Home About us Contact
|
Home About us Contact | ||
|
|
||
Medical Expertise (medical + expertise)
Selected AbstractsRe-inscribing Gender in New Modes of Medical Expertise: The Investigator,Coordinator Relationship in the Clinical Trials IndustryGENDER, WORK & ORGANISATION, Issue 2 2010Jill A. Fisher This article analyses the ways in which research coordinators forge professional identities in the highly gendered organizational context of the clinic. Drawing upon qualitative research on the organization of the clinical trials industry (that is, the private sector, for profit auxiliary companies that support pharmaceutical drug studies), this article explores the relationships between predominantly male physician-investigators and female research coordinators and the constitution of medical expertise in pharmaceutical drug development. One finding is that coordinators actively seek to establish relationships with investigators that mirror traditional doctor,nurse relationships, in which the feminized role is subordinated and devalued. Another finding is that the coordinators do, in fact, have profound research expertise that is frequently greater than that of the investigators. The coordinators develop expertise on pharmaceutical products and diseases through their observations of the patterns that occur in patient,participants' responses to investigational drugs. The article argues, however, that the nature of the relationships between coordinators and investigators renders invisible the coordinators' expertise. In this context, gender acts as a persistent social structure shaping both coordinators' and investigators' perceptions of who can be recognized as having authority and power in the workplace. [source] The intermediate effect and the diagnostic accuracy in clinical case recall of students and experts in dental medicineEUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 3 2009J. Eberhard Abstract Introduction:, The extensive knowledge of experts facilitates the solving of domain-specific problems. In general, this is due to the fact that experts recall more detailed information than do novices or even advanced students. However, if physicians of different expertise levels are asked to write down the details of a given case, advanced medical students recall more information than experts. This phenomenon was called the ,intermediate effect' and is considered to be a specific feature of medical expertise. The aim of the here presented study was to examine this observation in the domain of dental medicine. Materials and methods:, Sixty-one students and 20 specialised dentists participated in this study. Three clinical case descriptions were presented and afterwards the participants were told to write down all concrete information they remembered. Finally, they had to come up with a diagnosis. Interrater agreement, diagnostic accuracy and the recall explanation protocols were analysed statistically in comparison to state-of-the-art (canonical) explanations of the clinical cases. Results:, The mean interrater agreement was 96.2 ± 3.37%. It was shown statistically that the more experienced the participants, the more accurate their diagnoses were (P < 0.001). The statistical analysis using the Games-Howell test demonstrated significant more written recall of the 5th-year students compared with 3rd- and 4th-year students and experts (P < 0.05). Conclusion:, The results of this study suggest the existence of the intermediate effect in clinical case recall in dental medicine and thereby corroborate its importance and general applicability for different medical domains. [source] Re-inscribing Gender in New Modes of Medical Expertise: The Investigator,Coordinator Relationship in the Clinical Trials IndustryGENDER, WORK & ORGANISATION, Issue 2 2010Jill A. Fisher This article analyses the ways in which research coordinators forge professional identities in the highly gendered organizational context of the clinic. Drawing upon qualitative research on the organization of the clinical trials industry (that is, the private sector, for profit auxiliary companies that support pharmaceutical drug studies), this article explores the relationships between predominantly male physician-investigators and female research coordinators and the constitution of medical expertise in pharmaceutical drug development. One finding is that coordinators actively seek to establish relationships with investigators that mirror traditional doctor,nurse relationships, in which the feminized role is subordinated and devalued. Another finding is that the coordinators do, in fact, have profound research expertise that is frequently greater than that of the investigators. The coordinators develop expertise on pharmaceutical products and diseases through their observations of the patterns that occur in