Home About us Contact
|
Home About us Contact | ||
|
|
||
Appropriate Training (appropriate + training)
Selected AbstractsPreservation of sight in diabetes: developing a national risk reduction programmeDIABETIC MEDICINE, Issue 9 2000L. Garvican SUMMARY Background Early treatment for diabetic retinopathy is effective at saving sight, but dependent on pre-symptomatic detection. Although 60% of people with diabetes have their eyes examined annually, few UK health authorities have systematic programmes that meet the British Diabetic Association's standards for sensitivity (> 80%) and specificity (> 95%). Screening is generally performed by general practitioners and optometrists, with some camera-based schemes, operated by dedicated staff. The National Screening Committee commissioned a group to develop a model and cost estimates for a comprehensive national risk-reduction programme. Ophthalmoscopy Evidence indicates that direct ophthalmoscopy using a hand-held ophthalmoscope does not give adequate specificity and sensitivity, and should be abandoned as a systematic screening technique. Indirect ophthalmoscopy using a slit lamp is sensitive and specific enough to be viable, and widespread availability in high street optometrists is an advantage, but the method requires considerable skill. Photographic schemes The principal advantage of camera-based screening is the capturing of an image, for patient education, review of disease progression, and quality assurance. Digital cameras are becoming cheaper, and are now the preferred option. The image is satisfactory for screening and may be transmitted electronically. With appropriate training and equipment, different professional groups might participate in programme delivery, based on local decisions. Cost issues Considerable resources are already invested in ad hoc screening, with inevitable high referral rates incurring heavy outpatient costs. Treatment for advanced disease is expensive, but less likely to be effective. The costs of a new systematic screening and treatment programme appear similar to current expenditure, as a result of savings in treatment of late-presenting advanced retinopathy. Conclusion A systematic national programme based on digital photography is proposed. [source] Communications skills in dental education: a systematic research reviewEUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 2 2010J. A. Carey Abstract Communication is an essential element of the relationship between patient and dentist. Dental schools are required to ensure that undergraduates are adequately trained in communication skills yet little evidence exists to suggest what constitutes appropriate training and how competency can be assessed. This review aimed to explore the scope and quality of evidence relating to communication skills training for dental students. Eleven papers fitted the inclusion criteria. The review found extensive use amongst studies of didactic learning and clinical role-play using simulated patients. Reported assessment methods focus mainly on observer evaluation of student interactions at consultation. Patient involvement in training appears to be minimal. This review recommends that several areas of methodology be addressed in future studies, the scope of research extended to include intra-operative communication, and that the role of real patients in the development of communication skills be active rather than passive. [source] Extemporaneous product use in paediatric patients: a systematic reviewINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 1 2008Ms Jennifer A Giam pharmacist, postgraduate student Objective To identify the relative extent of extemporaneous product use reported in the paediatric population and the implications for pharmacy practice. Method A systematic literature review was undertaken to identify the prevalence of extemporaneous product use in paediatric patients including those studies examining both ,off-label' and unlicensed medicine use from which extemporaneous products were separately identified and compared to licensed drug use. Key findings Twenty studies were identified and evaluated in which extemporaneous products prepared by a pharmacy or licensed manufacturer could be identified. Although prescribing of unlicensed drugs and licensed drugs used ,off-label' occurs more frequently in younger children and for more serious conditions, the use of extemporaneous products is consistent across all age groups and therapeutic areas. Studies using pharmacy dispensing records identified details of extemporaneous products more accurately than studies using prescribing records. Despite efforts to improve the availability of suitable licensed medicine products for children, extemporaneously prepared products are still needed to ensure that optimal drug therapy is available to children in accurate and effective doses and dosage forms. Conclusions Paediatric patients have a continuing need for extemporaneously prepared medicines when suitable dose forms are unavailable from manufacturers. Pharmacists require access to stability, compatibility and formulation information, as well as appropriate training to ensure patients are supplied with high-quality, safe and effective preparations. [source] Future Directions for the Teaching and Learning of Statistics at the Tertiary LevelINTERNATIONAL STATISTICAL REVIEW, Issue 1 2001Des F. Nicholl Summary Significant advances in, and the resultant impact of, Information Technology (IT) during the last fifteen years has resulted in a much more data based society, a trend that can be expected to continue