th Volume. This analysis draws upon critical social science perspectives to allow the examination of unstated assumptions that underpin and shape educational tools and practices. A Foucauldian form of CDA was utilised to examine the journal over its first half-century. This approach emphasises the importance of language, and the ways in which words used affect and are affected by educational practices and priorities. An iterative methodology was used to organise the very large dataset (12,000 articles). A distilled dataset, within which particular focus was placed on the editorial pieces in the journal, was analysed. A major finding was the diversity of the journal as a site that has permitted multiple - and sometimes contradictory - discursive trends to emerge. One particularly dominant discursive tension across the time span of the journal is that between a persistent drive for standardisation and a continued questioning of the desirability of standardisation. This tension was traced across three prominent areas of focus in the journal: objectivity and the nature of medical education knowledge; universality and local contexts, and the place of medical education between academia and the community. The journal has provided the medical education community with a place in which to both discuss practical pedagogical concerns and ponder conceptual and social issues affecting the medical education community. This dual nature of the journal brings together educators and researchers; it also gives particular focus to a major and rarely cited tension in medical education between the quest for objective standards and the limitations of standard measures. © 2015 John Wiley & Sons Ltd.

Establishing advanced practice for medical imaging in New Zealand

International Nuclear Information System (INIS)

Yielder, Jill; Young, Adrienne; Park, Shelley; Coleman, Karen

2014-01-01

Introduction: This article presents the outcome and recommendations following the second stage of a role development project conducted on behalf of the New Zealand Institute of Medical Radiation Technology (NZIMRT). The study sought to support the development of profiles and criteria that may be used to formulate Advanced Scopes of Practice for the profession. It commenced in 2011, following on from initial research that occurred between 2005 and 2008 investigating role development and a possible career structure for medical radiation technologists (MRTs) in New Zealand (NZ). Methods: The study sought to support the development of profiles and criteria that could be used to develop Advanced Scopes of Practice for the profession through inviting 12 specialist medical imaging groups in NZ to participate in a survey. Results: Findings showed strong agreement on potential profiles and on generic criteria within them; however, there was less agreement on specific skills criteria within specialist areas. Conclusions: The authors recommend that one Advanced Scope of Practice be developed for Medical Imaging, with the establishment of generic and specialist criteria. Systems for approval of the overall criteria package for any individual Advanced Practitioner (AP) profile, audit and continuing professional development requirements need to be established by the Medical Radiation Technologists Board (MRTB) to meet the local needs of clinical departments. It is further recommended that the NZIMRT and MRTB promote and support the need for an AP pathway for medical imaging in NZ

Establishing advanced practice for medical imaging in New Zealand

Energy Technology Data Exchange (ETDEWEB)

Yielder, Jill, E-mail: j.yielder@auckland.ac.nz [University of Auckland, Auckland (New Zealand); Young, Adrienne; Park, Shelley; Coleman, Karen [University of Otago, Wellington (New Zealand); University of Auckland, Auckland (New Zealand)

2014-02-15

Introduction: This article presents the outcome and recommendations following the second stage of a role development project conducted on behalf of the New Zealand Institute of Medical Radiation Technology (NZIMRT). The study sought to support the development of profiles and criteria that may be used to formulate Advanced Scopes of Practice for the profession. It commenced in 2011, following on from initial research that occurred between 2005 and 2008 investigating role development and a possible career structure for medical radiation technologists (MRTs) in New Zealand (NZ). Methods: The study sought to support the development of profiles and criteria that could be used to develop Advanced Scopes of Practice for the profession through inviting 12 specialist medical imaging groups in NZ to participate in a survey. Results: Findings showed strong agreement on potential profiles and on generic criteria within them; however, there was less agreement on specific skills criteria within specialist areas. Conclusions: The authors recommend that one Advanced Scope of Practice be developed for Medical Imaging, with the establishment of generic and specialist criteria. Systems for approval of the overall criteria package for any individual Advanced Practitioner (AP) profile, audit and continuing professional development requirements need to be established by the Medical Radiation Technologists Board (MRTB) to meet the local needs of clinical departments. It is further recommended that the NZIMRT and MRTB promote and support the need for an AP pathway for medical imaging in NZ.

Standardising the Chinese Language in Singapore: Issues of Policy and Practice

Science.gov (United States)

Shang, Guowen; Zhao, Shouhui

2017-01-01

The selection of standards and norms constitutes the first and most important step for language standardisation. In this paper, we examine the standard establishment for Huayu (or Singapore Mandarin), a new Chinese variety that has emerged in Singapore as a result of centralised planning and inter-linguistic contact. Huayu is the officially…

Communication in Medical Education: The Future for Specialist Services.

Science.gov (United States)

Morton, Richard

1995-01-01

Contends that a willingness to harness new technology effectively to the communication needs of the medical community will mean that the skills of the biomedical communicator could become more valued than ever before. Discusses professionalism, changing needs, new expertise, and new technologies such as the Internet and virtual reality. (MKR)

Neutron Activation Analysis with k0 standardisation

International Nuclear Information System (INIS)

Pomme, S.

1998-01-01

The objectives of the research are: (1) to develop and implement the k0 standardisation method for neutron activation analysis in close collaboration with scientific partners; (2) to exploit fully the inherent qualities of NAA such as accuracy, traceability, and multi-element offer complete services in health-physics measurements according to international quality standards, (2) to improve continuously these measurement techniques and to follow up international recommendations and legislation concerning the surveillance of workers; (3) to support and advise nuclear and non-nuclear industry on problems of radioactive contamination. Achievements in 1997 related to gamma spectrometry, whole-body counting, beta and alpha spectrometry, dosimetry, radon measurements, calibration, instrumentation, and neutron activation analysis are described

Medical service use in children with cerebral palsy: The role of child and family factors characteristics.

Science.gov (United States)

Meehan, Elaine M; Reid, Susan M; Williams, Katrina J; Freed, Gary L; Sewell, Jillian R; Reddihough, Dinah S

2016-06-01

The aim of the study was to investigate the patterns of medical service use in children with cerebral palsy (CP), taking into account child and family characteristics. Nine hundred and one parents and carers of children registered with the Victorian CP Register were invited to complete a survey. Participants were asked about their child's appointments with general practitioners and public and private paediatric medical specialists over the preceding 12 months. Information on family characteristics and finances was also collected. Data on CP severity and complexity were extracted from the CP Register. Three hundred and fifty parents and carers (39%) participated. Of these, 83% reported that their child had ≥1 appointment with a general practitioner over the preceding 12 months, while 84% had ≥1 appointment with a public or private paediatric medical specialist. Overall, 58% of children saw 2-5 different paediatric medical specialists, while 9% had appointments with ≥6 clinicians. Children with severe and complex CP were more likely to have had ≥1 appointment with a publically funded paediatric medical specialist and had seen a greater number of different clinicians over the study period. Family characteristics were not associated with service use. Children with CP are managed by a number of paediatric medical specialists, and they continue to see a range of specialists throughout adolescence. In Victoria, differences in service use are not based on family characteristics; instead the highest service users are those with severe and complex CP. For this group, care co-ordination and information sharing between treating clinicians are important, if gaps in care are to be avoided. © 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Development, standardisation and validation of ELISA methods to improve the control of trypanosomosis

International Nuclear Information System (INIS)

Rebeski, D.E.; Winger, E.M.; Robinson, M.M.; Dwinger, R.H.; Crowther, J.R.

2000-01-01

During the period from 1995 to 2000, comprehensive laboratory and field studies on enzyme-linked immunosorbent assay (ELISA) methods for detection of trypanosomal antibodies and antigens were undertaken to improve the proficiency of diagnostic laboratories involved in control of trypanosomosis in the tropics. The work was initiated by the FAO/IAEA through the Coordinated Research Programme D3.20.13 and undertaken in close collaboration with Research Agreement Holders and Research Contract Holders. Initially, the CRP facilitated the field evaluation of three direct sandwich antigen detection ELISAs based on monoclonal antibodies. Diagnostic laboratories were supported with ELISA equipment, disposables, and training. ELISA reagents were produced in sufficient quantities and distributed in a standardised kit format. As a result of the laboratory and field evaluation studies, the assays were found unreliable for trypanosomosis control and rejected for routine use in diagnostic laboratories. At that time, no standardised ELISA system was available for trypanosomosis that was considered suitable for distribution and use under tropical conditions. Through the CRP, a new generation of standardised antibody ELISAs were developed and established using a novel approach, namely the use of antigen-precoated ELISA plates. In addition, the potential of native and denatured trypanosomal antigens as diagnostic candidates was examined. In-house and field evaluation studies in the tropics demonstrated that a reasonable robustness with an acceptable diagnostic assay proficiency was achieved by means of utilising plates precoated with denatured antigens. Moreover, a data charting method for continuous monitoring of the operational performance of the ELISAs was developed and established. It was routinely used as remote control and follow up tool saving the need for costly expert missions to the diagnostic laboratories during the assay validation period. In parallel, preliminary studies

Oferta y demanda de médicos especialistas en los establecimientos de salud del Ministerio de Salud: brechas a nivel nacional, por regiones y tipo de especialidad Supply and demand of medical specialists in the health facilities of the Ministry of Health: national, regional and by type of specialty gaps

Directory of Open Access Journals (Sweden)

Leslie Zevallos

2011-06-01

medical specialists in facilities of the Ministry of Health of Peru (MINSA at the national, regional and specialty type levels. Materials and methods. Observational, descriptive study through which we calculated the supply of medical specialists using secondary sources of MINSA. The analysis of the demand for medical specialists was based on two methodologies: the need for specialists according to the guidelines of classification of the health facilities and according to the epidemiological and demographic profile. The arithmetic difference between the estimated demand and the supply was the procedure used to calculate the gap of medical specialists. Results. The Ministry of Health has a total supply at the national level of 6,074 medical specialists of which 61.5% belong to the clinical specialties, 33.2% to the surgical specialties, 4.9% specialities related to aid to diagnosis and treatment and 0.4% to public health specialties. According to the categorization guideline there is a total demand of 11,176 medical specialists and according to the epidemiological and demographic profile of 11,738. The national estimated gaps found are similar in both methods, although they differ widely across regions and by type of specialty. At the regional level, the gaps are greater in Loreto, Piura, Puno and Madre de Dios when estimating the defficit in relation to the supply. Regarding the speciality, the gap is greater in the four basic specialties: gynecology and obstetrics, pediatrics, internal medicine and general surgery. Conclusions. There is a waid gap between supply and demand of medical specialists at the national and regional levels, as a whole representing approximately 45% of the current offer, regardless of the estimation method.

Radiation oncology training in France: demography, analysis of motivations of the young specialists, evaluation of the training

International Nuclear Information System (INIS)

Kantor, G.; Kantor, G.; Gerard, G.P.; Kantor, G.; Bey, P.; Huguet, F.; Toledano, A.; Lafond, C.; Quero, L.; Servagi, S.

2005-01-01

During the 5 past national courses organised by the French society of radiation oncology (SFRO), three different types of survey were performed to analyse demography, motivations and quality of training of the young specialists. During the 5 past years, 50 radiation oncologists were training for the whole country (about 15 per year were graduated). A recent increase the number of young specialists is observed with a total number of 50 in 2000 to 75 in 2005. Nevertheless, the number of young specialists is dramatically insufficient and exposes for the future to an important demographic crisis. Analysis of motivations of choice for radiation oncology confirms the influence of a practical stage of oncology during the second cycle of the medical studies for 60% of the young specialists. Analysis of practical and theoretical training was performed according to the point of view and living experiences of the students. On the other hand, informations from teachers were less complete. Some needs are emphasised as: 1) the quality of the follow during the training (importance of the recent implementation of a logbook); 2) importance of theoretical and practical training at the radiotherapy department: 3) help and incentive for research and scientific publication. (author)

An analysis of the medical specialty training system in Spain.

Science.gov (United States)

Freire, José-Manuel; Infante, Alberto; de Aguiar, Adriana Cavalcanti; Carbajo, Pilar

2015-06-02

In this paper, we analyse the medical specialty training system in Spain (the so-called "residency system"). In order to do so, we a) summarize its historical evolution; b) describe the five major architectural pillars on which the system is currently based; c) analyse the special contract of the specialist-in-training; d) discuss the three major challenges for the medical specialist training future: the evolution and expansion of the residency system to other health professions, the issue of grouping specialties with a common core trunk and the continuity of the learning process; and e) draw four conclusions that may be relevant for those who are in the process of developing or revising their own medical specialization systems.

Ophthalmic requirements and considerations for the en route air traffic control specialist : an ergonomic analysis of the visual work environment.

Science.gov (United States)

1996-04-01

The Federal Air Surgeon requested continued investigation of visual disorders and vision corrective devices as to their relevance to the medical certification of airmen and controllers. The en route Air Traffic Control Specialist (ATCS) works with a ...

Preparing Elementary Mathematics-Science Teaching Specialists.

Science.gov (United States)

Miller, L. Diane

1992-01-01

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…

Managing patients with heart failure: a qualitative study of multidisciplinary teams with specialist heart failure nurses.

Science.gov (United States)

Glogowska, Margaret; Simmonds, Rosemary; McLachlan, Sarah; Cramer, Helen; Sanders, Tom; Johnson, Rachel; Kadam, Umesh T; Lasserson, Daniel S; Purdy, Sarah

2015-09-01

The purpose of this study was to explore the perceptions and experiences of health care clinicians working in multidisciplinary teams that include specialist heart failure nurses when caring for the management of heart failure patients. We used a qualitative in-depth interview study nested in a broader ethnographic study of unplanned admissions in heart failure patients (HoldFAST). We interviewed 24 clinicians across primary, secondary, and community care in 3 locations in the Midlands, South Central, and South West of England. Within a framework of the role and contribution of the heart failure specialist nurse, our study identified 2 thematic areas that the clinicians agreed still represent particular challenges when working with heart failure patients. The first was communication with patients, in particular explaining the diagnosis and helping patients to understand the condition. The participants recognized that such communication was most effective when they had a long-term relationship with patients and families and that the specialist nurse played an important part in achieving this relationship. The second was communication within the team. Multidisciplinary input was especially needed because of the complexity of many patients and issues around medications, and the participants believed the specialist nurse may facilitate team communication. The study highlights the role of specialist heart failure nurses in delivering education tailored to patients and facilitating better liaison among all clinicians, particularly when dealing with the management of comorbidities and drug regimens. The way in which specialist nurses were able to be caseworkers for their patients was perceived as a method of ensuring coordination and continuity of care. © 2015 Annals of Family Medicine, Inc.

Radiation Exposure from Medical Exams and Procedures

Science.gov (United States)

Fact Sheet Adopted: January 2010 Health Physics Society Specialists in Radiation Safety Radiation Exposure from Medical Exams and Procedures Ionizing radiation is used daily in hospitals and clinics ...

Analysis of the logic and framing of a tobacco industry campaign opposing standardised packaging legislation in New Zealand.

Science.gov (United States)

Waa, Andrew Morehu; Hoek, Janet; Edwards, Richard; Maclaurin, James

2017-11-01

The tobacco industry routinely opposes tobacco control policies, often using a standard repertoire of arguments. Following proposals to introduce standardised packaging in New Zealand (NZ), British American Tobacco New Zealand (BATNZ) launched the 'Agree-Disagree' mass media campaign, which coincided with the NZ government's standardised packaging consultations. This study examined the logic of the arguments presented and rhetorical strategies employed in the campaign. We analysed each advertisement to identify key messages, arguments and rhetorical devices, then examined the arguments' structure and assessed their logical soundness and validity. All advertisements attempted to frame BATNZ as reasonable, and each contained flawed arguments that were either unsound or based on logical fallacies. Flawed arguments included misrepresenting the intent of the proposed legislation (straw man), claiming standardised packaging would harm all NZ brands (false dilemma), warning NZ not to adopt standardised packaging because of its Australian origins (an unsound argument) or using vague premises as a basis for claiming negative outcomes (equivocation). BATNZ's Agree-Disagree campaign relied on unsound arguments, logical fallacies and rhetorical devices. Given the industry's frequent recourse to these tactics, we propose strategies based on our study findings that can be used to assist the tobacco control community to counter industry opposition to standardised packaging. Greater recognition of logical fallacies and rhetorical devices employed by the tobacco industry will help maintain focus on the health benefits proposed policies will deliver. 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/.

Medication errors in home care: a qualitative focus group study.

Science.gov (United States)

Berland, Astrid; Bentsen, Signe Berit

2017-11-01

To explore registered nurses' experiences of medication errors and patient safety in home care. The focus of care for older patients has shifted from institutional care towards a model of home care. Medication errors are common in this situation and can result in patient morbidity and mortality. An exploratory qualitative design with focus group interviews was used. Four focus group interviews were conducted with 20 registered nurses in home care. The data were analysed using content analysis. Five categories were identified as follows: lack of information, lack of competence, reporting medication errors, trade name products vs. generic name products, and improving routines. Medication errors occur frequently in home care and can threaten the safety of patients. Insufficient exchange of information and poor communication between the specialist and home-care health services, and between general practitioners and healthcare workers can lead to medication errors. A lack of competence in healthcare workers can also lead to medication errors. To prevent these, it is important that there should be up-to-date information and communication between healthcare workers during the transfer of patients from specialist to home care. Ensuring competence among healthcare workers with regard to medication is also important. In addition, there should be openness and accurate reporting of medication errors, as well as in setting routines for the preparation, alteration and administration of medicines. To prevent medication errors in home care, up-to-date information and communication between healthcare workers is important when patients are transferred from specialist to home care. It is also important to ensure adequate competence with regard to medication, and that there should be openness when medication errors occur, as well as in setting routines for the preparation, alteration and administration of medications. © 2017 John Wiley & Sons Ltd.

Inter-observer agreement of canine and feline paroxysmal event semiology and classification by veterinary neurology specialists and non-specialists

DEFF Research Database (Denmark)

Packer, Rowena M A; Berendt, Mette; Bhatti, Sofie

2015-01-01

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...