patient,participants' responses to investigational drugs. The article argues, however, that the nature of the relationships between coordinators and investigators renders invisible the coordinators' expertise. In this context, gender acts as a persistent social structure shaping both coordinators' and investigators' perceptions of who can be recognized as having authority and power in the workplace. [source] Breath gas aldehydes as biomarkers of lung cancerINTERNATIONAL JOURNAL OF CANCER, Issue 11 2010Patricia Fuchs Abstract There is experimental evidence that volatile substances in human breath can reflect presence of neoplasma. Volatile aldehydes were determined in exhaled breath of 12 lung cancer patients, 12 smokers and 12 healthy volunteers. Alveolar breath samples were collected under control of expired CO2. Reactive aldehydes were transformed into stable oximes by means of on-fiber-derivatization (SPME-OFD). Aldehyde concentrations in the ppt and ppb level were determined by means of gas chromatography-mass spectrometry (GC-MS). Exhaled concentrations were corrected for inspired values. Exhaled C1,C10 aldehydes could be detected in all healthy volunteers, smokers and lung cancer patients. Concentrations ranged from 7 pmol/l (161 pptV) for butanal to 71 nmol/l (1,582 ppbV) for formaldehyde. Highest inspired concentrations were found for formaldehyde and acetaldehyde (0,55 nmol/l and 0,13 nmol/l, respectively). Acetaldehyde, propanal, butanal, heptanal and decanal concentrations showed no significant differences for cancer patients, smokers and healthy volunteers. Exhaled pentanal, hexanal, octanal and nonanal concentrations were significantly higher in lung cancer patients than in smokers and healthy controls (ppentanal = 0.001; phexanal = 0.006; poctanal = 0.014; pnonanal = 0.025). Sensitivity and specificity of this method were comparable to the diagnostic certitude of conventional serum markers and CT imaging. Lung cancer patients could be identified by means of exhaled pentanal, hexanal, octanal and nonanal concentrations. Exhaled aldehydes reflect aspects of oxidative stress and tumor-specific tissue composition and metabolism. Noninvasive recognition of lung malignancies may be realized if analytical skills, biochemical knowledge and medical expertise are combined into a joint effort. [source] Exploring the potential of video technologies for collaboration in emergency medical care: Part II.JOURNAL OF THE AMERICAN SOCIETY FOR INFORMATION SCIENCE AND TECHNOLOGY, Issue 14 2008Task performance We conducted an experiment with a posttest, between-subjects design to evaluate the potential of emerging 3D telepresence technology to support collaboration in emergency health care. 3D telepresence technology has the potential to provide richer visual information than do current 2D video conferencing techniques. This may be of benefit in diagnosing and treating patients in emergency situations where specialized medical expertise is not locally available. The experimental design and results concerning information behavior are presented in the article "Exploring the Potential of Video Technologies for Collaboration in Emergency Medical Care: Part I. Information Sharing" (Sonnenwald et al., this issue). In this article, we explore paramedics' task performance during the experiment as they diagnosed and treated a trauma victim while working alone or in collaboration with a physician via 2D videoconferencing or via a 3D proxy. Analysis of paramedics' task performance shows that paramedics working with a physician via a 3D proxy performed the fewest harmful interventions and showed the least variation in task performance time. Paramedics in the 3D proxy condition also reported the highest levels of self-efficacy. Interview data confirm these statistical results. Overall, the results indicate that 3D telepresence technology has the potential to improve paramedics' performance of complex medical tasks and improve emergency trauma health care if designed and implemented appropriately. [source] Medical Evidence and Expert Testimony in Child Sexual AbuseJUVENILE AND FAMILY COURT JOURNAL, Issue 1 2006LORI D. FRASIER ABSTRACT Expert medical testimony in child sexual abuse cases can be critical to the outcome of a legal case. This article will review the development of the medical knowledge and clinical expertise in child sexual abuse. Since the passage of mandatory child abuse reporting laws, the forensic medical examination of a child for evidence of sexual abuse has become standard. Until recently, many myths regarding female genital anatomy existed but were based primarily on dogma and lack of empirical research. Over the past 25 years, many research studies and accumulating clinical evidence have expanded medical knowledge and debunked old myths. Physical evidence, even in cases of alleged