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Adequate Training (adequate + training)
Selected AbstractsA North American multilaboratory study of CD4 counts using flow cytometric panleukogating (PLG): A NIAID-DAIDS Immunology Quality Assessment Program Study,,§¶CYTOMETRY, Issue S1 2008Thomas N. Denny Abstract Background The global HIV/AIDS pandemic and guidelines for initiating anti-retroviral therapy (ART) and opportunistic infection prophylaxis demand affordable, reliable, and accurate CD4 testing. A simple innovative approach applicable to existing technology that has been successfully applied in resource-challenged settings, PanLeukogated CD4 (PLG), could offer solutions for cost saving and improved precision. Methods Day-old whole blood from 99 HIV+ donors was simultaneously studied in five North-American laboratories to compare the performance of their predicate methods with the dual-platform PLG method. The predicate technology included varying 4-color CD45/CD3/CD4/CD8 protocols on different flow cytometers. Each laboratory also assayed eight replicate specimens of day-old blood from 10 to 14 local donors. Bias and precision of predicate and PLG methods was studied between- and within-participating laboratories. Results Significantly (P < 0.0001) improved between-laboratory precision/coefficient of variation (CV%) was noted using the PLG method (overall median 9.3% vs. predicate median CV 13.1%). Within-laboratory precision was also significantly (P < 0.0001) better overall using PLG (median 4.6% vs. predicate median CV 6.2%) and in 3 of the 5 laboratories. PLG counts tended to be 11% smaller than predicate methods (P < 0.0001) for shipped (median of predicate,PLG = 31) and local specimens (median of predicate,PLG = 23), both overall and in 4 of 5 laboratories (median decreases of 4, 16, 20, and 21% in shipped specimens); the other laboratory had a median increase of 5%. Conclusion Laboratories using predicate CD4 methods similar to those in this study could improve their between-laboratory and their within-laboratory precision, and reduce costs, by switching to the PLG method after adequate training, if a change (usually, a decrease) in CD4 counts is acceptable to their health systems. © 2008 Clinical Cytometry Society [source] The BSCC Code of Practice , exfoliative cytopathology (excluding gynaecological cytopathology)CYTOPATHOLOGY, Issue 4 2009A. Chandra Exfoliative cytopathology (often referred to as non-gynaecological cytology) is an important part of the workload of all diagnostic pathology departments. It clearly has a role in the diagnosis of neoplastic disease but its role in establishing non-neoplastic diagnoses should also be recognised. Ancillary tests may be required to establish a definitive diagnosis. Clinical and scientific teamwork is essential to establish an effective cytology service and staffing levels should be sufficient to support preparation, prescreening, on-site adequacy assessment and reporting of samples as appropriate. Routine clinical audit and histology/cytology correlation should be in place as quality control of a cytology service. Cytology staff should be involved in multidisciplinary meetings and appropriate professional networks. Laboratories should have an effective quality management system conforming to the requirements of a recognised accreditation scheme such as Clinical Pathology Accreditation (UK) Ltd. Consultant pathologists should sign out the majority of exfoliative cytology cases. Where specimens are reported by experienced biomedical scientists (BMS), referred to as cytotechnologists outside the UK, this must only be when adequate training has been given and be defined in agreed written local protocols. An educational basis for formalising the role of the BMS in exfoliative cytopathology is provided by the Diploma of Expert Practice in Non-gynaecological Cytology offered by the Institute of Biomedical Science (IBMS). The reliability of cytological diagnoses is dependent on the quality of the specimen provided and the quality of the preparations produced. The laboratory should provide feedback and written guidance on specimen procurement. Specimen processing should be by appropriately trained, competent staff with appropriate quality control. Microscopic examination of preparations by BMS should be encouraged wherever possible. Specific guidance is provided on the clinical role, specimen procurement, preparation and suitable staining techniques for urine, sputum, semen, serous cavity effusion, cerebrospinal fluid, synovial fluid, cyst aspirates, endoscopic specimens, and skin and mucosal scrapes. [source] Oro-facial injuries in Central American and Caribbean sports games: a 20-year experienceDENTAL TRAUMATOLOGY, Issue 3 2005Enrique Amy Abstract,,, Dental services in sports competitions in the Games sponsored by the International Olympic Committee are mandatory. In every Central American, Pan American and Olympic Summer Games, as well as Winter Games, the Organizing Committee has to take all the necessary measures to assure dental services to all competitors. In all Olympic villages, as part of the medical services, a dental clinic is set up to treat any dental emergency that may arise during the Games. Almost every participating country in the Games has its own medical team and some may include a dentist. The major responsibilities of the team dentist as a member of the national sports delegation include: (i) education of the sports delegation about different oral and dental diseases and the illustration of possible problems that athletes or other personnel may encounter during the Games, (ii) adequate training and management of orofacial trauma during the competition, (iii) knowledge about the rules and regulations of the specific sport that the dentist is working, (iv) understanding of the anti-doping control regulations and procedures, (v) necessary