The Surgical Nosology In Primary-care Settings (SNIPS): a simple bridging classification for the interface between primary and specialist care

Science.gov (United States)

Gruen, Russell L; Knox, Stephanie; Britt, Helena; Bailie, Ross S

2004-01-01

Background The interface between primary care and specialist medical services is an important domain for health services research and policy. Of particular concern is optimising specialist services and the organisation of the specialist workforce to meet the needs and demands for specialist care, particularly those generated by referral from primary care. However, differences in the disease classification and reporting of the work of primary and specialist surgical sectors hamper such research. This paper describes the development of a bridging classification for use in the study of potential surgical problems in primary care settings, and for classifying referrals to surgical specialties. Methods A three stage process was undertaken, which involved: (1) defining the categories of surgical disorders from a specialist perspective that were relevant to the specialist-primary care interface; (2) classifying the 'terms' in the International Classification of Primary Care Version 2-Plus (ICPC-2 Plus) to the surgical categories; and (3) using referral data from 303,000 patient encounters in the BEACH study of general practice activity in Australia to define a core set of surgical conditions. Inclusion of terms was based on the probability of specialist referral of patients with such problems, and specialists' perception that they constitute part of normal surgical practice. Results A four-level hierarchy was developed, containing 8, 27 and 79 categories in the first, second and third levels, respectively. These categories classified 2050 ICPC-2 Plus terms that constituted the fourth level, and which covered the spectrum of problems that were managed in primary care and referred to surgical specialists. Conclusion Our method of classifying terms from a primary care classification system to categories delineated by specialists should be applicable to research addressing the interface between primary and specialist care. By describing the process and putting the bridging

Compliance to medication among hypertensive patients in Murtala ...

African Journals Online (AJOL)

Compliance to medication among hypertensive patients in Murtala Mohammed Specialist Hospital, Kano, Nigeria. M Kabir, Z Iliyasu, LS Abubakar, M Jibril. Abstract. Background: Non-compliance to blood pressure-lowering medication is a major reason for poor control of hypertension worldwide. We assessed the level of ...

Which journals do primary care physicians and specialists access from an online service?

Science.gov (United States)

McKibbon, K Ann; Haynes, R Brian; McKinlay, R James; Lokker, Cynthia

2007-07-01

The study sought to determine which online journals primary care physicians and specialists not affiliated with an academic medical center access and how the accesses correlate with measures of journal quality and importance. Observational study of full-text accesses made during an eighteen-month digital library trial was performed. Access counts were correlated with six methods composed of nine measures for assessing journal importance: ISI impact factors; number of high-quality articles identified during hand-searches of key clinical journals; production data for ACP Journal Club, InfoPOEMs, and Evidence-Based Medicine; and mean clinician-provided clinical relevance and newsworthiness scores for individual journal titles. Full-text journals were accessed 2,322 times by 87 of 105 physicians. Participants accessed 136 of 348 available journal titles. Physicians often selected journals with relatively higher numbers of articles abstracted in ACP Journal Club. Accesses also showed significant correlations with 6 other measures of quality. Specialists' access patterns correlated with 3 measures, with weaker correlations than for primary care physicians. Primary care physicians, more so than specialists, chose full-text articles from clinical journals deemed important by several measures of value. Most journals accessed by both groups were of high quality as measured by this study's methods for assessing journal importance.

New handbook for standardised measurement of plant functional traits worldwide

OpenAIRE

Pérez-Harguindeguy N Díaz S Garnier E Lavorel S Poorter H Jaureguiberry P Bret-Harte MS Cor

2013-01-01

Plant functional traits are the features (morphological physiological phenological) that represent ecological strategies and determine how plants respond to environmental factors affect other trophic levels and influence ecosystem properties. Variation in plant functional traits and trait syndromes has proven useful for tackling many important ecological questions at a range of scales giving rise to a demand for standardised ways to measure ecologically meaningful plant traits. This line of r...

[Approaches to development and implementation of the medical information system for military-medical commission of the multidisciplinary military-medical organisation].

Science.gov (United States)

Kuvshinov, K E; Klipak, V M; Chaplyuk, A L; Moskovko, V M; Belyshev, D V; Zherebko, O A

2015-06-01

The current task of the implementation of medical information systems in the military and medical organizations is an automation of the military-medical expertise as one of the most important activities. In this regard, noteworthy experience of the 9th Medical Diagnostic Centre (9th MDC), where on the basis of medical information system "Interi PROMIS" for the first time was implemented the automation of the work of military medical commission. The given paper presents an algorithm for constructing of the information system for the military-medical examination; detailed description of its elements is given. According to military servicemen the implementation of the Military Medical Commission (MMC) subsystem of the medical information system implemented into the 9th MDC has reduced the time required for the MMC and paperwork, greatly facilitate the work of physicians and medical specialists on military servicemen examination. This software can be widely applied in ambulatory and hospital practice, especially in case of mass military-medical examinations.

The Political Economy of E-Learning Educational Development Strategies, Standardisation and Scalability

Science.gov (United States)

Kenney, Jacqueline; Hermens, Antoine; Clarke, Thomas

2004-01-01

The development of e-learning by government through policy, funding allocations, research-based collaborative projects and alliances has increased recently in both developed and under-developed nations. The paper notes that government, industry and corporate users are increasingly focusing on standardisation issues and the scalability of…

Problematising the Standardisation of Leadership and Management Development in South African Schools

Science.gov (United States)

Williams, Clarence

2015-01-01

In 2007 the Department of Education introduced the standards-based Advanced Certificate in Education: School Management and Leadership. The standardisation of leadership and management development in South African schools has been uncritically accepted by most academics and professionals. The purpose of this article is to problematise the…

49 CFR 391.47 - Resolution of conflicts of medical evaluation.

Science.gov (United States)

2010-10-01

... 49 Transportation 5 2010-10-01 2010-10-01 false Resolution of conflicts of medical evaluation. 391... Qualifications and Examinations § 391.47 Resolution of conflicts of medical evaluation. (a) Applications... field in which the medical conflict arose. The specialist should be one agreed to by the motor carrier...

The study of practices in planed diagnostic medical exposure

International Nuclear Information System (INIS)

Popescu, Irina-Anca; Perju, Nicoleta Ana-Maria; Cobzeanu, Camelia

2011-01-01

The exposure of population to ionizing radiations in medical diagnostic purposes represents a planed exposure procedure, medically justified, having a direct impact on patient health state. A justification of exposure, with a result that can confirm a clinical diagnostic, implies further important steps in treatment decisions. Optimization in patients radiological protection is the result of observing the reference levels recommendations, which maintains a reasonable individual exposure to ionizing radiation in medical purpose. In this paper we investigated the justification of 4189 exposures of patients who underwent planed diagnostic medical investigation over 36 months in a radiological unit. The most frequent investigation concerned the spinal column in 38.3% of total exposures-mainly at lumbar level (63.0% and 24.1%, respectively of total number of exposures), followed by limb bones (20.6%) and thorax (26.9%). Justification of practices included: rheumatic pains in 45.8% of exposures followed by traumatic injuries (20.6%), pleural and pulmonary pathology (19.3%), malignant processes (12.3%), ear-nose-throat investigations (1.1%) and car accidents (0.9%). The females over 40 years old were the group with the highest number of medical exposures, with 54.5% of total practices. This study revealed that the number of medical exposures justification is almost equal with non-justified examinations, confirming a not so good correlation between clinical diagnostic and the required radiological investigation. The percentages of justified versus non-justified practices indicated by specialist physicians and general practitioners were slightly equal - 59.3% vs. 40.7%, 56.9% vs. 43.1%, respectively. The analysis of data concluded that either specialist/general physicians must evaluate more rigorously the patients and all clinical signs in order to reduce as reasonable as possible the non-justified medical exposures to ionizing radiations, and thus to avoid financial and

14 CFR 1214.306 - Payload specialist relationship with sponsoring institutions.

Science.gov (United States)

2010-01-01

... 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...

The need for PGY2-trained clinical pharmacy specialists.

Science.gov (United States)

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

2014-06-01

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.

Academic learning for specialist nurses: a grounded theory study.

Science.gov (United States)

Millberg, Lena German; Berg, Linda; Brämberg, Elisabeth Björk; Nordström, Gun; Ohlén, Joakim

2014-11-01

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.

Sailing a safe ship: improving patient safety by enhancing the leadership skills of new consultant specialist surgeons.

Science.gov (United States)

Shah, Peter; Cross, Vinette; Sii, Freda

2013-01-01

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

Semi-structured interview is a reliable and feasible tool for selection of doctors for general practice specialist training.

Science.gov (United States)

Isaksen, Jesper Hesselbjerg; Hertel, Niels Thomas; Kjær, Niels Kristian

2013-09-01

In order to optimise the selection process for admission to specialist training in family medicine, we developed a new design for structured applications and selection interviews. The design contains semi-structured interviews, which combine individualised elements from the applications with standardised behaviour-based questions. This paper describes the design of the tool, and offers reflections concerning its acceptability, reliability and feasibility. We used a combined quantitative and qualitative evaluation method. Ratings obtained by the applicants in two selection rounds were analysed for reliability and generalisability using the GENOVA programme. Applicants and assessors were randomly selected for individual semi-structured in-depth interviews. The qualitative data were analysed in accordance with the grounded theory method. Quantitative analysis yielded a high Cronbach's alpha of 0.97 for the first round and 0.90 for the second round, and a G coefficient of the first round of 0.74 and of the second round of 0.40. Qualitative analysis demonstrated high acceptability and fairness and it improved the assessors' judgment. Applicants reported concerns about loss of personality and some anxiety. The applicants' ability to reflect on their competences was important. The developed selection tool demonstrated an acceptable level of reliability, but only moderate generalisability. The users found that the tool provided a high degree of acceptability; it is a feasible and useful tool for -selection of doctors for specialist training if combined with work-based assessment. Studies on the benefits and drawbacks of this tool compared with other selection models are relevant. not relevant. not relevant.

Standardisation Versus Adaptation in Canton’s Luxury Fashion Industry

OpenAIRE

Li, Yang

2009-01-01

In view of the dynamic growth in the luxury market and the availability of luxury goods to a wider range of consumers than ever before, it is critically important for luxury researchers and marketers to understand why consumers buy luxury, what they believe luxury is and how their perception of luxury value impacts their buying behavior. In a global context, it is faced with a very important marketing decision: to standardise or to adapt its marketing mix? This study draws a wide range of lit...

Mission Specialist Scott Parazynski arrives late at KSC

Science.gov (United States)

1998-01-01

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.

The Predictability of Phytophagous Insect Communities: Host Specialists as Habitat Specialists

NARCIS (Netherlands)

Müller, J.; Stadler, J.; Jarzabek-Müller, A.; Hacker, H.; Braak, ter C.J.F.; Brandl, R.

2011-01-01

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

Pharmacy specialists' attitudes toward pharmaceutical service quality at community pharmacies.

Science.gov (United States)

Urbonas, Gvidas; Jakušovaitė, Irayda; Savickas, Arūnas

2010-01-01

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

Medication Administration Errors Involving Paediatric In-Patients in a ...

African Journals Online (AJOL)

Erah

In-Patients in a Hospital in Ethiopia. Yemisirach Feleke ... Purpose: To assess the type and frequency of medication administration errors (MAEs) in the paediatric ward of .... prescribers, does not go beyond obeying ... specialists, 43 general practitioners, 2 health officers ..... Medication Errors, International Council of Nurses.

Standardised (plain) cigarette packaging increases attention to both text-based and graphical health warnings: experimental evidence.

Science.gov (United States)

Shankleman, M; Sykes, C; Mandeville, K L; Di Costa, S; Yarrow, K

2015-01-01

To investigate whether standardised cigarette packaging increases the time spent looking at health warnings, regardless of the format of those warnings. A factorial (two pack styles x three warning types) within-subject experiment, with participants randomised to different orders of conditions, completed at a university in London, UK. Mock-ups of cigarette packets were presented to participants with their branded portion in either standardised (plain) or manufacturer-designed (branded) format. Health warnings were present on all packets, representing all three types currently in use in the UK: black & white text, colour text, or colour images with accompanying text. Gaze position was recorded using a specialised eye tracker, providing the main outcome measure, which was the mean proportion of a five-second viewing period spent gazing at the warning-label region of the packet. An opportunity sample of 30 (six male, mean age = 23) young adults met the following inclusion criteria: 1) not currently a smoker; 2) 50% viewing time. These participants spent a greater proportion of the available time gazing at the warning-label region when the branded section of the pack was standardised (following current Australian guidelines) rather than containing the manufacturer's preferred design (mean difference in proportions = 0.078, 95% confidence interval 0.049 to 0.106, p interaction p = 0.295). During incidental viewing of cigarette packets, young adult never-smokers are likely to spend more time looking at health warnings if manufacturers are compelled to use standardised packaging, regardless of the warning design. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Adult patients' experiences of NHS specialist services for chronic fatigue syndrome (CFS/ME): a qualitative study in England.

Science.gov (United States)

Broughton, Jessica; Harris, Sarah; Beasant, Lucy; Crawley, Esther; Collin, Simon M

2017-06-02

Few studies have explored patients' experiences of treatment for CFS/ME. This study aims to fill this gap by capturing the perspective of patients who have been treated by NHS specialist CFS/ME services in England. Semi-structured interviews were conducted during the period June-September 2014 with 16 adults who were completing treatment at one of three outpatient NHS specialist CFS/ME services. Interviews were analysed thematically using constant comparison techniques, with particular attention paid to contrasting views. Three themes were identified: 'Journey to specialist services'; 'Things that help or hinder treatment'; and 'Support systems'. Within these themes nine sub-themes were identified. A wide range of factors was evident in forming participants' experiences, including personal characteristics such as perseverance and optimism, and service factors such as flexibility and positive, supportive relationships with clinicians. Participants described how specialist services played a unique role, which was related to the contested nature of the condition. Many participants had experienced a lack of validation and medical and social support before attending a specialist service. Patients' experiences of life before referral, and the concerns that they expressed about being discharged, highlighted the hardship and obstacles which people living with CFS/ME continue to experience in our society. The experiences of CFS/ME patients in our study showed that NHS specialist CFS/ME services played a vital role in patients' journeys towards an improved quality of life. This improvement came about through a process which included validation of patients' experiences, acceptance of change, practical advice and support, and therapeutic outcomes.

Acanthamoeba Keratitis at the King Khaled Eye Specialist Hospital

International Nuclear Information System (INIS)

Al-Mezaine, H.; Al-Muteb, M.; Al-Motowa, S.; Wagoner, M. D.

2005-01-01

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)

Is Consumer Response to Plain/Standardised Tobacco Packaging Consistent with Framework Convention on Tobacco Control Guidelines? A Systematic Review of Quantitative Studies

Science.gov (United States)

Stead, Martine; Moodie, Crawford; Angus, Kathryn; Bauld, Linda; McNeill, Ann; Thomas, James; Hastings, Gerard; Hinds, Kate; O'Mara-Eves, Alison; Kwan, Irene; Purves, Richard I.; Bryce, Stuart L.

2013-01-01

Background and Objectives Standardised or ‘plain’ tobacco packaging was introduced in Australia in December 2012 and is currently being considered in other countries. The primary objective of this systematic review was to locate, assess and synthesise published and grey literature relating to the potential impacts of standardised tobacco packaging as proposed by the guidelines for the international Framework Convention on Tobacco Control: reduced appeal, increased salience and effectiveness of health warnings, and more accurate perceptions of product strength and harm. Methods Electronic databases were searched and researchers in the field were contacted to identify studies. Eligible studies were published or unpublished primary research of any design, issued since 1980 and concerning tobacco packaging. Twenty-five quantitative studies reported relevant outcomes and met the inclusion criteria. A narrative synthesis was conducted. Results Studies that explored the impact of package design on appeal consistently found that standardised packaging reduced the appeal of cigarettes and smoking, and was associated with perceived lower quality, poorer taste and less desirable smoker identities. Although findings were mixed, standardised packs tended to increase the salience and effectiveness of health warnings in terms of recall, attention, believability and seriousness, with effects being mediated by the warning size, type and position on pack. Pack colour was found to influence perceptions of product harm and strength, with darker coloured standardised packs generally perceived as containing stronger tasting and more harmful cigarettes than fully branded packs; lighter coloured standardised packs suggested weaker and less harmful cigarettes. Findings were largely consistent, irrespective of location and sample. Conclusions The evidence strongly suggests that standardised packaging will reduce the appeal of packaging and of smoking in general; that it will go some way

Is consumer response to plain/standardised tobacco packaging consistent with framework convention on tobacco control guidelines? A systematic review of quantitative studies.

Science.gov (United States)

Stead, Martine; Moodie, Crawford; Angus, Kathryn; Bauld, Linda; McNeill, Ann; Thomas, James; Hastings, Gerard; Hinds, Kate; O'Mara-Eves, Alison; Kwan, Irene; Purves, Richard I; Bryce, Stuart L

2013-01-01

Standardised or 'plain' tobacco packaging was introduced in Australia in December 2012 and is currently being considered in other countries. The primary objective of this systematic review was to locate, assess and synthesise published and grey literature relating to the potential impacts of standardised tobacco packaging as proposed by the guidelines for the international Framework Convention on Tobacco Control: reduced appeal, increased salience and effectiveness of health warnings, and more accurate perceptions of product strength and harm. Electronic databases were searched and researchers in the field were contacted to identify studies. Eligible studies were published or unpublished primary research of any design, issued since 1980 and concerning tobacco packaging. Twenty-five quantitative studies reported relevant outcomes and met the inclusion criteria. A narrative synthesis was conducted. Studies that explored the impact of package design on appeal consistently found that standardised packaging reduced the appeal of cigarettes and smoking, and was associated with perceived lower quality, poorer taste and less desirable smoker identities. Although findings were mixed, standardised packs tended to increase the salience and effectiveness of health warnings in terms of recall, attention, believability and seriousness, with effects being mediated by the warning size, type and position on pack. Pack colour was found to influence perceptions of product harm and strength, with darker coloured standardised packs generally perceived as containing stronger tasting and more harmful cigarettes than fully branded packs; lighter coloured standardised packs suggested weaker and less harmful cigarettes. Findings were largely consistent, irrespective of location and sample. The evidence strongly suggests that standardised packaging will reduce the appeal of packaging and of smoking in general; that it will go some way to reduce consumer misperceptions regarding product harm

Is consumer response to plain/standardised tobacco packaging consistent with framework convention on tobacco control guidelines? A systematic review of quantitative studies.