genital or anal penetration is rare. Sexually transmitted infections are also uncommon and often require medical interpretation as to their significance in a prepubertal child. Specialized medical knowledge, training, and clinical expertise have developed in order to evaluate children presenting with allegations of sexual abuse. Such medical expertise provides invaluable service to courts. We review criteria for evaluating such expertise in light of current medical practice. [source] How expertise develops in medicine: knowledge encapsulation and illness script formationMEDICAL EDUCATION, Issue 12 2007Henk G Schmidt Context, For over 30 years, research has focused on the question of how knowledge is organised in the doctor's mind. The development of encapsulated knowledge, followed by the formation of illness scripts, may both be considered as important stages in the development of medical expertise. Methods, This paper reviews research on the knowledge encapsulation and illness script hypotheses since their initial formulation. Findings in support of these views of expertise development are reported and conflicting data are discussed. Results, A great deal of empirical data have been collected over the years to investigate the view that, through clinical experiences, biomedical knowledge becomes encapsulated and eventually integrated into illness scripts. The findings of most studies, which have used various techniques to probe the ways by which students and doctors mentally represent clinical cases, are in line with this view of expertise development. However, there is still debate concerning the role of biomedical knowledge in clinical case processing. Conclusions, To facilitate the development of expertise in medical school, it is important to teach the basic sciences in a clinical context, and to introduce patient problems early in the curriculum in order to support the processes of encapsulation and illness script formation. In addition, during clerkships ample time should be devoted to enabling reflection on patient problems with peers and expert doctors. [source] Evaluation of a pharmacotherapy context-learning programme for preclinical medical studentsBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 6 2006J. A. Vollebregt What is already known about this subject ,,Context-learning in medicine is mainly based on theories explaining how medical expertise is achieved, particularly with regard to diagnostic problem solving. ,,By frequently solving diagnostic clinical problems doctors generate so-called networks of organized knowledge in their memory. ,,Preclinical medical students are well able to learn to choose and prescribe drugs. What this study adds ,,Preclinical pharmacotherapy context learning for medical students has a modest but positive effect on learning cognitive pharmacotherapeutic skills, i.e. choosing a drug treatment and determining patient information. ,,The effect can be obtained with role-play sessions, a suboptimal form of context learning, with a minimal study load and a high appreciation by students. Aim To evaluate a context-learning pharmacotherapy programme for approximately 750 2nd, 3rd and 4th year preclinical medical students with respect to mastering cognitive pharmacotherapeutic skills, i.e. choosing a (drug) treatment and determining patient information. Methods The context-learning pharmacotherapy programme consists of weekly organized role play sessions in the form of consulting hours. Fourth year students sit for a therapeutic Objective Structured Clinical Examination (OSCE) in the form of consulting hours at the outpatient clinic. Sixty-one 2nd, 74 3rd and 49 4th year medical students who attended the role play sessions and the OSCE were randomly selected. Their performances were assessed by clinical examiners and clinical experts and compared with a reference group of 6th year graduated students. Additionally, the scores of a questionnaire on study load and appreciation were collected. Results The level of the pharmacotherapeutic skills of the 4th year students who followed the pharmacotherapy context-learning programme was not far below that of 6th year graduates who had finished their clinical clerkships, but had not followed the pharmacotherapy programme. The time spent on the programme was about 1% of the total study load per year. The students appreciated the role play sessions and OSCE by around 80% and 99% of the maximum possible scores. Conclusions Preclinical pharmacotherapy context learning has a modest but positive effect on learning cognitive pharmacotherapeutic skills, i.e. choosing a drug treatment and determining patient information. This effect has been obtained with role play sessions, a suboptimal form of context learning, with a minimal study load and a high appreciation by students. [source] | ||||||||||