skills to fabricate a custom-made and properly fitted mouthguard to all participants in contact or collision sports of the delegation. This study illustrates the dental services and occurrence of orofacial injury at the Central American and Caribbean Sports Games of the Puerto Rican Delegation for the past 20 years. A total of 2107 participants made up the six different delegations at these Games. Of these 279 or 13.2% were seen for different dental conditions. The incidence of acute or emergency orofacial conditions was 18 cases or 6% of the total participants. The most frequent injury was lip contusion with four cases and the sport that experienced more injuries was basketball with three cases. [source] Obstetrician-gynecologists' screening patterns for anxiety during pregnancy,DEPRESSION AND ANXIETY, Issue 2 2008Victoria H. Coleman M.A. Abstract As obstetrician-gynecologists (ob-gyns) take on a greater role in women's healthcare, it is important that they are aware of the high prevalence of anxiety disorders in their patient population. Anxiety disorders present during pregnancy can have detrimental effects on both mother and child. In this study, we queried 1,193 ob-gyns on their screening rates, practice patterns, training, and knowledge as they relate to anxiety disorders during pregnancy. We achieved a 44% response rate (n=397) after three mailings. Physicians reported a moderate interest in screening for and diagnosing anxiety, but less interest in treatment. Only 20% of respondents (n=79) screen for anxiety during pregnancy, and they typically refer anxiety-disordered patients to mental health professionals. Ob-gyns with comprehensive or adequate training were significantly more likely to screen than those who stated that their training was inadequate. Having a friend who has been diagnosed with an anxiety disorder also significantly increased both the likelihood that these physicians would screen and the reported level of interest in screening of anxiety disorders during pregnancy. At present, the majority of ob-gyns feel that their training in this area was barely adequate to inadequate. Specifically, generalized anxiety disorder may be the least understood. Increased training in this area would allow ob-gyns to overcome what they list as the primary barrier to anxiety screening during pregnancy,that is, inadequate training about anxiety disorders. Depression and Anxiety 0:1,10, 2007. Published © 2007 Wiley-Liss, Inc. [source] Beauty Versus Medicine: The Nonphysician Practice of Dermatologic SurgeryDERMATOLOGIC SURGERY, Issue 4 2003Harold J. Brody MD Background This investigation was initiated because of a growing concern by the American Society for Dermatologic Surgery about the proliferation of nonphysicians practicing medicine and its impact on public health, safety, and welfare. Objective Prompted by an alarming rise in anecdotal reports among dermatologic surgeons, the study sought to determine whether there was a significant increase in the number of patients seeking corrective treatment due to complications from laser and light-based hair removal, subsurface laser/light rejuvenation techniques, chemical peels, microdermabrasion, injectables, and other cosmetic medical/surgical procedures performed by nonphysicians without adequate training or supervision. Methods A survey of 2,400 American Society for Dermatologic Surgery members in July 2001 and in-depth phone interviews with eight patients who experienced complications from nonphysicians performing cosmetic dermatologic surgery procedures were conducted. Results Survey data and qualitative research results attributed patient complications primarily to "nonphysician operators" such as cosmetic technicians, estheticians, and employees of medical/dental professionals who performed various invasive medical procedures outside of their scope of training or with inadequate or no physician supervision. Conclusion The results underscore the need for improved awareness, legislation, and enforcement regarding the nonphysician practice of medicine, along with further study of this issue. [source] Attitudes towards skills examinations for basic surgical traineesINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 1 2005S.D. Bann Summary Objective measures of surgical skill and cognition are becoming available. A questionnaire study examining surgeons' beliefs towards a skills-based examination, current standards and possible benefits was devised. Three hundred pairs of standardised anonymous questionnaires were sent to consultants and their basic surgical trainees (BSTs) irrespective of surgical speciality. Responses were requested using a Likert scale (1,5, 3 = neutral response). Two-hundred and two replies were received (including 54 pairs). BST experience ranged from 6 to 60 months (mean 24 months). When questioned regarding current training in basic surgical skills, only 34% believed that they were given adequate training at present. Sixty-four per cent of respondents believed the introduction of a skills examination would raise standards and 66% believed it necessary. Eighty-three per cent of respondents believed that they or their BST would practice these skills, if an examination were introduced and 85% wanted or would provide dedicated teaching time for this. However, 68% had no access to a dedicated skills facility, and uptake of these, where available, was variable. When questioned about their ability to perform the six appropriate tasks, there was a poor correlation of scoring between the groups. Consultants and their BSTs do not believe that they are given adequate training in basic skills. The introduction of an examination would lead to practice of these skills and is seen as a positive move. [source] Barriers for dental treatment of primary teeth in East and West GermanyINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 2 