Directory of Open Access Journals (Sweden)

Martine Stead

Full Text Available Standardised or 'plain' tobacco packaging was introduced in Australia in December 2012 and is currently being considered in other countries. The primary objective of this systematic review was to locate, assess and synthesise published and grey literature relating to the potential impacts of standardised tobacco packaging as proposed by the guidelines for the international Framework Convention on Tobacco Control: reduced appeal, increased salience and effectiveness of health warnings, and more accurate perceptions of product strength and harm.Electronic databases were searched and researchers in the field were contacted to identify studies. Eligible studies were published or unpublished primary research of any design, issued since 1980 and concerning tobacco packaging. Twenty-five quantitative studies reported relevant outcomes and met the inclusion criteria. A narrative synthesis was conducted.Studies that explored the impact of package design on appeal consistently found that standardised packaging reduced the appeal of cigarettes and smoking, and was associated with perceived lower quality, poorer taste and less desirable smoker identities. Although findings were mixed, standardised packs tended to increase the salience and effectiveness of health warnings in terms of recall, attention, believability and seriousness, with effects being mediated by the warning size, type and position on pack. Pack colour was found to influence perceptions of product harm and strength, with darker coloured standardised packs generally perceived as containing stronger tasting and more harmful cigarettes than fully branded packs; lighter coloured standardised packs suggested weaker and less harmful cigarettes. Findings were largely consistent, irrespective of location and sample.The evidence strongly suggests that standardised packaging will reduce the appeal of packaging and of smoking in general; that it will go some way to reduce consumer misperceptions

484 Allergen Standardisation in Allergens and Allergoids—Challenges and Considerations

Science.gov (United States)

Skinner, Murray; Bullimore, Alan; Hewings, Simon; Swan, Nicola

2012-01-01

Background The range of therapeutics and dosing schedules for allergen preparations and allergoids produced and used clinically are considerable. Standardisation of allergy immunotherapies is considered a positive step; however there are difficulties in identifying universal metrics for standardisation. Many advocate the use of major allergen content whilst others advocate total allergenicity. Additionally as a compounding argument, where major allergen is used, many disagree on what the major allergen is for certain species. Methods Major allergen content measurement allows a consistent recognised measure, and IgE responses of a serum pool are often dominated by IgE against major allergens. However issues such as specificity of different assays toward isoforms and other variants of single allergens often results in diverging allergen contents that can cause unexpected and misleading disparity. Other aspects that increase complication are the relevance to modified allergens, use of adjuvants and differing dosing regimes. Results The major allergen content of key products in different therapeutic formats has been measured. Conclusions This has been performed in conjunction with techniques such as total allergenicity, as allergy treatments and therapeutics require careful characterisation to allow supply of consistent, safe and efficacious products.

[History in the public communication of specialist scientific societies: history marketing].

Science.gov (United States)

Moll, F H; Halling, T; Rathert, P; Fangerau, H

2014-10-01

History is nowadays used as an economic factor. The past is therefore specifically targeted and cultivated, which for specialist scientific associations and societies often fullfils totally different functions in comparison to the open market, although the techniques and requirements are similar. Within medical specialties these facts are often still unknown. Museums and archives as well as the historians and curators working in them are very familiar with the special cultures of communication within these scientific communities and they play a major role in the establishment and development of history as a modern part of public relations and public identity.

Emergency Medical Service (EMS): Rotorcraft Technology Workshop

Science.gov (United States)

Bauchspies, J. S.; Adams, R. J.

1981-01-01

A lead organization on the national level should be designated to establish concepts, locations, and the number of shock trauma air medical services. Medical specialists desire a vehicle which incorporates advances in medical technology trends in health care. Key technology needs for the emergency medical services helicopter of the future include the riding quality of fixed wing aircraft (reduced noise and vibration), no tail rotor, small rotor, small rotor diameter, improved visibility, crashworthy vehicle, IFR capability, more affordability high reliability, fuel efficient, and specialized cabins to hold medical/diagnostic and communications equipment. Approaches to a national emergency medical service are discussed.

Adverse events following cervical manipulative therapy: consensus on classification among Dutch medical specialists, manual therapists, and patients.

Science.gov (United States)

Kranenburg, Hendrikus A; Lakke, Sandra E; Schmitt, Maarten A; Van der Schans, Cees P

2017-12-01

To obtain consensus-based agreement on a classification system of adverse events (AE) following cervical spinal manipulation. The classification system should be comprised of clear definitions, include patients' and clinicians' perspectives, and have an acceptable number of categories. Design : A three-round Delphi study. Participants : Thirty Dutch participants (medical specialists, manual therapists, and patients) participated in an online survey. Procedure : Participants inventoried AE and were asked about their preferences for either a three- or a four-category classification system. The identified AE were classified by two analysts following the International Classification of Functioning, Disability and Health (ICF), and the International Classification of Diseases and Related Health Problems (ICD-10). Participants were asked to classify the severity for all AE in relation to the time duration. Consensus occurred in a three-category classification system. There was strong consensus for 16 AE in all severities (no, minor, and major AE) and all three time durations [hours, days, weeks]. The 16 AE included anxiety, flushing, skin rash, fainting, dizziness, coma, altered sensation, muscle tenderness, pain, increased pain during movement, radiating pain, dislocation, fracture, transient ischemic attack, stroke, and death. Mild to strong consensus was reached for 13 AE. A consensus-based classification system of AE is established which includes patients' and clinicians' perspectives and has three categories. The classification comprises a precise description of potential AE in accordance with internationally accepted classifications. After international validation, clinicians and researchers may use this AE classification system to report AE in clinical practice and research.

Reporting Statistical Results in Medical Journals

Science.gov (United States)

Arifin, Wan Nor; Sarimah, Abdullah; Norsa’adah, Bachok; Najib Majdi, Yaacob; Siti-Azrin, Ab Hamid; Kamarul Imran, Musa; Aniza, Abd Aziz; Naing, Lin

2016-01-01

Statistical editors of the Malaysian Journal of Medical Sciences (MJMS) must go through many submitted manuscripts, focusing on the statistical aspect of the manuscripts. However, the editors notice myriad styles of reporting the statistical results, which are not standardised among the authors. This could be due to the lack of clear written instructions on reporting statistics in the guidelines for authors. The aim of this editorial is to briefly outline reporting methods for several important and common statistical results. It will also address a number of common mistakes made by the authors. The editorial will serve as a guideline for authors aiming to publish in the MJMS as well as in other medical journals. PMID:27904419

[Giving medico-legal opinions in cases with suspicion of medical mistake.part 1. between medicine and justice.

Science.gov (United States)

Chowaniec, Czesław; Chowaniec, Małgorzata; Wilk, Mateusz

2017-01-01

Creating medico-legal opinion is a sophisticated investigative, analytical, decision-making and creative process. Forensic medicine specialist in cooperation with clinical medicine consultants, on the basis of evidence analysis, which was gathered during procedures and contained in the acts has to create an objective and essential opinion. This opinion is a vital, very important and irreplaceable proof in every case. Judicial body consults with forensic medicine specialist or specialists if there are circumstances for settlement of which there is a need of classified informations - art. 193 of Penalty Code. Forensic medicine specialists face many difficulties which may have effect on quality, positiveness of opinion, compliance with the deadline, increasing expectancy of judicial body or sides. It is very difficult to find clinical specialists which except their clinical knowledge have basic knowledge about law, the role and duties of an court expert. In this article we discuss creating-opinion problems, role and position of court expert in confrontation with expectations of judicial body and the Justice with particular emphasis on medical mistakes and assessment of medical proceedings. We show the complexity of creating of medical opinions, especially these institutional.

Opportunity for Collaboration Between Radiation Injury Treatment Network Centers and Medical Toxicology Specialists.

Science.gov (United States)

Davlantes, Elizabeth; Shartar, Samuel; Venero, Jennifer; Steck, Alaina; Langston, Amelia; Kazzi, Ziad N

2017-08-01

The Radiation Injury Treatment Network (RITN) comprises >50 centers across the United States that are poised to care for victims of a radiation emergency. The network is organized around bone marrow transplant centers because these facilities excel in both radiation medicine and the care of patients with severe bone marrow depression. A radiation emergency may cause not only irradiation from an external source but also internal contamination with radioactive material. Because medical toxicologists are trained in radiation injury management and have expertise in the management of internal contamination, RITN centers may benefit from partnerships with medical toxicology resources, which may be located at academic medical centers, hospital inpatient clinical services, outpatient clinics, or poison control centers. We determined the locations of existing RITN centers and assessed their proximity to various medical toxicology resources, including medical toxicology fellowship programs, inpatient toxicology services, outpatient toxicology clinics, and poison control centers. Data were derived from publicly available Internet sources in March 2015. The majority of RITN centers do not have a medical toxicology fellowship, an inpatient toxicology service, or an outpatient toxicology clinic within the same institution. Fifty-seven percent of RITN centers have at least one of these resources located in the same city, however, and 73% of centers have at least one of these resources or a poison control center within the same city. Ninety-five percent of RITN centers have at least one medical toxicology resource within the state. Most RITN centers are located in the same city as at least one medical toxicology resource. Establishing relationships between RITN centers and medical toxicologists needs to be explored further.

Building Information Modelling and Standardised Construction Contracts: a Content Analysis of the GC21 Contract

Directory of Open Access Journals (Sweden)

Aaron Manderson

2015-08-01

Full Text Available Building Information Modelling (BIM is seen as a panacea to many of the ills confronting the Architectural, Engineering and Construction (AEC sector. In spite of its well documented benefits the widespread integration of BIM into the project lifecycle is yet to occur. One commonly identified barrier to BIM adoption is the perceived legal risks associated with its integration, coupled with the need for implementation in a collaborative environment. Many existing standardised contracts used in the Australian AEC industry were drafted before the emergence of BIM. As BIM continues to become ingrained in the delivery process the shortcomings of these existing contracts have become apparent. This paper reports on a study that reviewed and consolidated the contractual and legal concerns associated with BIM implementation. The findings of the review were used to conduct a qualitative content analysis of the GC21 2nd edition, an Australian standardised construction contract, to identify possible changes to facilitate the implementation of BIM in a collaborative environment. The findings identified a number of changes including the need to adopt a collaborative contract structure with equitable risk and reward mechanisms, recognition of the model as a contract document and the need for standardisation of communication/information exchange.

How tobacco companies in the UK prepared for and responded to standardised packaging of cigarettes and rolling tobacco.

Science.gov (United States)

Moodie, Crawford; Angus, Kathryn; Mitchell, Danielle; Critchlow, Nathan

2018-01-10

As a result of the Standardised Packaging of Tobacco Products Regulations and Tobacco Products Directive, all packs of cigarettes (factory-made and hand-rolled) in the UK must be drab brown, display pictorial warnings on the principal display areas and contain no less than 20 cigarettes or 30 g of tobacco. The legislation was phased in between May 2016 and May 2017. Our objective was to monitor pack, brand and product changes preimplementation and postimplementation. Our surveillance of the cigarette market involved a review of the trade press, a monthly monitor of online supermarkets and regular visits to stores, from May 2015 to June 2017. Before standardised packaging there were changes to the pack graphics (eg, redesigned packs and limited editions) and pack structure (eg, resealable inner foil) and the issue of a number of reusable tins. After standardised packaging, changes included newer cigarette pack sizes for some brand variants (eg, 23 and 24 packs). Changes to the branding prestandardised packaging included brand extensions, and poststandardised packaging included brand and/or variant name change, often with the inclusion of colour descriptors and brand migrations. Product changes prestandardised packaging included the introduction of novel filters (eg, filters with two flavour-changing capsules, tube filters, firmer filters and filters with granular additives). There was non-compliance with the legislation, with slim packs, which are not permitted, on sale after standardised packaging was implemented. Our findings highlight the need to monitor developments in markets introducing standardised packaging and have policy implications for countries considering this measure. © 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.

Osteoarthritis in Spain: A nationwide survey of medical specialists.

Science.gov (United States)

Arriaza, Rafael; Sancho, Carlos; Fernandez-Gutierrez, Benjamin

2017-11-25

To determine the reality of the resources and care needs in Spain for the management of patients with osteoarthritis. An online survey. Description of 190 responses to a structured questionnaire (141 orthopedic surgeons and 49 rheumatologists). Osteoarthritis has yet to receive appropriate medical attention and a patient management model. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

School Library Media Specialist-Teacher Collaboration: Characteristics, Challenges, Opportunities

Science.gov (United States)

Cooper, O. P.; Bray, Marty

2011-01-01

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,…

Variations in 123I-metaiodobenzylguanidine (MIBG) late heart mediastinal ratios in chronic heart failure: a need for standardisation and validation

International Nuclear Information System (INIS)

Verberne, Hein J.; Habraken, Jan B.A.; Eck-Smit, Berthe L.F. van; Agostini, Denis; Jacobson, Arnold F.

2008-01-01

There is lack of validation and standardisation of acquisition parameters for myocardial 123 I-metaiodobenzylguanidine (MIBG). This lack of standardisation hampers large scale implementation of 123 I-MIBG parameters in the evaluation of patients with chronic heart failure (CHF). In a retrospective multi-centre study 123 I-MIBG planar scintigrams obtained on 290 CHF patients (82% male; 58% dilated cardiomyopathy; New York Heart Association [NYHA classification] > I) were reanalysed to determine the late heart-to-mediastinum ratio (H/M). There was a large variation in acquisition parameters. Multivariate forward stepwise regression showed that a significant proportion (31%, p 123 I-MIBG uptake. Improved standardisation of cardiac 123 I-MIBG imaging parameters would contribute to increased clinical applicability for this procedure. (orig.)

Evaluation of a diabetes nurse specialist prescribing project.

Science.gov (United States)

Wilkinson, Jill; Carryer, Jenny; Adams, Jeffery

2014-08-01

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

You need to bond with the ones you train : Mixing epistemic cultures in medical residency training

NARCIS (Netherlands)

I. Wallenburg (Iris); J. Pols (Jeannette); A.A. de Bont (Antoinette)

2015-01-01

textabstractThis paper addresses contemporary reform in postgraduate medical education that aims to standardise training. The reforms are guided by public policy interventions to increase quality of care, objectify performance, and to prepare residents for changing health care needs. This

Preliminary Insights into the Implementation of Standardised IT in Franchise Systems

OpenAIRE

Angele Cavaye; Colin McCosker; Chad Perry

1999-01-01

The franchise context provides a rich background for studying the implementation of standardised, interlinked IT systems. Benefits of IT implementation in franchises appear obvious, but the small business context and potential tension between the two main stakeholders (franchisor and franchisees) tend to create difficulties in the implementation process. Case study methods were used to investigate IT implementation in franchise systems. Franchisee-related factors that clearly impact on implem...

Indigenous Respiratory Outreach Care: the first 18 months of a specialist respiratory outreach service to rural and remote Indigenous communities in Queensland, Australia.

Science.gov (United States)

Medlin, Linda G; Chang, Anne B; Fong, Kwun; Jackson, Rebecca; Bishop, Penny; Dent, Annette; Hill, Deb C; Vincent, Stephen; O'Grady, Kerry-Ann F

2014-09-01

Respiratory diseases are a leading cause of morbidity and mortality in Indigenous Australians. However, there are limited approaches to specialist respiratory care in rural and remote communities that are culturally appropriate. A specialist Indigenous Respiratory Outreach Care (IROC) program, developed to address this gap, is described. The aim of the present study was to implement, pilot and evaluate multidisciplinary specialist respiratory outreach medical teams in rural and remote Indigenous communities in Queensland, Australia. Sites were identified based on a perception of unmet need, burden of respiratory disease and/or capacity to use the clinical service and capacity building for support offered. IROC commenced in March 2011 and, to date, has been implemented in 13 communities servicing a population of approximately 43000 Indigenous people. Clinical service delivery has been possible through community engagement and capacity building initiatives directed by community protocols. IROC is a culturally sensitive and sustainable model for adult and paediatric specialist outreach respiratory services that may be transferrable to Indigenous communities across Queensland and Australia.

Art Appreciation as a Learned Competence: A Museum-based Qualitative Study of Adult Art Specialist and Art Non-Specialist Visitors

Directory of Open Access Journals (Sweden)

Rajka Bračun Sova

2015-12-01

Full Text Available 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 adults were recruited and accompanied during their visit to the museum. Participants were requested to “think out loud”, which meant to talk about what they saw, thought, and felt about the artworks. There was a short interview conducted with each participant before entering the museum to gain insight into their art-related and museum-visiting experience. The analysis of the data revealed that some processes of art appreciation were similar within the two groups. Both art specialists and art non-specialists interact with museum objects physically and intellectually; they see contents and formal qualities as a whole; they respond emotionally to artworks; appreciation includes their personal experience; they search museum interpretation/information for their understanding. Some noticeable differences were found. Art specialists respond to artworks with more understanding and are willing to put more effort into art appreciation, whereas art non-specialists respond with less understanding and put less effort into art appreciation. This paper focuses on the differences between the two groups; reflective and spontaneous appreciation of art, objective and subjective appreciation of art and the effort put into art appreciation. The paper ends with a discussion of the implications of the study for the teaching of art and museum education.

[Learning how to learn for specialist further education].

Science.gov (United States)

Breuer, G; Lütcke, B; St Pierre, M; Hüttl, S

2017-02-01

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.

Gait and Lower Limb Observation of Paediatrics (GALLOP): development of a consensus based paediatric podiatry and physiotherapy standardised recording proforma.

Science.gov (United States)

Cranage, Simone; Banwell, Helen; Williams, Cylie M

2016-01-01

Paediatric gait and lower limb assessments are frequently undertaken in podiatry and physiotherapy clinical practice and this is a growing area of expertise within Australia. No concise paediatric standardised recording proforma exists to assist clinicians in clinical practice. The aim of this study was to develop a gait and lower limb standardised recording proforma guided by the literature and consensus, for assessment of the paediatric foot and lower limb in children aged 0-18 years. Expert Australian podiatrists and physiotherapists were invited to participate in a three round Delphi survey panel using the online Qualtrics(©) survey platform. The first round of the survey consisted of open-ended questions on paediatric gait and lower limb assessment developed from existing templates and a literature search of standardised lower limb assessment methods. Rounds two and three consisted of statements developed from the first round responses. Questions and statements were included in the final proforma if 70 % or more of the participants indicated consensus or agreement with the assessment method and if there was support within the literature for paediatric age-specific normative data with acceptable reliability of outcome measures. There were 17 of the 21 (81 %) participants who completed three rounds of the survey. Consensus was achieved for 41 statements in Round one, 54 statements achieved agreement in two subsequent rounds. Participants agreed on 95 statements relating to birth history, developmental history, hip measurement, rotation of the lower limb, ankle range of motion, foot posture, balance and gait. Assessments with acceptable validity and reliability were included within the final Gait and Lower Limb Observation of Paediatrics (GALLOP) proforma. The GALLOP proforma is a consensus based, systematic and standardised way to collect information and outcome measures in paediatric lower limb assessment. This standardised recording proforma will assist

Specialist training in pediatric anesthesia

DEFF Research Database (Denmark)

Hansen, Tom G

2009-01-01

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...

Collaborative work and medical talk: opportunities for learning through knowledge sharing.

Science.gov (United States)

Nilsen, Line Lundvoll; Ludvigsen, Sten R

2010-01-01

Teleconsultations provide new opportunities for learning in medical settings. This study explores the conditions under which learning among physicians takes place. The empirical context is 47 real-time video conferences carried out to examine collaborative work and the medical talk involved. Sixteen of the observations were consultations wherein general practitioners (GPs) and specialists shared knowledge with the purpose of solving a medical problem related to a patient under treatment. In this exploratory study, the learning opportunities are seen as what medical practitioners with different types of expertise achieve through interaction while working with patients over periods of time. The analysis of medical talk in consultations shows that collaborative work among GPs and specialists creates a shared understanding of the patient's clinical history and treatment trajectory. As knowledge is demanded and attributed and gaps of knowledge become shared, consultations create a work tool that expands the medical work and talk. Collaborative work in and between different levels of the health care service expands knowledge, creates opportunities for learning in everyday settings, and improves the quality of knowledge distribution in the health care system.

Learning beyond graduation: exploring newly qualified specialists' entrance into daily practice from a learning perspective.

Science.gov (United States)

Cuyvers, Katrien; Donche, Vincent; Van den Bossche, Piet

2016-05-01

The entrance of newly qualified medical specialists into daily practice is considered to be a stressful period in which curriculum support is absent. Although engaging in both personal and professional learning and development activities is recognized fundamental for lifelong professional competence, research on medical professionals' entrance into practice is scarce. This research aims to contribute to the framework of medical professionals' informal learning and outlines the results of an exploratory study on the nature of learning in daily practice beyond postgraduate training. Eleven newly qualified physicians from different specialized backgrounds participated in a phenomenographic study, using a critical incident method and a grounded theory approach. Results demonstrated that learning in the workplace is, to a large extent, informal and associated with a variety of learning experiences. Analysis shows that experiences related to diagnostics and treatments are important sources for learning. Furthermore, incidents related to communication, changing roles, policy and organization offer learning opportunities, and therefore categorized as learning experiences. A broad range of learning activities are identified in dealing with these learning experiences. More specifically, actively engaging in actions and interactions, especially with colleagues of the same specialty, are the most mentioned. Observing others, consulting written sources, and recognizing uncertainties, are also referred to as learning activities. In the study, interaction, solely or combined with other learning activities, are deemed as very important by specialists in the initial entrance into practice. These insights can be used to develop workplace structures to support the entrance into practice following postgraduate training.

[Databases for surgical specialists in Cancún, Quintana Roo].

Science.gov (United States)

Contla-Hosking, Jorge Eduardo; Ceballos-Martínez, Zoila Inés; Peralta-Bahena, Mónica Esther

2004-01-01

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.

The evolution of resource adaptation: how generalist and specialist consumers evolve.

Science.gov (United States)

Ma, Junling; Levin, Simon A

2006-07-01

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.

Professional Competencies of Cuban Specialists in Intensive Care and Emergency Medicine.

Science.gov (United States)

Véliz-Martínez, Pedro L; Jorna-Calixto, Ana R; Oramas-González, René

2016-10-01

INTRODUCTION The quality of medical training and practice reflects the competency level of the professionals involved. The intensive care and emergency medicine specialty in Cuba has not defined its competencies. OBJECTIVE Identify the competencies required for specialty practice in intensive care and emergency medicine. METHODS The study was conducted from January 2014 to December 2015, using qualitative techniques; 48 professionals participated. We undertook functional occupational analysis, based on functions defined in a previous study. Three expert groups were utilized: the first used various group techniques; the second, the Delphi method; and the third, the Delphi method and a Likert questionnaire. RESULTS A total of 73 specific competencies were defined, grouped in 11 units: 44 in the patient care function, 16 in management, 7 in teaching and 6 in research. A competency map is provided. CONCLUSIONS The intensive care and emergency medicine specialty competencies identified will help improve professional standards, ensure health workforce quality, improve patient care and academic performance, and enable objective evaluation of specialists' competence and performance. KEYWORDS Clinical competency, competency-based education, professional education, intensive care, emergency medicine, urgent care, continuing medical education, curriculum, medical residency, Cuba.

Caprine Butchery and Bone Modification Templates: A step towards standardisation

Directory of Open Access Journals (Sweden)

Peter Popkin

2005-03-01

Full Text Available Widely accepted zooarchaeological procedure for recording butchery marks and other types of bone modification involves two processes: Drawing the bone showing the exact location and orientation of the modification and recording all of the information about the bone and its modification into an electronic database. No recording templates have ever been published, however, resulting in individual zooarchaeologists repeating the effort of developing their own templates or drawings for each bone in an assemblage showing a modification. Both of these tasks are time consuming and lead to inconsistencies in recording and quantification methods. To help alleviate this problem a series of caprine (sheep and goat bone templates have been created. These templates show every bone in a goat skeleton, apart from the skull, from six views at life-size when printed on A4 paper. They have intentionally been produced with a minimum of detail (without shading or stippling etc. so that the recorded butchery marks and bone modifications will be clearly visible. Because the skeletal morphology of sheep and goats is so similar these templates may be used interchangeably for either species. They may also be used for many other artiodactyl species such as cattle and deer as no scale has been indicated. The study of butchery marks and bone modification has the potential to provide zooarchaeologists with information about taphonomy, site formation processes, burial/ritual practices, human behaviour, ancient technologies and possibly ethnicity amongst other things, but only if the recording of these bone modifications is undertaken in a standardised fashion across the field. While much effort has been directed towards standardising the recognition and classification of various bone modifications, the recording of these modifications regularly occurs in various ways. Using standardised recording templates will save valuable time and help to alleviate problems of data

Does the specialist nurse enhance or deskill the general nurse?

Science.gov (United States)

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.

International Standardisation in the Field of Renewable Energy

Energy Technology Data Exchange (ETDEWEB)

NONE

2013-03-15

Renewable energy standards, regularly reviewed and updated by international committees of technical experts, can help policy makers as an instrument to demonstrate national regulatory compliance, as well as ensuring successful deployment of renewable energy technologies (RET). This study identifies over 570 standards in the current RET landscape, yet finds gaps in the existing standards, particularly for post-installation aspects of RET, such as operation, maintenance and repair. The study calls for a more structured information platform to make appropriate standards accessible to a variety of users. All stakeholders, including those from developing countries, need to be engaged in the standardisation process. IRENA's analysis also underlines the importance of RET certification schemes as a risk-mitigation tool, particularly to help small-scale projects obtain financing.

Standardisation of radiation portal monitor controls and readouts

International Nuclear Information System (INIS)

Tinker, Michael R.

2010-01-01

There is an urgent need to standardise the numbering configuration of radiation portal monitor sensing panels. Currently, manufacturers use conflicting numbering schemes that may confuse operators of these varied systems. There is a similar problem encountered with the varied choices of colored indicator lights and colored print lines designated for gamma and neutron alarms. In addition, second-party software that changes the alarm color scheme may also have been installed. Furthermore, no provision exists for the color blind or to provide work stations with only black ink on alarm printouts. These inconsistencies and confusing setups could inadvertently cause a misinterpretation of the alarm, resulting in the potential release of a radiological hazard into a sovereign country. These issues are discussed, and a proposed solution is offered.

Educational programme on radiation protection for veterinary medicine specialists

International Nuclear Information System (INIS)

Djuric, G.; Popovic, D.

1992-01-01

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)

Needlestick injuries and infectious patients in a major academic medical centre from 2003 to 2010

NARCIS (Netherlands)

Frijstein, G.; Hortensius, J.; Zaaijer, H. L.

2011-01-01

To implement adequate preventive measures in a hospital, the number and nature of occupational exposures to blood must be known. In the Amsterdam Academic Medical Centre a standardised procedure was used to assess all reported occupational exposures to blood from 2003 to 2010. 1601 incidents were

Headache service quality: evaluation of quality indicators in 14 specialist-care centres.

Science.gov (United States)

Schramm, Sara; Uluduz, Derya; Gouveia, Raquel Gil; Jensen, Rigmor; Siva, Aksel; Uygunoglu, Ugur; Gvantsa, Giorgadze; Mania, Maka; Braschinsky, Mark; Filatova, Elena; Latysheva, Nina; Osipova, Vera; Skorobogatykh, Kirill; Azimova, Julia; Straube, Andreas; Eren, Ozan Emre; Martelletti, Paolo; De Angelis, Valerio; Negro, Andrea; Linde, Mattias; Hagen, Knut; Radojicic, Aleksandra; Zidverc-Trajkovic, Jasna; Podgorac, Ana; Paemeleire, Koen; De Pue, Annelien; Lampl, Christian; Steiner, Timothy J; Katsarava, Zaza

2016-12-01

The study was a collaboration between Lifting The Burden (LTB) and the European Headache Federation (EHF). Its aim was to evaluate the implementation of quality indicators for headache care Europe-wide in specialist headache centres (level-3 according to the EHF/LTB standard). Employing previously-developed instruments in 14 such centres, we made enquiries, in each, of health-care providers (doctors, nurses, psychologists, physiotherapists) and 50 patients, and analysed the medical records of 50 other patients. Enquiries were in 9 domains: diagnostic accuracy, individualized management, referral pathways, patient's education and reassurance, convenience and comfort, patient's satisfaction, equity and efficiency of the headache care, outcome assessment and safety. Our study showed that highly experienced headache centres treated their patients in general very well. The centres were content with their work and their patients were content with their treatment. Including disability and quality-of-life evaluations in clinical assessments, and protocols regarding safety, proved problematic: better standards for these are needed. Some centres had problems with follow-up: many specialised centres operated in one-touch systems, without possibility of controlling long-term management or the success of treatments dependent on this. This first Europe-wide quality study showed that the quality indicators were workable in specialist care. They demonstrated common trends, producing evidence of what is majority practice. They also uncovered deficits that might be remedied in order to improve quality. They offer the means of setting benchmarks against which service quality may be judged. The next step is to take the evaluation process into non-specialist care (EHF/LTB levels 1 and 2).

'The use of technical specialists in quality assurance audits'

International Nuclear Information System (INIS)

Higgins, T.J.; Diaz, M.R.

1993-01-01

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

The "diamond port configuration": A standardised laparoscopic technique for adolescent intestinal resection and anastomosis

Directory of Open Access Journals (Sweden)

Richard Hill

2012-01-01

Full Text Available Background: Familiarity with technique and repetition enhance efficiency during laparoscopic surgery. This is particularly important when undertaking complex bowel resections. We report a standardised protocol that includes theatre layout, patient position and port insertion, which we believe facilitates excellent abdominal access and ergonomics and has the potential to shorten the duration of the team-learning curve. Materials and Methods: A strategic unit development plan led to the commencement of a laparoscopic service for adolescents with bowel disorders. A standardised protocol for intestinal resections was agreed upon at a monthly Paediatric Minimal Access Group meeting. This covered patient position, port insertion, technical aspects of intestinal resection and perioperative management. In particular, a diamond configuration for ports was agreed upon. Data were prospectively collected, and included patient demographics, operative times, conversion rates and postoperative outcomes. Unless otherwise indicated, data are presented as medians with ranges. Results: Seven procedures were carried out in six patients (three female aged 14 (11-14 years. Access to the entire abdominal cavity, vision and ergonomics were excellent in all. There were no conversions to open surgery. In all procedures, the technique was considered safe and effective. The length of hospital stay was 6.5 (5.8-14 days. Conclusion: A standardised protocol including the use of the diamond port configuration has several putative advantages for laparoscopic bowel resections and anastomoses. These include efficiency, reproducibility, predictability, good visibility and excellent ergonomics. We recommend this approach as a means to shorten the procedure-specific learning curve of the laparoscopic team.

Art Appreciation as a Learned Competence: A Museum-Based Qualitative Study of Adult Art Specialist and Art Non-Specialist Visitors

Science.gov (United States)

Bracun Sova, Rajka

2015-01-01

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…

Derivation of standardised BMD using the European Spine Phantom

International Nuclear Information System (INIS)

McCloskey, E.V.

2000-01-01

The primary aim of this study is to compare peak bone mass in a range of populations and to examine the determinants of any differences which may be observed. Bone mineral density (areal BMD) has been measured by densitometers manufactured by two companies, Hologic (Waltham, USA) and Lunar (Madison, USA). Systematic differences exist between tile manufacturers in several stages of the scanning procedure (e.g. edge-detection, calibration) so that the normal ranges produced are specific to each brand. To allow comparison of BMD between manufacturers (and thus between centres) we have therefore undertaken a cross-calibration of the scanners in order to derive a standardised BMD

Standardised pre-hospital care of acute myocardial infarction patients: MISSION! guidelines applied in practice

NARCIS (Netherlands)

Atary, J. Z.; de Visser, M.; van den Dijk, R.; Bosch, J.; Liem, S. S.; Antoni, M. L.; Bootsma, M.; Viergever, E. P.; Kirchhof, C. J.; Padmos, I.; Sedney, M. I.; van Exel, H. J.; Verwey, H. F.; Atsma, D. E.; van der Wal, E. E.; Jukema, J. W.; Schalij, M. J.

2010-01-01

Background. To improve acute myocardial infarction (AMI) care in the region 'Hollands-Midden' (the Netherlands), a standardised guideline-based care program was developed (MISSION!). This study aimed to evaluate the outcome of the pre-hospital part of the MISSION! program and to study potential

Guidelines for Professional Training of Junior Medical Staff in the Context of European Experience

Science.gov (United States)

Sosnova, Myroslava

2016-01-01

The article deals with outlining guidelines for improving professional training of junior medical staff based on European experience. Consequently, guidelines and recommendations on enhancing the efficiency of medical education in general and junior medical specialists' professional training, in particular, published by European Union of Medical…

The impact of economic factors on migration considerations among Icelandic specialist doctors: a cross-sectional study.

Science.gov (United States)

Solberg, Ingunn Bjarnadóttir; Tómasson, Kristinn; Aasland, Olaf; Tyssen, Reidar

2013-12-18

Globalization has facilitated the employability of doctors almost anywhere in the world. In recent years, the migration of doctors seems to have increased. However, we lack studies on doctors' migration from developed countries. Because the economic recession experienced by many countries might have affected the migration of doctors, research on this topic is important for the retention of doctors. Iceland was hit hard by the economic recession in 2008. Therefore, we want to explore how many specialist doctors in Iceland have considered migrating and whether economic factors at work and in private life, such as extensive cost-containment initiatives at work and worries about personal finances, are related to doctors' migration considerations. In 2010, all doctors in Iceland registered with the Icelandic Medical Association were sent an electronic cross-sectional survey by email. The 467 specialists who participated in this study represent 55% of all specialist doctors working in Iceland. Information on doctors' contemplation of migration was available from responses to the question: "Have you considered moving and working abroad?" The predictor variables in our logistic regression model are perceived cost-containment initiatives at work, stress related to personal finances, experience of working abroad during vacations, job dissatisfaction, job position, age, and gender. Sixty-three per cent of Iceland's specialist doctors had considered relocation abroad, 4% were moving in the next year or two, and 33% had not considered relocating. Logistic regression analysis shows that, controlling for age, gender, job position, job satisfaction, and experience of working abroad during vacations, doctors' migration considerations were significantly affected by their experiences of cost-containment initiatives at work (odds ratio (OR) = 2.0, p Economic factors affect whether specialist doctors in Iceland consider migration. More studies on the effect of economic recession

Standardised method for reporting exercise programmes: protocol for a modified Delphi study.

Science.gov (United States)

Slade, Susan C; Dionne, Clermont E; Underwood, Martin; Buchbinder, Rachelle

2014-12-30

Exercise is integral to health across the lifespan and important for people with chronic health conditions. A systematic review of exercise trials for chronic conditions reported suboptimal descriptions of the evaluated interventions and concluded that this hinders interpretation and replication. The aim of this project is to develop a standardised method for reporting essential exercise programme details being evaluated in clinical trials. A modified Delphi technique will be used to gain consensus among international exercise experts. We will use three sequential rounds of anonymous online questionnaires to refine a standardised checklist. A draft checklist of potentially relevant items was developed based on the results of a systematic review of exercise systematic reviews. An international panel of experts was identified by exercise systematic review authorship, established international profile in exercise research and practice and by peer referral. In round 1, the international panel of experts will be asked to rate the importance of each draft item and provide additional suggestions for revisions or new items. Consensus will be considered reached if at least 70% of the panel strongly agree/disagree that an item should be included or excluded. Where agreement is not reached or there are suggestions for altered or new items, these will be taken to round 2 together with an aggregated summary of round 1 responses. Following the second round, a ranking of item importance will be made to rationalise the number of items. The final template will be distributed to panel members for approval. Ethics approval was received from The Cabrini Institute Ethics Committee, Melbourne, Australia (HREC 02-07-04-14). We plan to use a stepwise process to develop and refine a standardised and internationally agreed template for explicit reporting of exercise programmes. The template will be generalisable across all types of exercise interventions. The findings will be disseminated

Naval Medical R and D News, February 2017, Volume 9, Issue 2

Science.gov (United States)

2017-02-01

preventive medical specialist Capt. Charles Miller, MC, USN, to Vietnam in July 1969. Much of his work would be conducted in concert the Navy...service members.... SILVER SPRING, Md. — Former Naval Medical Research Center (NMRC) Science, Technology, Engineering and Mathematics (STEM) intern

The Joint Committee for Traceability in Laboratory Medicine (JCTLM): A Global Approach to Promote the Standardisation of Clinical Laboratory Test Results

OpenAIRE

Armbruster, David; Miller, Richard R

2007-01-01

Clinical laboratories are moving towards global standardisation to produce equivalent test results across space and time. Standardisation allows use of evidence-based medicine, eliminates the need of method-specific reference intervals, decision levels and cut-offs, and can be achieved by application of metrological principles. For example, in vitro diagnostics (IVD) manufacturers can make kit calibrators traceable to internationally recognised reference materials and reference methods.