2009CHRISTIAN H. SPLIETH Background., In many countries, restorative treatment in primary teeth is suboptimal. Aim., Thus, this study tried to detect barriers for dentists to restore primary teeth in kindergarten children (3,6 years). Design., For a representative survey, 320 dentists (184 West, 136 East Germany) were randomly selected from the dental associations' registers and asked to answer a questionnaire on their profile, their view of the National Health System, and possible barriers for restoring primary teeth. Results., The analysis (response rate 57.7%) showed that the parents were no barrier and the dentists felt the need of restoring primary teeth. In addition to the children's anxiety, the inadequate reimbursement for fillings were perceived as clear barrier. The comparison of West and East German dentists detected statistically significantly higher barriers in West Germany, where , in contrast to the German Democratic Republic , no structured training in paediatric dentistry was compulsory before unification. Only 35% of the East German dentists rated restorative treatment in 3- to 6-year-olds as stressful in contrast to 65% in West Germany, where especially male dentists found no time to treat children. Conclusion., This study reveals that dentists can also be a considerable barrier to restorative treatment in small children, especially without adequate training in dental schools. [source] Leading change through an international faculty development programmeJOURNAL OF NURSING MANAGEMENT, Issue 8 2009LORA C. LACEY-HAUN PhD Aims, The purpose of the study was to evaluate the modification of an American model of academic leadership training for utilization in an African university and to pilot test the efficacy of the resulting model. Background, Traditionally many educators have moved into administrative positions without adequate training. Current world standards require leadership preparation for a wide array of persons. However, this opportunity did not yet exist in the study setting. Method, University leaders from the University of the Western Cape and the University of Missouri collaborated on revising and pilot testing a successful American academic leadership programme for use among African faculty. Cross-cultural adaptations, participant satisfaction and subsequent outcomes were assessed during the 2-year ,train-the-trainer' leadership development programme. Results, African faculty successfully modified the American training model, participated in training activities, and after 2 years, began to offer the service to other institutions in the region, which has increased the number of nurses in Africa who have had, and who will continue to have, the opportunity to move up the career ladder. Conclusion, The impact of the project extended further than originally expected, as the original plan to utilize the training materials at the University of the Western Cape (UWC) for the in-house faculty was expanded to allow UWC to utilize the modified materials to serve leadership development needs of faculty in other African universities. Implications for nursing management, Study findings will inform those interested in university policy and procedure on leadership training issues. The successful development of a self-sustaining leadership programme in which values of multiple cultures must be appropriately addressed has a significant impact for nursing administration. With the severe nursing shortage, health care institutions must develop cost effective yet quality development programmes to assure the succession of current staff into leadership positions. We no longer have the luxury of recruiting broadly and we must identify those talented nurses within our own institutions and prepare them for advanced leadership roles. This succession plan is especially important for the next generation of nurse leaders representing minority populations. In particular, nurse managers will find the overview of the literature for middle managers enlightening, and may find links to key resources that could be revised to be more culturally relevant for use in a wide array of settings. [source] European Federation of Neurological Societies/Peripheral Nerve Society Guideline on the use of skin biopsy in the diagnosis of small fiber neuropathy.JOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 2 2010Report of a joint task force of the European Federation of Neurological Societies, the Peripheral Nerve Society Revision of the guidelines on the use of skin biopsy in the diagnosis of peripheral neuropathy, published in 2005, has become appropriate due to publication of more relevant papers. Most of the new studies focused on small fiber neuropathy (SFN), a subtype of neuropathy for which the diagnosis was first developed through skin biopsy examination. This revision focuses on the use of this technique to diagnose SFN. Task force members searched the Medline database from 2005, the year of the publication of the first EFNS guideline, to June 30th, 2009. All pertinent papers were rated according to the EFNS and PNS guidance. After a consensus meeting, the task force members created a manuscript that was subsequently revised by two experts (JML and JVS) in the field of peripheral neuropathy and clinical neurophysiology, who were not previously involved in the use of skin biopsy. Distal leg skin biopsy with quantification of the linear density of intraepidermal nerve fibers (IENF), using generally agreed upon counting rules, is a reliable and efficient technique to assess the diagnosis of SFN (level A recommendation). Normative reference values are available for bright-field immunohistochemistry (level A recommendation) but not yet for confocal immunofluorescence or the blister technique. The morphometric analysis of IENF density, either performed with bright-field or immunofluorescence microscopy, should always refer to