Proceedings of international conference of leading specialists, young scientists and students 'Ecological problems of XXI century'

International Nuclear Information System (INIS)

Milyutin, A.A.

2002-05-01

The present publication represents the collection of materials of a scientific conference of the leading specialists, young scientists and students, which was organized by Ministry for Education of the Republic of Belarus on the basis of International A. Sakharov Environmental University (Minsk, Republic of Belarus). The ecological problems were viewed on the following directions: ecology, radioecology, ecological monitoring, ecological information systems, eco priority power engineering, eco biology, medical ecology, molecular medicine, social ecology

Recognising contributions to work in research collaboratives: Guidelines for standardising reporting of authorship in collaborative research.

Science.gov (United States)

2018-04-01

Trainee research collaboratives (TRCs) have been revolutionary changes to the delivery of high-quality, multicentre research. The aim of this study was to define common roles in the conduct of collaborative research, and map these to academic competencies as set out by General Medical Council (GMC) in the United Kingdom. This will support trainers and assessors when judging academic achievements of those involved in TRC projects, and supports trainees by providing guidance on how to fulfil their role in these studies. A modified Delphi process was followed. Electronic discussion with key stakeholders was undertaken to identify and describe common roles. These were refined and mapped to GMC educational domains and International Committee of Medical Journal Editors authorship (ICJME) guidelines. The resulting roles and descriptions were presented to a face-to-face consensus meeting for voting. The agreed roles were then presented back to the electronic discussion group for approval. Electronic discussion generated six common roles. All of these were agreed in face-to-face meetings, where two further roles identified and described. All eight roles required skills that map to part of the academic requirements for surgical training in the UK. This paper presents a standardised framework for reporting authorship in collaborative group authored research publications. Linkage of collaborator roles to the ICMJE guidelines and GMC academic competency guidelines will facilitate incorporation into relevant training curricular and journal publication policies. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Standardised Observation Analogue Procedure (SOAP) for Assessing Parent and Child Behaviours in Clinical Trials

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Johnson, Cynthia R.; Butter, Eric M.; Handen, Benjamin L.; Sukhodolsky, Denis G.; Mulick, James; Lecavalier, Luc; Aman, Michael G.; Arnold, Eugene L.; Scahill, Lawrence; Swiezy, Naomi; Sacco, Kelley; Stigler, Kimberly A.; McDougle, Christopher J.

2009-01-01

Background: Observational measures of parent and child behaviours have a long history in child psychiatric and psychological intervention research, including the field of autism and developmental disability. We describe the development of the Standardised Observational Analogue Procedure (SOAP) for the assessment of parent-child behaviour before…

Improvement of the Russian system of medical care at the site of space crew landing

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Rukavishnikov, Ilya; Bogomolov, Valery; Polyakov, Alexey

The crew members are delivered to ISS and return back to the Earth on the space craft "Soyuz TMA" at present time. The technical means providing the safe landing of space crews are reliable enough. In spite of that the complex of negative factors (long lasting alternating and shock overloads, effects of landing apparatus rotation on vestibular system) affects the crew during landing and can reach the extreme values under the certain conditions. According to this fact there is a possibility of appearance of bodily damages of different weight besides the traditional functional disturbances. The group of search and rescue on the landing site includes the medical specialists appropriately equipped to stop the symptoms of medical contingency (strong vestibule-vegetative reactions, traumas of different weight, etc.) Medical evacuation complex which provides the acceptable conditions for the cosmonauts including the conditions for medical care is delivered to the landing site as well. The long term experience of search and rescue assurance at the landing site have shown that the specialists successfully cope with this task. In some cases it was required to give the medical help which allowed to improve the general condition and physical capacity of crewmembers and provide their evacuation to the places of postflight rehabilitation. At the same time the solution of some of the problems from our point of view could increase the efficacy of medical care for the landing crew. The organization of the training on emergency under the field conditions for medical specialists on the regular basis (not less that once a year) is extremely important. The equipment of medical specialists requires the regular improvement and modernization due to the fast changing medical technologies and standards. Wearable medical sets must provide the first aid performing in accordance to the modern medical requirements. It is also necessary to include in the list of equipment the textbook of

The effect of a standardised source of divided attention in airway management: A randomised, crossover, interventional manikin study.

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Prottengeier, Johannes; Petzoldt, Marlen; Jess, Nikola; Moritz, Andreas; Gall, Christine; Schmidt, Joachim; Breuer, Georg

2016-03-01

Dual-tasking, the need to divide attention between concurrent tasks, causes a severe increase in workload in emergency situations and yet there is no standardised training simulation scenario for this key difficulty. We introduced and validated a quantifiable source of divided attention and investigated its effects on performance and workload in airway management. A randomised, crossover, interventional simulation study. Center for Training and Simulation, Department of Anaesthesiology, Erlangen University Hospital, Germany. One hundred and fifty volunteer medical students, paramedics and anaesthesiologists of all levels of training. Participants secured the airway of a manikin using a supraglottic airway, conventional endotracheal intubation and video-assisted endotracheal intubation with and without the Paced Auditory Serial Addition Test (PASAT), which served as a quantifiable source of divided attention. Primary endpoint was the time for the completion of each airway task. Secondary endpoints were the number of procedural mistakes made and the perceived workload as measured by the National Aeronautics and Space Administration's task load index (NASA-TLX). This is a six-dimensional questionnaire, which assesses the perception of demands, performance and frustration with respect to a task on a scale of 0 to 100. All 150 participants completed the tests. Volunteers perceived our test to be challenging (99%) and the experience of stress and distraction true to an emergency situation (80%), but still fair (98%) and entertaining (95%). The negative effects of divided attention were reproducible in participants of all levels of expertise. Time consumption and perceived workload increased and almost half the participants make procedural mistakes under divided attention. The supraglottic airway technique was least affected by divided attention. The scenario was effective for simulation training involving divided attention in acute care medicine. The significant effects

STS-95 Mission Specialist Duque suits up during TCDT

Science.gov (United States)

1998-01-01

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.

Bridging the care continuum: patient information needs for specialist referrals

Directory of Open Access Journals (Sweden)

Steltenkamp Carol L

2009-09-01

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.

Science without meritocracy. Discrimination among European specialists in infectious diseases and clinical microbiology: a questionnaire survey.

Science.gov (United States)

Tacconelli, Evelina; Poljak, Mario; Cacace, Marina; Caiati, Giovanni; Benzonana, Nur; Nagy, Elisabeth; Kortbeek, Titia

2012-01-01

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.

Models of care for musculoskeletal health: a cross-sectional qualitative study of Australian stakeholders' perspectives on relevance and standardised evaluation.

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Briggs, Andrew M; Jordan, Joanne E; Speerin, Robyn; Jennings, Matthew; Bragge, Peter; Chua, Jason; Slater, Helen

2015-11-16

The prevalence and impact of musculoskeletal conditions are predicted to rapidly escalate in the coming decades. Effective strategies are required to minimise 'evidence-practice', 'burden-policy' and 'burden-service' gaps and optimise health system responsiveness for sustainable, best-practice healthcare. One mechanism by which evidence can be translated into practice and policy is through Models of Care (MoCs), which provide a blueprint for health services planning and delivery. While evidence supports the effectiveness of musculoskeletal MoCs for improving health outcomes and system efficiencies, no standardised national approach to evaluation in terms of their 'readiness' for implementation and 'success' after implementation, is yet available. Further, the value assigned to MoCs by end users is uncertain. This qualitative study aimed to explore end users' views on the relevance of musculoskeletal MoCs to their work and value of a standardised evaluation approach. A cross-sectional qualitative study was undertaken. Subject matter experts (SMEs) with health, policy and administration and consumer backgrounds were drawn from three Australian states. A semi-structured interview schedule was developed and piloted to explore perceptions about musculoskeletal MoCs including: i) aspects important to their work (or life, for consumers) ii) usefulness of standardised evaluation frameworks to judge 'readiness' and 'success' and iii) challenges associated with standardised evaluation. Verbatim transcripts were analysed by two researchers using a grounded theory approach to derive key themes. Twenty-seven SMEs (n = 19; 70.4 % female) including five (18.5 %) consumers participated in the study. MoCs were perceived as critical for influencing and initiating changes to best-practice healthcare planning and delivery and providing practical guidance on how to implement and evaluate services. A 'readiness' evaluation framework assessing whether critical components across the

Methodological bases of innovative training of specialists in nanotechnology field

Directory of Open Access Journals (Sweden)

FIGOVSKY Oleg Lvovich

2016-10-01

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.

National Target for South Asia Specialists. A Report.

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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…

The corporate transformation of medical specialty care: the exemplary case of neonatology.

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Kinney, Eleanor D

2008-01-01

The key to wealth in health care is the physician, who certifies to third-party payers that health care items and services are necessary for patient care. To compete more effectively for this wealth, physician specialists are organizing their practices into for-profit corporations and employing other physicians. Focusing on neonatology, this article describes the prevailing business model of these for-profit medical groups as controlling employed physicians through restrictive employment contract provisions, e.g., non-compete and mandatory arbitration clauses. With this business model and because of deficiencies in current law, for-profit medical groups eliminate competition from other physician specialists to the detriment of patients and consumers.

Optometry Specialist (AFSC 91255).

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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…

Antidepressant activity of standardised extract of Marsilea minuta Linn.

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Bhattamisra, Subrat Kumar; Khanna, Vinay Kumar; Agrawal, Ashok Kumar; Singh, Paras Nath; Singh, Sushil Kumar

2008-04-17

Marsilea minuta Linn. (Marsileaceae) has been referred in Indian traditional medicine system (Ayurveda) for the treatment of insomnia and other mental disorders. Marsiline isolated from Marsilea minuta was reported to have sedative and anticonvulsant property. The ethanol extract of Marsilea minuta was standardised for marsiline (1.15%, w/w) and studied for its antidepressant activity. Antidepressant activity was studied using forced swimming test (FST), tail suspension test (TST), learned helplessness test (LHT) and 5-hydroxytryptophan (5-HTP) induced head twitches response in rodents. Standardised extract of Marsilea minuta in doses of 100, 200 and 400 mg/kg/day were administered orally for three consecutive days and evaluated on day 3, 1h after the last dose treatment. Imipramine (15 mg/kg/day, i.p.) was used as the standard drug. Neurochemical mechanism of antidepressant activity was elucidated by using radioligand receptor binding assays for 5-HT2A and benzodiazepine receptors in rat frontal cortex. Immobility time in FST and TST was significantly (P<0.05) reduced by ethanol extract of Marsilea minuta treated animals. A decrease in number of escape failures in LHT was also observed in Marsilea minuta treated rats. Head twitch response induced by 5-HTP was significantly attenuated by Marsilea minuta (400 mg/kg, p.o.) and imipramine showing the involvement of serotonergic system. This effect was corroborated with radioligand receptor binding study where Marsilea minuta (400 mg/kg, p.o.) significantly (P<0.05) down regulated 5-HT2A receptor in frontal cortex, whereas, no marked effect was observed for benzodiazepine receptor. The antidepressant effect exhibited by Marsilea minuta extract may be due to its effect on 5-HT2A density in rat frontal cortex.

Drought characterisation based on an agriculture-oriented standardised precipitation index

Science.gov (United States)

Tigkas, Dimitris; Vangelis, Harris; Tsakiris, George

2018-03-01

Drought is a major natural hazard with significant effects in the agricultural sector, especially in arid and semi-arid regions. The accurate and timely characterisation of agricultural drought is crucial for devising contingency plans, including the necessary mitigation measures. Many drought indices have been developed during the last decades for drought characterisation and analysis. One of the most widely used indices worldwide is the Standardised Precipitation Index (SPI). Although other comprehensive indices have been introduced over the years, SPI remains the most broadly accepted index due to a number of reasons, the most important of which are its simple structure and the fact that it uses only precipitation data. In this paper, a modified version of SPI is proposed, namely the Agricultural Standardised Precipitation Index (aSPI), based on the substitution of the total precipitation by the effective precipitation, which describes more accurately the amount of water that can be used productively by the plants. Further, the selection of the most suitable reference periods and time steps for agricultural drought identification using aSPI is discussed. This conceptual enhancement of SPI aims at improving the suitability of the index for agricultural drought characterisation, while retaining the advantages of the original index, including its dependence only on precipitation data. The evaluation of the performance of both SPI and aSPI in terms of correlating drought magnitude with crop yield response in four regions of Greece under Mediterranean conditions indicated that aSPI is more robust than the original index in identifying agricultural drought.

A qualitative evaluation of the Scottish Staff and Associate Specialist Development Programme.

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Cleland, Jennifer; Burr, Jacqueline; Johnston, Peter

2016-05-01

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.

The surmountable challenge of setting up postgraduate medical ...

African Journals Online (AJOL)

Consultant Physician,. International Adviser to the Royal College of ... Midwifery and improve medical assistants/clinical officers training schools. These institutions compliment each other ... future South Sudanese physicians, obstetricians, gynaecologist, paediatricians, public health specialists and surgeons with skills to ...

[What medical students want - evaluation of medical recruitment ads by future physicians].

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Renkawitz, T; Schuster, T; Benditz, A; Craiovan, B; Grifka, J; Lechler, P

2013-10-01

Three-quarters of all hospitals in Germany are now struggling to fill open positions for doctors. The medical job ad is a vital tool for human resources marketing and an important image factor. The present study examines the importance of information and offers in medical recruitment ads on application decisions by medical students. A total of 184 future physicians from clinical semesters participated voluntarily in an anonymous cross-sectional survey. Using a standardised questionnaire, the importance of 49 -individual items extracted from medical recruitment ads were rated with the help of a 4-point Likert Scale. Finally, the study participants prioritised their reasons for an application as a physician. Primary influence on the application decision on medical recruitment ads by medical students had offers/information in relation to education and training aspects and work-life balance. Payment rates for physicians and work load played an important role for the application motivation. Additional earnings for, e. g., emergency calls, providing of medical expertise and assistance with housing, relocation and reimbursement of interview expenses were less crucial. In prioritising key reasons for selecting a prospective employer "regular working hours," an "individual training concept" and an "attractive work-life balance" scored the highest priority. The "opportunity for scientific work" was assigned only a small significance. High importance for the application decision by future physicians on medical recruitment ads is placed on jobs with an opportunity for personal development and aspects that contribute to work-life balance. © Georg Thieme Verlag KG Stuttgart · New York.

Why support a women's medical college? Philadelphia's early male medical pro-feminists.

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Peitzman, Steven J

2003-01-01

The male founders and early faculty of Philadelphia's Woman's Medical College were mostly abolitionist physicians, zealous moralists for whom medical feminism formed only one of the cherished causes they could "manfully" and righteously defend. Male faculty of the late nineteenth century comprised "self-made" men, mostly new specialists, for whom strict sexism probably seemed inconsistent with progressive medicine. For some of these physicians-obviously a small minority-defending medical women and breaking the barriers of fraternity could be consistent with "manly" responsibility. The outcome of the collaboration of women and the dissident men physicians in nineteenth-century Philadelphia amounted to another seeming paradox: the majority of the male medical profession, both locally and nationally, tyrannically hindered women's entry into the profession, yet medicine opened its doors in advance of law and the clergy; and where this first occurred, such as in the community centered on Woman's Medical College, a novel gender rearrangement arose based on collaboration and friendship.

Medical education and law: withholding/withdrawing treatment from adults without capacity.

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Parker, M; Willmott, L; White, B; Williams, G; Cartwright, C

2015-06-01

Law is increasingly involved in clinical practice, particularly at the end of life, but undergraduate and postgraduate education in this area remains unsystematic. We hypothesised that attitudes to and knowledge of the law governing withholding/withdrawing life-sustaining treatment from adults without capacity (the WWLST law) would vary and demonstrate deficiencies among medical specialists. We investigated perspectives, knowledge and training of medical specialists in the three largest (populations and medical workforces) Australian states, concerning the WWLST law. Following expert legal review, specialist focus groups, pre-testing and piloting in each state, seven specialties involved with end-of-life care were surveyed, with a variety of statistical analyses applied to the responses. Respondents supported the need to know and follow the law. There were mixed views about its helpfulness in medical decision-making. Over half the respondents conceded poor knowledge of the law; this was mirrored by critical gaps in knowledge that varied by specialty. There were relatively low but increasing rates of education from the undergraduate to continuing professional development (CPD) stages. Mean knowledge score did not vary significantly according to undergraduate or immediate postgraduate training, but CPD training, particularly if recent, resulted in greater knowledge. Case-based workshops were the preferred CPD instruction method. Teaching of current and evolving law should be strengthened across all stages of medical education. This should improve understanding of the role of law, ameliorate ambivalence towards the law and contribute to more informed deliberation about end-of-life issues with patients and families. © 2015 Royal Australasian College of Physicians.

Preliminary adaptation into Portuguese of a standardised picture set for the use in research and neuropsychological assessment

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POMPÉIA SABINE

1998-01-01

Full Text Available Pictorial stimuli and words have been widely used to evaluate mnemonic processes in clinical settings, neuropsychological investigations, as well as in studies on the mechanisms underlying the phenomena of memory. However, there seem to be few studies of standardisation of pictures for research in this field. The present paper aimed at adapting the use of a set of pictures standardised for English speaking subjects for Portuguese speakers. Name agreement of 150 pictures was assessed in 100 high-school students. Ninety pictures were found to present the same name for over 90 subjects. Results yield data that may help create more controlled tests for the study of memory for pictorial stimuli in Brazil.

Mapping the Demand for Serious Games in Postgraduate Medical Education Using the Entrustable Professional Activities Framework.

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Graafland, Maurits; Ten Cate, Olle; van Seventer, Jan-Pieter; Schraagen, Jan Maarten C; Schijven, Marlies P

2015-10-01

Serious games are potentially powerful tools for residency training and increasingly attract attention from medical educators. At present, serious games have little evidence-based relations with competency-based medical education, which may impede their incorporation into residency training programs. The aim of this study was to identify highly valued entrustable professional activities (EPAs) to support designers in the development of new, serious games built on a valid needs-assessment. All 149 licensed medical specialists from seven specialties in one academic hospital participated in seven different Delphi expert panels. They filled out a two-round Delphi survey, aimed at identifying the most valuable EPAs in their respective curricula. Specialists were asked to name the most highly valued EPA in their area in the first Delphi round. In the second round, the generated responses were presented and ranked according to priority by the medical specialists. Sixty-two EPAs were identified as valuable training subjects throughout five specialties. Eleven EPAs--"management of trauma patient," "chest tube placement," "laparoscopic cholecystectomy," "assessment of vital signs," "airway management," "induction of general anesthesia," "assessment of suicidal patient," "psychiatric assessment," "gastroscopy," "colonoscopy," and "resuscitation of emergency patients"--were consistently given a high score. The future medical specialist is an active learner, comfortable with digital techniques and learning strategies such as serious gaming. In order to maximize the impact and acceptance of new serious games, it is vital to select the most relevant training subjects. Although some serious games have already targeted top-priority EPAs, plenty of opportunities remain.

Automated Medical Literature Retrieval

Directory of Open Access Journals (Sweden)

David Hawking

2012-09-01

Full Text Available Background The constantly growing publication rate of medical research articles puts increasing pressure on medical specialists who need to be aware of the recent developments in their field. The currently used literature retrieval systems allow researchers to find specific papers; however the search task is still repetitive and time-consuming. Aims In this paper we describe a system that retrieves medical publications by automatically generating queries based on data from an electronic patient record. This allows the doctor to focus on medical issues and provide an improved service to the patient, with higher confidence that it is underpinned by current research. Method Our research prototype automatically generates query terms based on the patient record and adds weight factors for each term. Currently the patient’s age is taken into account with a fuzzy logic derived weight, and terms describing blood-related anomalies are derived from recent blood test results. Conditionally selected homonyms are used for query expansion. The query retrieves matching records from a local index of PubMed publications and displays results in descending relevance for the given patient. Recent publications are clearly highlighted for instant recognition by the researcher. Results Nine medical specialists from the Royal Adelaide Hospital evaluated the system and submitted pre-trial and post-trial questionnaires. Throughout the study we received positive feedback as doctors felt the support provided by the prototype was useful, and which they would like to use in their daily routine. Conclusion By supporting the time-consuming task of query formulation and iterative modification as well as by presenting the search results in order of relevance for the specific patient, literature retrieval becomes part of the daily workflow of busy professionals.

A qualitative study of barriers to the implementation of a rheumatoid arthritis guideline among generalist and specialist physical therapists.

Science.gov (United States)

van Bodegom-Vos, Leti; Verhoef, John; Dickmann, Margot; Kleijn, Marjon; van Vliet, Ingrid; Hurkmans, Emalie; van der Wees, Philip; Vliet Vlieland, Thea

2012-10-01

Although the increasing complexity and expansion of the body of knowledge in physical therapy have led to specialized practice areas to provide better patient care, the impact of specialization on guideline implementation has been scarcely studied. Objectives The objective of this study was to identify the similarities and differences in barriers to the implementation of a Dutch rheumatoid arthritis (RA) guideline by generalist and specialist physical therapists. Design This observational study consisted of 4 focus group interviews in which 24 physical therapists (13 generalist and 11 specialist physical therapists) participated. Physical therapists were asked to discuss barriers to the implementation of the RA guideline. Data were analyzed qualitatively using a directed approach to content analysis. Both the interviews and the interview analysis were informed by a previously developed conceptual framework. Besides a number of similarities (eg, lack of time), the present study showed important, although subtle, differences in barriers to the implementation of the RA guideline between generalist physical therapists and specialist physical therapists. Generalist physical therapists more frequently reported difficulties in interpreting the guideline (cognitive barriers) and had less favorable opinions about the guideline (affective barriers) than specialist physical therapists. Specialist physical therapists were hampered by external barriers that are outside the scope of generalist physical therapists, such as a lack of agreement about the roles and responsibilities of medical professionals involved in the care of the same patient. The identified differences in barriers to the implementation of the RA guideline indicated that the effectiveness of implementation strategies could be improved by tailoring them to the level of specialization of physical therapists. However, it is expected that tailoring implementation strategies to barriers that hamper both generalist

UK HSE Training of HM Radiation Specialist Inspectors

International Nuclear Information System (INIS)

Nattres, E.; Barrett, J. A.

2004-01-01

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

Management Matters: The Library Media Specialist's Management Toolbox

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Pappas, Marjorie L.

2004-01-01

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…

Enhancing medical students' communication skills: development and evaluation of an undergraduate training program

Science.gov (United States)

2012-01-01

Background There is a relative lack of current research on the effects of specific communication training offered at the beginning of the medical degree program. The newly developed communication training "Basics and Practice in Communication Skills" was pilot tested in 2008 and expanded in the following year at the University Medical Centre Hamburg-Eppendorf in Germany. The goal was to promote and improve the communicative skills of participants and show the usefulness of an early offered intervention on patient-physician communication within the medical curriculum. Methods The students participating in the project and a comparison group of students from the standard degree program were surveyed at the beginning and end of the courses. The survey consisted of a self-assessment of their skills as well as a standardised expert rating and an evaluation of the modules by means of a questionnaire. Results Students who attended the communication skills course exhibited a considerable increase of communication skills in this newly developed training. It was also observed that students in the intervention group had a greater degree of self-assessed competence following training than the medical students in the comparison group. This finding is also reflected in the results from a standardised objective measure. Conclusions The empirical results of the study showed that the training enabled students to acquire specialised competence in communication through the course of a newly developed training program. These findings will be used to establish new communication training at the University Medical Centre Hamburg-Eppendorf. PMID:22443807

EAU standardised medical terminology for urologic imaging: a taxonomic approach.

Science.gov (United States)

Loch, Tillmann; Carey, Brendan; Walz, Jochen; Fulgham, Pat Fox

2015-05-01

The terminology and abbreviations used in urologic imaging have generally been adopted on an ad hoc basis by different speciality groups; however, there is a need for shared nomenclature to facilitate clinical communication and collaborative research. This work reviews the current nomenclature for urologic imaging used in clinical practice and proposes a taxonomy and terminology for urologic imaging studies. A list of terms used in urologic imaging were compiled from guidelines published by the European Association of Urology and the American Urological Association and from the American College of Radiology Appropriateness Criteria. Terms searched were grouped into broad categories based on technology, and imaging terms were further stratified based on the anatomic extent, contrast or phases, technique or modifiers, and combinations or fusions. Terms that had a high degree of utilisation were classified as accepted. We propose a new taxonomy to define a more useful and acceptable nomenclature model acceptable to all health professionals involved in urology. The major advantage of a taxonomic approach to the classification of urologic imaging studies is that it provides a flexible framework for classifying the modifications of current imaging modalities and allows the incorporation of new imaging modalities. The adoption of this hierarchical classification model ranging from the most general to the most detailed descriptions should facilitate hierarchical searches of the medical literature using both general and specific terms. This work is limited in its scope, as it is not currently all-inclusive. This will hopefully be addressed by future modification as others embrace the concept and work towards uniformity in nomenclature. This paper provides a noncomprehensive list of the most widely used terms across different specialties. This list can be used as the basis for further discussion, development, and enhancement. In this paper we describe a classification system

The clinical nurse specialist: leadership in quality improvement.

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Finkelman, Anita

2013-01-01

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.

Transition from specialist to primary diabetes care: A qualitative study of perspectives of primary care physicians

Directory of Open Access Journals (Sweden)

Liddy Clare

2009-06-01

Full Text Available Abstract Background The growing prevalence of diabetes and heightened awareness of the benefits of early and intensive disease management have increased service demands and expectations not only of primary care physicians but also of diabetes specialists. While research has addressed issues related to referral into specialist care, much less has been published about the transition from diabetes specialists back to primary care. Understanding the concerns of family physicians related to discharge of diabetes care from specialist centers can support the development of strategies that facilitate this transition and result in broader access to limited specialist services. This study was undertaken to explore primary care physician (PCP perspectives and concerns related to reassuming responsibility for diabetes care after referral to a specialized diabetes center. Methods Qualitative data were collected through three focus groups. Sessions were audio-taped and transcribed verbatim. Data were coded and sorted with themes identified using a constant comparison method. The study was undertaken through the regional academic referral center for adult diabetes care in Ottawa, Canada. Participants included 22 primary care physicians representing a variety of referral frequencies, practice types and settings. Results Participants described facilitators and barriers to successful transition of diabetes care at the provider, patient and systems level. Major facilitators included clear communication of a detailed, structured plan of care, ongoing access to specialist services for advice or re-referral, continuing education and mentoring for PCPs. Identified provider barriers were gaps in PCP knowledge and confidence related to diabetes treatment, excessive workload and competing time demands. Systems deterrents included reimbursement policies for health professionals and inadequate funding for diabetes medications and supplies. At the PCP-patient interface

Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine (StEP) initiative

DEFF Research Database (Denmark)

Myles, P S; Boney, O; Botti, M

2018-01-01

Medicine initiative was established to derive a set of standardised endpoints for use in perioperative clinical trials. METHODS: We undertook a systematic review to identify measures of patient comfort used in the anaesthetic, surgical, and other perioperative literature. A multi-round Delphi consensus...

The Copenhagen Standardised MRI protocol to assess the pubic symphysis and adductor regions of athletes

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Branci, Sonia; Thorborg, Kristian; Bech, Birthe Højlund

2015-01-01

radiologists developed an 11-element MRI evaluation protocol defined according to precise criteria and illustrated in a pictorial atlas. Eighty-six male athletes (soccer players and non-soccer players) underwent standardised 3 Tesla MRI of the pelvis. Two external musculoskeletal radiologists were trained...

Anthropometric standardisation and quality control protocols for the construction of new, international, fetal and newborn growth standards: the INTERGROWTH-21st Project.

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Cheikh Ismail, L; Knight, H E; Ohuma, E O; Hoch, L; Chumlea, W C

2013-09-01

The primary aim of the INTERGROWTH-21(st) Project is to construct new, prescriptive standards describing optimal fetal and preterm postnatal growth. The anthropometric measurements include the head circumference, recumbent length and weight of the infants, and the stature and weight of the parents. In such a large, international, multicentre project, it is critical that all study sites follow standardised protocols to ensure maximal validity of the growth and nutrition indicators used. This paper describes in detail the anthropometric training, standardisation and quality control procedures used to collect data for these new standards. The initial standardisation session was in Nairobi, Kenya, using newborns, which was followed by similar sessions in the eight participating study sites in Brazil, China, India, Italy, Kenya, Oman, UK and USA. The intraobserver and inter-observer technical error of measurement values for head circumference range from 0.3 to 0.4 cm, and for recumbent length from 0.3 to 0.5 cm. These standardisation protocols implemented at each study site worldwide ensure that the anthropometric data collected are of the highest quality to construct international growth standards. © 2013 Royal College of Obstetricians and Gynaecologists.

Establishment of an innovative specialist cardiac indigenous outreach service in rural and remote Queensland.

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Tibby, David; Corpus, Rohan; Walters, Darren L

2010-01-01

Cardiovascular diseases are the leading cause of mortality in Indigenous Australians. Indigneous Australians present at a younger age and have a greater incidence of cardiac risk including smoking and diabetes than non-Indigenous Australians. Access to specialist health services is an important determinant of health care outcomes for these patients. We describe an innovative and successful for model for providing Outreach Cardiac Specialist services to Indigenous communities in rural and remote locations. The approach involves a step-wise process of a) community engagement, b) delivering recovery interventions to improve health outcomes, c) building community capacity to self manage chronic illness and promoting health and well being with the aim of d) community self governance of chronic disease and health promotion. Key elements to this process are community participation in the program, disease self-management led by local health care workers, open access that is all-inclusive utilising community-generated referral, and the translation of scientific knowledge of disease processes into community understanding and making culturally relevant connections. Specialist cardiac services and point of care diagnostics have been provided to 18 sites across rural and remote Queensland. More than 1400 episodes of care have been provided to Indigenous Australians with rheumatic heart disease, ischaemic heart disease and congenital heart conditions. Traditional values can work harmoniously with an inclusive medical approach in this relational model. Crown Copyright 2010. Published by Elsevier B.V. All rights reserved.

TRAINING SYSTEM OF FUTURE SPECIALISTS: QUALITY CONTROL

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Vladimir A. Romanov

2015-01-01

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

Introduction to Medical Terminology for Claretian Medical Center Worker Education Program of Northeastern Illinois University's Chicago Teachers' Center in Partnership with the Union of Needletrades, Industrial, Textile Employers (UNITE).

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Essex Community Coll., MD.

This manual consists of glossaries and descriptions of medical terminology for use in a workplace literacy program for hospital workers. The sections are as follows: hospital patient care areas; hospital departments; medical specialists; word elements (root, prefix, suffix, combining vowel, compound word); surgical procedures; diseases and…

Medical education in difficult circumstances: analysis of the experience of clinical medical students following the new innovative medical curriculum in Aksum, rural Ethiopia.

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Morgan, C; Teshome, M; Crocker-Buque, T; Bhudia, R; Singh, K

2018-05-31

In 2012, 12 medical schools were opened in Ethiopia to tackle the significant shortage of doctors. This included Aksum School of Medicine situated in Aksum, a rural town in Northern Ethiopia. The new Innovative Medical Curriculum (NIMC) is a four-year programme designed by the Ethiopian Federal Ministries of Health and Education. The curriculum is designed to train biomedical science graduates to become doctors in 4 years, with a focus on the healthcare needs of rural people living in poverty. This research was conducted at Aksum School of Medicine and included two hospitals (Aksum Referral Hospital and St Mary's District Hospital). This study focused on medical students during their clinical years across multiple specialities (61 Clerkship 1 students and 13 Clerkship 2 students). We used primarily qualitative research methods supplemented with quantitative measures. There were 3 stages of data collection over a 1 month period, this included qualitative group interviews, direct observation of students in a clinical setting and direct observation of skills sessions followed by a questionnaire on the sessions. We analysed the data by reconstructing the student experience and comparing it with the NIMC. The proposed typical week set out in the NIMC tended to differ from the real clinical experience of these students. Through qualitative group interview and direct observation of teaching, the main theme that was consistent throughout was the lack of doctors with specialist postgraduate training. Clinical need often took priority over education. However, students enjoyed taking early responsibility and gaining practical experience. Through direct observation of skills sessions and short questionnaires, these sessions were highly valuable to the students and they felt confident in carrying out the taught procedures in the future. The combination of poorly resourced hospitals and lack of specialist doctors provides a challenging environment for medical students to learn

Gestalt descriptions embodiments and medical image interpretation

DEFF Research Database (Denmark)

Friis, Jan Kyrre Berg Olsen

2017-01-01

In this paper I will argue that medical specialists interpret and diagnose through technological mediations like X-ray and fMRI images, and by actualizing embodied skills tacitly they are determining the identity of objects in the perceptual field. The initial phase of human interpretation of vis...

mCME project V.2.0: randomised controlled trial of a revised SMS-based continuing medical education intervention among HIV clinicians in Vietnam.

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Gill, Christopher J; Le, Ngoc Bao; Halim, Nafisa; Chi, Cao Thi Hue; Nguyen, Viet Ha; Bonawitz, Rachael; Hoang, Pham Vu; Nguyen, Hoang Long; Huong, Phan Thi Thu; Larson Williams, Anna; Le, Ngoc Anh; Sabin, Lora

2018-01-01

Continuing medical education (CME) is indispensable, but costs are a barrier. We tested the effectiveness of a novel mHealth intervention (mCME V.2.0) promoting CME among Vietnamese HIV clinicians. We enrolled HIV clinicians from three provinces near Hanoi. The 6-month intervention consisted of (1) daily short message service multiple-choice quiz questions, (2) daily linked readings, (3) links to online CME courses and (4) feedback messages describing the performance of the participant relative to the group. Control participants had equal access to the online CME courses. Our primary endpoint was utilisation of the online CME courses; secondary endpoints were self-study behaviour, performance on a standardised medical exam and job satisfaction. From 121 total HIV clinicians in the three provinces, 106 (87.6%) enrolled, and 48/53 intervention (90%) and 47/53 control (89%) participants completed the endline evaluations. Compared with controls, intervention participants were more likely to use the CME courses (risk ratio (RR) 2.3, 95% CI 1.4 to 3.8, accounting for 83% of course use (P<0.001)). Intervention participants increased self-study behaviours over controls in terms of use of medical textbooks (P<0.01), consulting with colleagues (P<0.01), searching on the internet (P<0.001), using specialist websites (P=0.02), consulting the Vietnam HIV/AIDS treatment guidelines (P=0.02) and searching the scientific literature (P=0.09). Intervention participants outperformed controls on the exam (+23% vs +12% score gains, P=0.05) and had higher job satisfaction. The mCME V.2.0 intervention improved self-study behaviour, medical knowledge and job satisfaction. This approach has potential for expansion in Vietnam and similar settings. NCT02381743.

Regimental Medical Officer Charles McKerrow: saving lives on the Western Front.