normative values matched for age (level A recommendation). Newly established laboratories should undergo adequate training in a well established skin biopsy laboratory and provide their own stratified age and gender-matched normative values, intra- and interobserver reliability, and interlaboratory agreement. Quality control of the procedure at all levels is mandatory (Good Practice Point). Procedures to quantify subepidermal nerve fibers and autonomic innervated structures, including erector pili muscles, and skin vessels are under development but need to be confirmed by further studies. Sweat gland innervation can be examined using an unbiased stereologic technique recently proposed (level B recommendation). A reduced IENF density is associated with the risk of developing neuropathic pain (level B recommendation), but it does not correlate with its intensity. Serial skin biopsies might be useful for detecting early changes of IENF density, which predict the progression of neuropathy, and to assess degeneration and regeneration of IENF (level C recommendation). However, further studies are warranted to confirm the potential usefulness of skin biopsy with measurement of IENF density as an outcome measure in clinical practice and research. Skin biopsy has not so far been useful for identifying the etiology of SFN. Finally, we emphasize that 3-mm skin biopsy at the ankle is a safe procedure based on the experience of 10 laboratories reporting absence of serious side effects in approximately 35,000 biopsies and a mere 0.19% incidence of non-serious side effects in about 15 years of practice (Good Practice Point). [source] Validation of microsurgical models in microsurgery training and competence: A reviewMICROSURGERY, Issue 5 2007M.R.C.S., Woan-Yi Chan M.Sc. Microsurgery has expanded the scope of many surgical specialties and is evolving into an integral part of training programmes. The complexity of microsurgery requires considerable time and resources for adequate training and practice. This article reviews the validation of microsurgical models for microsurgery training and competence. © 2007 Wiley-Liss, Inc. Microsurgery, 2007. [source] The role of the senior health care worker in critical careNURSING IN CRITICAL CARE, Issue 4 2004Paula Ormandy Summary ,,This article identifies that the introduction of the support worker role in the critical care team facilitates flexibility when organizing and managing patient care ,,Qualified nurses' time can be used more effectively, enhancing the quality of the patient care delivered ,,Aspects of the qualified nurses' workload in critical care can be shared and delegated successfully to unqualified staff ,,It is our view that staffing levels in critical care environments need to be reviewed with more flexible working practices to meet the current and future demands of critical care ,,There is a need for national consensus amongst qualified nurses to clarify and define the role of the support worker and develop a critical care competency framework to standardize training ,,To ensure proficiency, adequate training and appropriate accountability, support workers require regulation by a nationally recognized body [source] Attention-Deficit/Hyperactivity Disorder (ADHD): A national survey of training and current assessment practices in the schoolsPSYCHOLOGY IN THE SCHOOLS, Issue 6 2003Michelle Kilpatrick Demaray The primary purpose of this research was to survey school psychologists to investigate their training and current assessment practices for attention-deficit/hyperactivity disorder (ADHD) in the schools. The survey consisted of 38 questions regarding participant characteristics and three main areas relevant to ADHD: (a) training, (b) caseloads/referral patterns, and (c) assessment. The respondents reported receiving adequate training in the assessment of ADHD, with doctorate-level psychologists self-reporting being better trained than nondoctorate psychologists. Results confirmed a substantial caseload of ADHD referrals. In the assessment of ADHD, the results indicated school psychologists are using multiple informants, methods, and settings for the assessment of ADHD with rating scales, observations, and interviews the most common methods identified. Limitations of current practices will be discussed. © 2003 Wiley Periodicals, Inc. Psychol Schs 40: 583,597, 2003. [source] Gender effects in spatial orientation: cognitive profiles and mental strategiesAPPLIED COGNITIVE PSYCHOLOGY, Issue 5 2004Andrea Bosco Experimental evidence and meta-analyses offer some support for gender-related differences in visuo-spatial ability. However, few studies addressed this issue in an ecological context and/or in everyday tasks implying spatial abilities, such as geographical orientation. Moreover, the relation of specific strategies and gender is still unclear. In the present investigation, we compared men and women in a newly designed battery of spatial orientation tasks in which landmark, route and survey knowledge were considered. In addition, four visuo-spatial working memory (VSWM) tasks were presented. Significant differences favouring men in VSWM tasks were reported, supporting existing evidence. However, men and women did not significantly differ in orientation tasks performance. The patterns of correlation between working memory and spatial orientation tasks indicated that men and women used somewhat different strategies in carrying out the orientation tasks. In particular, active processes seem to play a greater role in females' performance, thus confirming the importance of this variable in interpreting gender effect in VSWM tasks. Altogether, results indicate that gender effects could well result from differences in cognitive strategies and support data indicating that adequate training could reduce or eliminate them. Copyright © 2004 John Wiley & Sons, Ltd. [source] | ||||||||||