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Mayhew, E

2014-01-01

Ayrshire general practitioner Charles McKerrow was appointed regimental medical officer (RMO) to the 10th Battalion Northumberland Fusiliers in 1915. At this time, fundamental restructuring of the military medical service on the Western Front had two main effects: surgical capability was moved forward as close to the front as possible and specialist stretcher bearers were trained to apply emergency first aid at the place of injury and to triage casualties appropriately. The specialist stretcher bearers were the equivalent of today's combat medical technicians. The reorganisation was undertaken in a rapid, improvised 'bottom-up' manner and there are very few official records to detail the process. McKerrow and RMOs of his calibre were integral to the successful implementation and operation of this reorganisation so their personal archives are the primary sources for its history. McKerrow's record is particularly detailed and insightful on the process; he was not only an extraordinarily fine medical officer but also provided expert testimony on a period of military medical change that was enduringly successful.

Tensions and Fissures: The Politics of Standardised Testing and Accountability in Ontario, 1995-2015

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Pinto, Laura Elizabeth

2016-01-01

While Ontario has received international accolades for its enactment of province-wide standardised testing upon the formation of the Education Quality and Accountability Office (EQAO), a closer look at provincial assessments over a 20-year span reveals successes as well as systemic tensions and fissures. The purpose of this paper is twofold.…

Host specialist clownfishes are environmental niche generalists

Science.gov (United States)

Litsios, Glenn; Kostikova, Anna; Salamin, Nicolas

2014-01-01

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

Decision making in specialist forensic psychiatric (the psychological aspect

Directory of Open Access Journals (Sweden)

Shmakova E.V.

2016-06-01

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.

Find an Endocrinology - Thyroid Specialist

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... 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 ...

The seven CanMEDS roles in postgraduate medical education should be revised

DEFF Research Database (Denmark)

Malling, Bente Vigh; Sørensen, Jette Led; Mikines, Kári J

2013-01-01

The seven CanMEDS roles were adopted by the Danish reform in postgraduate medical education in 2004. The roles have become a natural part of defining specialist competence. However, the definition of the seven roles from 2000 might not be aligned with the perception of good medical practice anno...

Cultivating a community of practice: the evolution of a health information specialists program for public librarians.

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Clifton, Shari; Jo, Phill; Longo, Jean Marie; Malone, Tara

2017-07-01

To help improve the culture of health in Oklahoma-a state that frequently ranks poorly on multiple measures of health and wellness-faculty librarians from an academic health sciences library sought to create a collaborative network of health information professionals in Oklahoma's public libraries through the implementation of the Health Information Specialists Program. Health sciences librarians offered a variety of consumer health information courses for public library staff across the state of Oklahoma for three years. Courses were approved by the Medical Library Association for credit toward the Consumer Health Information Specialization. A total of seventy-two participants from public libraries attended the courses, sixty-five achieved a Level I Consumer Health Information Specialization, and nine went on to achieve Level II. Feedback from participants in the Health Information Specialists Program has indicated a positive impact on the health information expertise of participants, who in turn have used the knowledge that they gained to help their patrons.

New Investigator and Trainee Task Force Survey on the Recruitment and Retention of Headache Specialists.

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Minen, Mia T; Monteith, Tesha; Strauss, Lauren D; Starling, Amaal

2015-09-01

We sought to survey the New Investigators and Trainees Section (NITS) members of the American Headache Society (AHS) to better understand their exposure to headache medicine during training and to determine their perceptions and attitudes about the field and the future of headache medicine. Despite the high prevalence of headache disorders in the general population, only about 2% of neurology residents pursue headache medicine fellowships. Furthermore, there is a paucity of United Council of Neurologic Subspecialties headache specialists in the country to meet the population demands. Thus, there needs to be a focus on how to recruit and retain more headache specialists. A survey was distributed via SurveyMonkey to the NITS listserv. It remained online for 60 days, during which reminder emails were sent to members of the listserv. In addition, the survey was available on laptops at NITS-related events at an annual AHS meeting. Descriptive analyses were then conducted using SurveyMonkey and Excel. Of the 93 members of NITS, 64 of the 96 (68.8%) clicked to initiate the survey and 52.7% successfully completed it. Attendings made up the majority of respondents (62.5%), followed by fellows (10.9%), and residents (7.8%). Key highlights of the survey included the following: just under 10% reported no exposure to a headache center during any time in their training (medical school, residency, or fellowship); less than 2% had exposure to a headache center during medical school; less than half of participants reported exposure to a headache center in residency (45.3%) and during fellowship (43.4%). Having a mentor in the field, liking the patient population, and working in a headache center, 64.7%, 52.9%, and 41.2%, respectively, were the top ways in which participants became interested in headache. The journal Headache (56.9%), attendings (56.3%), and the AHS/American Academy of Neurology guidelines for migraine management (52.0%) are the resources cited as being used all

Expected roles and utilization of specialist nurses in Japan: the nurse administrators' perspective.

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Onishi, Mami; Kanda, Katsuya

2010-04-01

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.

A combined teamwork training and work standardisation intervention in operating theatres: controlled interrupted time series study.

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Morgan, Lauren; Pickering, Sharon P; Hadi, Mohammed; Robertson, Eleanor; New, Steve; Griffin, Damian; Collins, Gary; Rivero-Arias, Oliver; Catchpole, Ken; McCulloch, Peter

2015-02-01

Teamwork training and system standardisation have both been proposed to reduce error and harm in surgery. Since the approaches differ markedly, there is potential for synergy between them. Controlled interrupted time series with a 3 month intervention and observation phases before and after. Operating theatres conducting elective orthopaedic surgery in a single hospital system (UK Hospital Trust). Teamwork training based on crew resource management plus training and follow-up support in developing standardised operating procedures. Focus of subsequent standardisation efforts decided by theatre staff. Paired observers watched whole procedures together. We assessed non-technical skills using NOTECHS II, technical performance using glitch rate and compliance with WHO checklist using a simple quality tool. We measured complication and readmission rates and hospital stay using hospital administrative records. Before/after change was compared in the active and control groups using two-way ANOVA and regression models. 1121 patients were operated on before and 1100 after intervention. 44 operations were observed before and 50 afterwards. Non-technical skills (p=0.002) and WHO compliance (pteamwork and system improvement causes marked improvements in team behaviour and WHO performance, but not technical performance or outcome. These findings are consistent with the synergistic hypothesis, but larger controlled studies with a strong implementation strategy are required to test potential outcome effects. 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.

Professional training of future specialists with the use of information technologies

Directory of Open Access Journals (Sweden)

Виктор Семенович Корнилов

2013-12-01

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.

A Medical Consultation System to Support Health Care of Inhabitants through A Dialogue with Artificial Intelligence

Science.gov (United States)

Miyake, Hiroshi; Masuzawa, Hideaki

A medical consultation system has been developed that encompasses knowledge of various specialties. The system is designed to be used by general practitioners, and inhabitants themselves. It has the characteristics of ; 1. The input task of complaints is simplified by use of multiple choice questionaires. 2. The system advices the person whether to seek medical help or not, and if so, the degree of urgency, and from what type of practitioner or specialist. 3. It supplies the doctor information regarding essential symptoms and possible diagnosis. 4. The system offer easy tools to make a medical consultation system to the specialists themselves. This system is intended as an answer to the common problem of uncertainty on the part of both inhabitants and doctors as to the area of medical speciality that applies to a given disease.

Medical x-ray

International Nuclear Information System (INIS)

Abd Aziz Mhd Ramli; Gui Ah Auu; Husaini Salleh; Idris Besar; Mohd Ashhar Khalid; Muhammad Jamal Md Isa; Shaharuddin Mohd; Siti Najila Mohd Janib; Mohamed Ali Abdul Khader; Mahalatchimi Dave; Mohd Fazly Abdul Rahim; Ng Chee Moon; Ram Piari; Teoh Hoon Heng; Lee Peter

2004-01-01

This book describes the fundamental subject about medical radiography. It is a multidisciplinary field that requires cross professional input from scientists, engineers and medical doctors. However, it is presented in simple language to suit different levels of readers from x-ray operators and radiographers to physists, general practitioners and radiology specialists.The book is written in accordance to the requirements of the standard syllabus approved by the Ministry of Health Malaysia for the training of medical x-ray operator and general practitioners. In general, the content is not only designed to provide relevant and essential subject for related professionals in medical radiological services such as x-ray operator, radiographer and radiologists, but also to address those in associated radiological services including nurses, medical technologists and physicists.The book is organized and arranged sequentially into 3 parts for easy reference: Radiation safety; X-ray equipment and associated facilities; Radiography practices. With proper grasping of all these parts, the radiological services could be provided with confident and the highest professional standard. Thus, medical imaging with highest quality that can provide useful diagnostic information at minimum doses and at cost effective could be assured

Information needs of generalists and specialists using online best-practice algorithms to answer clinical questions.

Science.gov (United States)

Cook, David A; Sorensen, Kristi J; Linderbaum, Jane A; Pencille, Laurie J; Rhodes, Deborah J

2017-07-01

To better understand clinician information needs and learning opportunities by exploring the use of best-practice algorithms across different training levels and specialties. We developed interactive online algorithms (care process models [CPMs]) that integrate current guidelines, recent evidence, and local expertise to represent cross-disciplinary best practices for managing clinical problems. We reviewed CPM usage logs from January 2014 to June 2015 and compared usage across specialty and provider type. During the study period, 4009 clinicians (2014 physicians in practice, 1117 resident physicians, and 878 nurse practitioners/physician assistants [NP/PAs]) viewed 140 CPMs a total of 81 764 times. Usage varied from 1 to 809 views per person, and from 9 to 4615 views per CPM. Residents and NP/PAs viewed CPMs more often than practicing physicians. Among 2742 users with known specialties, generalists ( N  = 1397) used CPMs more often (mean 31.8, median 7 views) than specialists ( N  = 1345; mean 6.8, median 2; P  < .0001). The topics used by specialists largely aligned with topics within their specialties. The top 20% of available CPMs (28/140) collectively accounted for 61% of uses. In all, 2106 clinicians (52%) returned to the same CPM more than once (average 7.8 views per topic; median 4, maximum 195). Generalists revisited topics more often than specialists (mean 8.8 vs 5.1 views per topic; P  < .0001). CPM usage varied widely across topics, specialties, and individual clinicians. Frequently viewed and recurrently viewed topics might warrant special attention. Specialists usually view topics within their specialty and may have unique information needs. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Redefining "Community" through Collaboration and Co-Teaching: A Case Study of an ESOL Specialist, a Literacy Specialist, and a Fifth-Grade Teacher

Science.gov (United States)

Ahmed Hersi, Afra; Horan, Deborah A.; Lewis, Mark A.

2016-01-01

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…

On occupational-appointment demands on radiation hygiene for medical radiologists

International Nuclear Information System (INIS)

Usol'tsev, V.I.; Kuzin, V.I.; Tselikov, N.V.

1988-01-01

The aim of the work was to determine occupational requirements on radiation hygiene for medical radiologists. To solve the problem using questionnaire, personal conversations with doctors, analysis of basis control and examinations volume and character of work on radiation hygiene were studied in 510 medical radiologists. Occupational requirements for these specialists were worked out on the basis the obtained data. 4 refs

The School Librarian as Information Specialist: A Vibrant Species

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Harris, Frances Jacobson

2011-01-01

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.

Recommendations for successful sensory screening in older adults with dementia in long-term care: a qualitative environmental scan of Canadian specialists.

Science.gov (United States)

Wittich, Walter; Höbler, Fiona; Jarry, Jonathan; McGilton, Katherine S

2018-01-26

This study aimed to identify screening tools, technologies and strategies that vision and hearing care specialists recommend to front-line healthcare professionals for the screening of older adults in long-term care homes who have dementia. An environmental scan of healthcare professionals took place via telephone interviews between December 2015 and March 2016. All interviews were audio recorded, transcribed, proofed for accuracy, and their contents thematically analysed by two members of the research team. A convenience sample of 11 professionals from across Canada specialising in the fields of vision and hearing healthcare and technology for older adults with cognitive impairment were included in the study. As part of a larger mixed-methods project, this qualitative study used semistructured interviews and their subsequent content analysis. Following a two-step content analysis of interview data, coded citations were grouped into three main categories: (1) barriers, (2) facilitators and (3) tools and strategies that do or do not work for sensory screening of older adults with dementia. We report on the information offered by participants within each of these themes, along with a summary of tools and strategies that work for screening older adults with dementia. Recommendations from sensory specialists to nurses working in long-term care included the need for improved interprofessional communication and collaboration, as well as flexibility, additional time and strategic use of clinical intuition and ingenuity. These suggestions at times contradicted the realities of service provision or the need for standardised and validated measures. © 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.

Standardised mortality rate for cerebrovascular diseases in the Slovak Republic from 1996 to 2013 in the context of income inequalities and its international comparison.

Science.gov (United States)

Gavurová, Beáta; Kováč, Viliam; Vagašová, Tatiana

2017-12-01

Non-communicable diseases represent one of the greatest challenges for health policymakers. The main objective of this study is to analyse the development of standardised mortality rates for cerebrovascular disease, which is one of the most common causes of deaths, in relation to income inequality in individual regions of the Slovak Republic. Direct standardisation was applied using data from the Slovak mortality database, covering the time period from 1996 to 2013. The standardised mortality rate declined by 4.23% in the Slovak Republic. However, since 1996, the rate has been higher by almost 33% in men than in women. Standardised mortality rates were lower in the northern part of the Slovak Republic than in the southern part. The regression models demonstrated an impact of the observed income-related dimensions on these rates. The income quintile ratio and Gini coefficient appeared to be the most influencing variables. The results of the analysis highlight valuable baseline information for creating new support programmes aimed at eliminating health inequalities in relation to health and social policy.

Nuclear criticality safety specialist training and qualification programs

International Nuclear Information System (INIS)

Hopper, C.M.

1993-01-01

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

Becoming a Specialist Nurse in Psychiatric Mental Health Care

Science.gov (United States)

Södergren, Ulrika; Benjaminson, Carin; Mattsson, Janet

2017-01-01

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…

The changing role of the subject specialist

Directory of Open Access Journals (Sweden)

Michael Cotta-Schønberg

2007-11-01

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.

[How many generalists and how many specialists does orthopedics and traumatology need?].

Science.gov (United States)

Achatz, G; Perl, M; Stange, R; Mutschler, M; Jarvers, J S; Münzberg, M

2013-01-01

The training in orthopedic and trauma surgery has changed significantly with the introduction of the new residency program. The contents taught have already been reduced in breadth and the current developments in the outpatient and particularly in the clinical landscape also contribute to increasing specialization. This trend favors structures in which comprehensive medical care for the population in Germany in orthopedic and trauma surgery appears to be endangered and in which the future efforts for e.g. polytraumatised patients need to be questioned. The Young Forum of the German Society for Orthopedics and Traumatology actively accompanies a discussion about the necessity and value of generalists to ensure the level of care in Germany in addition to the specialists.

Standardised risk analysis as a communication tool

International Nuclear Information System (INIS)

Pluess, Ch.; Montanarini, M.; Bernauer, M.

1998-01-01

Full text of publication follows: several European countries require a risk analysis for the production, storage or transport a dangerous goods. This requirement imposes considerable administrative effort for some sectors of the industry. In order to minimize the effort of such studies, a generic risk analysis for an industrial sector proved to help. Standardised procedures can consequently be derived for efficient performance of the risk investigations. This procedure was successfully established in Switzerland for natural gas transmission lines and fossil fuel storage plants. The development process of the generic risk analysis involved an intense discussion between industry and authorities about methodology of assessment and the criteria of acceptance. This process finally led to scientific consistent modelling tools for risk analysis and to an improved communication from the industry to the authorities and the public. As a recent example, the Holland-Italy natural gas transmission pipeline is demonstrated, where this method was successfully employed. Although this pipeline traverses densely populated areas in Switzerland, using this established communication method, the risk problems could be solved without delaying the planning process. (authors)

Certification of the instructional competence of nuclear training specialists

International Nuclear Information System (INIS)

Wollert, T.N.

1990-01-01

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

Strengthening medical education in haematology and blood transfusion: postgraduate programmes in Tanzania.

Science.gov (United States)

Makani, Julie; Lyimo, Magdalena; Magesa, Pius; Roberts, David J

2017-06-01

Haematology and blood transfusion, as a clinical and laboratory discipline, has a far-reaching impact on healthcare both through direct patient care as well as provision of laboratory and transfusion services. Improvement of haematology and blood transfusion may therefore be significant in achieving advances in health in Africa. In 2005, Tanzania had one of the lowest distributions of doctors in the world, estimated at 2·3 doctors per 100 000 of population, with only one haematologist, a medical doctor with postgraduate medical education in haematology and blood transfusion. Here, we describe the establishment and impact of a postgraduate programme centred on Master of Medicine and Master of Science programmes to build the capacity of postgraduate training in haematology and blood transfusion. The programme was delivered through Muhimbili University of Health and Allied Sciences (MUHAS) with partnership from visiting medical and laboratory staff from the UK and complemented by short-term visits of trainees from Tanzania to Haematology Departments in the UK. The programme had a significant impact on the development of human resources in haematology and blood transfusion, successfully training 17 specialists with a significant influence on delivery of health services and research. This experience shows how a self-sustaining, specialist medical education programme can be developed at low cost within Lower and Middle Income Countries (LMICs) to rapidly enhance delivery of capacity to provide specialist services. © 2017 John Wiley & Sons Ltd.

Standardised studies on Molar Incisor Hypomineralisation (MIH) and Hypomineralised Second Primary Molars (HSPM): a need.

Science.gov (United States)

Elfrink, M E C; Ghanim, A; Manton, D J; Weerheijm, K L

2015-06-01

In November 2014, a review of literature concerning prevalence data of Molar Incisor Hypomineralisation (MIH) and Hypomineralised Second Primary Molars (HSPM) was performed. A search of PubMed online databases was conducted for relevant articles published until November 2014. The reference lists of all retrieved articles were hand-searched. Studies were included after assessing the eligibility of the full-text article. Out of 1078 manuscripts, a total of 157 English written publications were selected based on title and abstract. Of these 157, 60 were included in the study and allocated as 52 MIH and 5 HSPM, and 3 for both MIH and HSPM. These studies utilised the European Academy of Paediatric Dentistry judgment criteria, the modified index of developmental defects of enamel (mDDE) and self-devised criteria, and demonstrated a wide variation in the reported prevalence (MIH 2.9-44 %; HSPM 0-21.8 %). Most values mentioned were representative for specific areas. More studies were performed in cities compared with rural areas. A great variation was found in calibration methods, number of participants, number of examiners and research protocols between the studies. The majority of the prevalence studies also investigated possible aetiological factors. To compare MIH and HSPM prevalence and or aetiological data around the world, standardisation of such studies seems essential. Standardisation of the research protocol should include a clearly described sample of children (minimum number of 300 for prevalence and 1000 for aetiology studies) and use of the same calibration sets and methods whereas aetiological studies need to be prospective in nature. A standardised protocol for future MIH and HSPM prevalence and aetiology studies is recommended.

Meanings of medical treatment among HIV/AIDS family caregivers pr

African Journals Online (AJOL)

Mokhantšo Makoae a mmakoae@hsrc.ac.za

Mokhantšo Makoae is a senior research specialist at the Human Sciences Research Council (HSRC) in the Population Health, ... symptoms that diminish their quality of life and that of their family ...... medical diagnosis, Artificial Intelligence.

Review of The Behavioral Health Specialist in Primary Care: Skills for Integrated Practice.

Science.gov (United States)

Harsh, Jennifer

2016-03-01

Reviews the book, The Behavioral Health Specialist in Primary Care: Skills for Integrated Practice edited by Mary Ann Burg and Oliver Oyama (see record 2015-46891-000). The editors and the chapter authors of this useful book provide insight into the skills and knowledge needed to do integrated behavioral health in primary care. The most beneficial part of the book is the layout of the chapters, and the authors do a great job of articulating the clinical components of care. Behavioral health and medical providers in practice or in training could greatly benefit from reading this book. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

An analysis of specialist and non-specialist user requirements for geographic climate change information.

Science.gov (United States)

Maguire, Martin C

2013-11-01

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.

Nurse specialists in adult congenital heart disease: The current status in Europe

NARCIS (Netherlands)

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.

2006-01-01

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

The Person over Standardisation: A Humanistic Framework for Teacher Learning in Diverse School-Based Contexts

Science.gov (United States)

Kazanjian, Christopher J.; Choi, Su-Jin

2016-01-01

This paper argues that the purpose of education is to help students realise their unique potentials and pursue inner directions. With this assumption, we critique the inadequacy of the current emphasis on standardisation and provide a theoretical framework for teacher education based on humanistic psychology. Three tenets of humanistic psychology,…

22 CFR 62.26 - Specialists.

Science.gov (United States)

2010-04-01

... 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...

Medical handling of accidentally exposed individuals

International Nuclear Information System (INIS)

1988-01-01

In 1978 the International Atomic Energy Agency issued a publication in the IAEA Safety Series entitled Manual on Early Medical Treatment of Possible Radiation Injury (Safety Series No. 47). The contents were directed to first aid and early medical treatment of workers who might be concerned in an accident involving exposure to radiation, whether external or internal. The present manual is the first of a set of three safety series publications dealing with assessment and treatment of overexposures which will constitute an articulated system of documents covering all aspects of diagnosis, prognosis and treatment of overexposures. This document establishes a set of general criteria and recommendations to aid specialists involved in the medical handling of overexposed persons. It deals with the medical management of individual patients or small groups of patients under close medical supervision. 14 refs, 7 figs, 7 tabs

Introducing competency-based postgraduate medical education in the Netherlands.

Science.gov (United States)

Scheele, Fedde; Teunissen, Pim; Van Luijk, Scheltus; Heineman, Erik; Fluit, Lia; Mulder, Hanneke; Meininger, Abe; Wijnen-Meijer, Marjo; Glas, Gerrit; Sluiter, Henk; Hummel, Thalia

2008-01-01

Medical boards around the world face the challenge of creating competency-based postgraduate training programs. Recent legislation requires that all postgraduate medical training programmes in The Netherlands be reformed. In this article the Dutch Advisory Board for Postgraduate Curriculum Development shares some of their experiences with guiding the design of specialist training programs, based on the Canadian Medical Educational Directives for Specialists (CanMEDS). All twenty-seven Dutch Medical Specialty Societies take three steps in designing a curriculum. First they divide the entire content of a specialty into logical units, so-called 'themes'. The second step is discussing, for each theme, for which tasks trainees have to be instructed, guided, and assessed. Finally, for each task an assessment method is chosen to focus on a limited number of CanMEDS roles. This leads to a three step training cycle: (i) based on their in-training assessment and practices, trainees will gather evidence on their development in a portfolio; (ii) this evidence stimulates the trainee and the supervisor to regularly reflect on a trainee's global development regarding the CanMEDS roles as well as on the performance in specific tasks; (iii) a personal development plan structures future learning goals and strategies. The experiences in the Netherlands are in line with international developments in postgraduate medical education and with the literature on workplace-based teaching and learning.

Payload specialist Reinhard Furrer show evidence of previous blood sampling

Science.gov (United States)

1985-01-01

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.

Satellite medical centers project

Science.gov (United States)

Aggarwal, Arvind

2002-08-01

World class health care for common man at low affordable cost: anywhere, anytime The project envisages to set up a national network of satellite Medical centers. Each SMC would be manned by doctors, nurses and technicians, six doctors, six nurses, six technicians would be required to provide 24 hour cover, each SMC would operate 24 hours x 7 days. It would be equipped with the Digital telemedicine devices for capturing clinical patient information and investigations in the form of voice, images and data and create an audiovisual text file - a virtual Digital patient. Through the broad band connectivity the virtual patient can be sent to the central hub, manned by specialists, specialists from several specialists sitting together can view the virtual patient and provide a specialized opinion, they can see the virtual patient, see the examination on line through video conference or even PCs, talk to the patient and the doctor at the SMC and controlle capturing of information during examination and investigations of the patient at the SMC - thus creating a virtual Digital consultant at the SMC. Central hub shall be connected to the doctors and consultants in remote locations or tertiary care hospitals any where in the world, thus creating a virtual hub the hierarchical system shall provide upgradation of knowledge to thedoctors in central hub and smc and thus continued medical education and benefit the patient thru the world class treatment in the smc located at his door step. SMC shall be set up by franchisee who shall get safe business opportunity with high returns, patients shall get Low cost user friendly worldclass health care anywhere anytime, Doctors can get better meaningful selfemplyment with better earnings, flexibility of working time and place. SMC shall provide a wide variety of services from primary care to world class Global consultation for difficult patients.

A review of imaging protocols for suspected skeletal dysplasia and a proposal for standardisation

International Nuclear Information System (INIS)

Watson, Sarah G.; Calder, Alistair D.; Offiah, Amaka C.; Negus, Samantha

2015-01-01

Expert radiology opinions are often requested to aid diagnosis of skeletal dysplasias or dysostoses, but due to variability in the imaging protocols used at different centres the views presented may be considered inadequate or incomplete resulting in diagnostic delays and increased patient and family anxiety. We propose the introduction of a standardised protocol that may be adapted in certain specific situations. (orig.)

A review of imaging protocols for suspected skeletal dysplasia and a proposal for standardisation

Energy Technology Data Exchange (ETDEWEB)

Watson, Sarah G. [Royal Surrey County Hospital, Department of Radiology, Surrey (United Kingdom); Calder, Alistair D. [Great Ormond Street Hospital for Children, NHS Foundation Trust, Department of Radiology, London (United Kingdom); Offiah, Amaka C. [Sheffield Children' s NHS Foundation Trust, The University of Sheffield Academic Unit of Child Health, Sheffield (United Kingdom); Negus, Samantha [St George' s Hospital, Department of Radiology, London (United Kingdom)

2015-11-15

Expert radiology opinions are often requested to aid diagnosis of skeletal dysplasias or dysostoses, but due to variability in the imaging protocols used at different centres the views presented may be considered inadequate or incomplete resulting in diagnostic delays and increased patient and family anxiety. We propose the introduction of a standardised protocol that may be adapted in certain specific situations. (orig.)

A combination of process of care and clinical target among type 2 diabetes mellitus patients in general medical clinics and specialist diabetes clinics at hospital levels.

Science.gov (United States)

Sieng, Sokha; Hurst, Cameron

2017-08-07

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.

Education governance and standardised tests in Denmark and England

DEFF Research Database (Denmark)

Kousholt, Kristine; Kelly, Peter; McNess, Elizabeth

2017-01-01

In this study we identify and compare the impact of standardised student assessment in England, an established neoliberal context, and in Denmark where a neoliberal education reform agenda is emerging in response to both national concerns and international governance. National reading tests...... for students aged 11–12 years, long established in England, were introduced in Denmark in 2010. The form they take differs considerably, being primarily formative in Denmark and largely summative in England. Culturally sensitive extended semi-structured interviews are conducted with both teachers and students...... they believe to be their students’ best interests. In England, however, teachers try to accommodate a concern for both their students’ and their own interests, and the pedagogy they enact is more often controlling, instrumental and reductionist; their wish to be proactive is compromised by their need...

A retrospective cohort study on lifestyle habits of cardiovascular patients: how informative are medical records?

NARCIS (Netherlands)

Fouwels, Annemarie J.; Bredie, Sebastiaan J. H.; Wollersheim, Hub; Schippers, Gerard M.

2009-01-01

ABSTRACT: BACKGROUND: To evaluate the vigilance of medical specialists as to the lifestyle of their cardiovascular outpatients by comparing lifestyle screening as registered in medical records versus a lifestyle questionnaire (LSQ), a study was carried out at the cardiovascular outpatient clinic of

A retrospective cohort study on lifestyle habits of cardiovascular patients: how informative are medical records?

NARCIS (Netherlands)

Fouwels, A.J.; Bredie, S.J.H.; Wollersheim, H.C.H.; Schippers, G.M.

2009-01-01

BACKGROUND: To evaluate the vigilance of medical specialists as to the lifestyle of their cardiovascular outpatients by comparing lifestyle screening as registered in medical records versus a lifestyle questionnaire (LSQ), a study was carried out at the cardiovascular outpatient clinic of the

Addressing cultural diversity: the hepatitis B clinical specialist perspective.

Science.gov (United States)

Wallace, Jack; Smith, Elizabeth; Hajarizadeh, Behzad; Richmond, Jacqueline; Lucke, Jayne

2017-08-31

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

Does an in-house internist at a GP practice result in reduced referrals to hospital-based specialist care?

Science.gov (United States)

Quanjel, Tessa C C; Winkens, Anne; Spreeuwenberg, Marieke D; Struijs, Jeroen N; Winkens, Ron A G; Baan, Caroline A; Ruwaard, Dirk

2018-03-01

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.

Wildlife Private Lands Specialist Support Areas

Data.gov (United States)

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...

A multi-centre study of interactional style in nurse specialist- and physician-led Rheumatology clinics in the UK.

Science.gov (United States)

Vinall-Collier, Karen; Madill, Anna; Firth, Jill

2016-07-01

Nurse-led care is well established in Rheumatology in the UK and provides follow-up care to people with inflammatory arthritis including treatment, monitoring, patient education and psychosocial support. The aim of this study is to compare and contrast interactional style with patients in physician-led and nurse-led Rheumatology clinics. A multi-centre mixed methods approach was adopted. Nine UK Rheumatology out-patient clinics were observed and audio-recorded May 2009-April 2010. Eighteen practitioners agreed to participate in clinic audio-recordings, researcher observations, and note-taking. Of 9 nurse specialists, 8 were female and 5 of 9 physicians were female. Eight practitioners in each group took part in audio-recorded post-clinic interviews. All patients on the clinic list for those practitioners were invited to participate and 107 were consented and observed. In the nurse specialist cohort 46% were female; 71% had a diagnosis of Rheumatoid Arthritis (RA). The physician cohort comprised 31% female; 40% with RA and 16% unconfirmed diagnosis. Nineteen (18%) of the patients observed were approached for an audio-recorded telephone interview and 15 participated (4 male, 11 female). Forty-four nurse specialist and 63 physician consultations with patients were recorded. Roter's Interactional Analysis System (RIAS) was used to code this data. Thirty-one semi-structured interviews were conducted (16 practitioner, 15 patients) within 24h of observed consultations and were analyzed using thematic analysis. RIAS results illuminated differences between practitioners that can be classified as 'socio-emotional' versus 'task-focussed'. Specifically, nurse specialists and their patients engaged significantly more in the socio-emotional activity of 'building a relationship'. Across practitioners, the greatest proportion of 'patient initiations' were in 'giving medical information' and reflected what patients wanted the practitioner to know rather than giving insight into

Reasons why specialist doctors undertake rural outreach services: an Australian cross-sectional study.

Science.gov (United States)

O'Sullivan, Belinda G; McGrail, Matthew R; Stoelwinder, Johannes U

2017-01-07

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.

Subject Specialist Mentors in the Lifelong Learning Sector: The Subject Specialist Mentor Model; is it working? A case study approach

Directory of Open Access Journals (Sweden)

Bailey, Wayne

2011-01-01

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.

STS-9 payload specialists and backup in training session

Science.gov (United States)

1983-01-01

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.

IMPROVEMENT OF INNOVATIVE TRAINING OF ROAD SPECIALISTS

Directory of Open Access Journals (Sweden)

I. I. Leonovich

2007-01-01

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. 

The Perception of Teachers and School Library Media Specialist on ...

African Journals Online (AJOL)

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 ...

Pharmacovigilance training for specialist oncology nurses-a two way evaluation

NARCIS (Netherlands)

Schutte, T.; Van Eekeren, R.; Richir, M.; Van Staveren, J.; Van Puijenbroek, E.P.; Tichelaar, J.; Van Agtmael, M.A.

2017-01-01

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.

The requirements of a specialist Prostate Cancer Unit: a discussion paper from the European School of Oncology.

Science.gov (United States)

Valdagni, Riccardo; Albers, Peter; Bangma, Chris; Drudge-Coates, Lawrence; Magnani, Tiziana; Moynihan, Clare; Parker, Chris; Redmond, Kathy; Sternberg, Cora N; Denis, Louis; Costa, Alberto

2011-01-01

The widely recognised benefits of a multidisciplinary approach to treating cancer may be particularly important in prostate cancer, where there are so many treatment options to choose from. It offers patients the best chance of receiving high-quality medical procedures administered by a team of specialists in prostate disease, which is able to tailor treatment and observational strategies to their needs, and ensure access to specialist counselling, supportive care and rehabilitation. This article proposes Prostate Cancer Units as the most suitable structures for organising specialist multidisciplinary care for patients at all stages, from newly diagnosed to advanced disease, including preventing and managing the main complications, whether physical, emotional or psychological, arising from the disease and its treatment. Following the German example with prostate cancer, the British example with urological malignancies and the European breast cancer units, this article proposes general recommendations and mandatory requirements for Prostate Cancer Units, with a view to laying the basis for a network of certified units across Europe. Such a network could help improve standards of care throughout the region, providing patients, practitioners and health authorities with a means of identifying high-quality units and providing a system of quality control and audit. The article is intended as a contribution to the debate within the European uro-oncologic community on the best way to organise prostate cancer care. Copyright © 2010 Elsevier Ltd. All rights reserved.

Medical oncology future plan of the Spanish Society of Medical Oncology: challenges and future needs of the Spanish oncologists.

Science.gov (United States)

Rivera, F; Andres, R; Felip, E; Garcia-Campelo, R; Lianes, P; Llombart, A; Piera, J M; Puente, J; Rodriguez, C A; Vera, R; Virizuela, J A; Martin, M; Garrido, P

2017-04-01

The SEOM Future Plan is aimed at identifying the main challenges, trends and needs of the medical oncology speciality over the next years, including potential oncologist workforce shortages, and proposing recommendations to overcome them. The estimations of the required medical oncologists workforce are based on an updated Medical Oncologist Register in Spain, Medical Oncology Departments activity data, dedication times and projected cancer incidence. Challenges, needs and future recommendations were drawn from an opinion survey and an advisory board. A shortage of 211 FTE medical oncologist specialists has been established. To maintain an optimal ratio of 158 new cases/FTE, medical oncology workforce should reach 1881 FTE by 2035. Main recommendations to face the growing demand and complexity of oncology services include a yearly growth of 2.5% of medical oncologist's workforce until 2035, and development and application of more accurate quality indicators for cancer care and health outcomes measure.

The Application of Box–Cox Transformation to Determine the Standardised Precipitation Index (SPI, the Standardised Discharge Index (SDI and to Identify Drought Events: Case Study in Eastern Kujawy (Central Poland

Directory of Open Access Journals (Sweden)

Bartczak Arkadiusz

2014-10-01

Full Text Available The article presents the results of research into the transformation of series of hydro-meteorological data for determining dry periods with the Standardised Precipitation Index (SPI and the Standardised Discharge Index (SDI. Time series from eight precipitation stations and five series of river discharge data in Eastern Kujawy (central Poland were analysed for 1951–2010. The frequency distribution of the series for their convergence with the normal distribution was tested with the Shapiro–Wilk test and homogeneity with the Bartlett's test. The transformation of the series was done with the Box–Cox technique, which made it possible to homogenise the series in terms of variance. In Poland, the technique has never been used to determine the SPI. After the transformation the distributions of virtually all series complied with the normal distribution and were homogeneous. Moreover, a statistically significant correlation between the δ transformation parameter and the skewness of the series of monthly precipitation was observed. It was similar for the series of mean monthly discharges in the winter half-year and the hydrological year. The analysis indicates an alternate occurrence of dry and wet periods both in case of precipitation and run-offs. Drought periods coincided with low flow periods. Thus, the fluctuations tend to affect the development of agriculture more than long-term ones.

Improved education after implementation of the Danish postgraduate medical training reform

DEFF Research Database (Denmark)

Kodal, Troels; Kjær, Niels Kristian; Qvesel, Dorte

2012-01-01

A reform of educational postgraduate medical training was launched in Denmark in 2004. The reform was based on a report by the Danish Medical Specialist Commission and consisted of a number of initiatives that were all aimed at improving the quality of medical training. Since 1998, all junior...... doctors in Denmark have been requested to rate the quality of their training on a Danish standardized questionnaire (DSQ) comprising 24 questions. In this study, we examined how junior doctors in hospitals rated their postgraduate medical training before and six years after the reform was implemented....

Medical cyber-physical systems: A survey.

Science.gov (United States)