into the foreseeable future. This phenomenon has had a real impact on the Statistics discipline and will continue to result in changes in both content and course delivery. Major research directions have also evolved during the last ten years directly as a result of advances in IT. The impact of these advances has started to flow into course content, at least for advanced courses. One question which arises relates to what impact will this have on the future training of statisticians, both with respect to course content and mode of delivery. At the tertiary level the last 40 years has seen significant advances in theoretical aspects of the Statistics discipline. Universities have been outstanding at producing scholars with a strong theoretical background but questions have been asked as to whether this has, to some degree, been at the expense of appropriate training of the users of statistics (the ,tradespersons'). Future directions in the teaching and learning of Statistics must take into account the impact of IT together with the competing need to produce scholars as well as competent users of statistics to meet the future needs of the market place. For Statistics to survive as a recognizable discipline the need to be able to train statisticians with an ability to communicate is also seen as an areā of crucial importance. Satisfying the needs of society as well as meeting the needs of the profession are considered as the basic determinants which will derive the future teaching and training of statisticians at the tertiary level and will form the basis of this presentation. [source] Multivessel Off-Pump Coronary Artery Bypass Grafting Can Be Taught to Trainee SurgeonsJOURNAL OF CARDIAC SURGERY, Issue 5 2003David Jenkins F.R.C.S. The purpose of this study was to address the reproducibility of the OPCAB in a unit where this technique is used extensively. Methods: Registry data, notes, and charts of 64 patients who were operated on by four trainee cardiac surgeons over a period of thirteen months at Harefield Hospital, were reviewed retrospectively. These trainees were part of an accredited training program for cardiothoracic training and were trained by a single consultant trainer in a cardiac unit after it had an established recent experience in performing nonselective OPCAB for all in-coming patients. Five (7.8%) patients (with 17 distal anastomoses) consented and underwent early postoperative angiography to check the quality of the grafts and anastomoses. Results: The mean age of the study patients was 65.6 and the mean Parsonnet score was 9.4. There was a mean of 2.9 grafts per patient and circumflex territory anastomoses were performed in 48 (75%) patients. No operation required conversion to Cardiopulmonary Bypass (CPB). Angiography of the five patients revealed 17 satisfactory (100%) distal anastomoses. Conclusion: With appropriate training, it is possible for trainees to learn OPCAB and perform multivessel revascularization in relatively high-risk patients with good results. [source] Zero tolerance of abuse of people with intellectual disabilities: implications for nursingJOURNAL OF CLINICAL NURSING, Issue 22 2008Robert Jenkins Aims., This paper explores the concept of ,zero tolerance' to abuse in the context of the professional responsibilities of all nurses. The workability of zero tolerance will be considered in light of findings of a study into abuse. Background., Registered nurses are led to believe that zero tolerance of abuse of patients is the only philosophy consistent with protecting the public. However, the approach of zero tolerance is not without its difficulties. Staff, particularly registered nurses, who come into contact with people with intellectual disabilities have a professional responsibility to prevent and report all forms of abuse. Design., This study used a multiphase, multimethod approach (literature review, survey and focus groups). Methods., The results reported here relate to the focus group stage of the study. There were 70 participants in the focus group who worked either as direct care staff with people with intellectual disabilities or as investigators of abuse. Results., Analysis of recurrent themes indicated that both individual (e.g. a positive value base) and systemic factors (e.g. environment) seemed to have an impact on how staff will respond to abuse. Conclusions., This study found that a ,hierarchy of abuse' existed among staff who worked with people with intellectual disabilities. Individual staff members seemed to be ,weighing up' what they perceived as serious abuse before reporting areas of concern. This is in contrast to a philosophy of zero tolerance which registered nurses have to adhere to. Relevance to clinical practice., There needs to be a consistent approach to abuse and nurses need to have appropriate training in which to gain confidence in their role in preventing, identifying and responding to abuse of patients or clients. [source] Caring for older people in prehospital emergency care: can nurses make a difference?JOURNAL OF CLINICAL NURSING, Issue 9 2005MPhil, PGCTHE, Vidar Melby BSc Aims and objectives., The aim of this paper is to explore older people's experiences in prehospital emergency care, and identify benefits and difficulties associated with developing a nurse-led ambulance service. Data were collected at sites in Sweden and Norway. Focus group interviews were conducted to enable the collection of data from paramedics, ambulance nurses and nursing students, while individual interviews were utilized to gather data from older people. Background., There is little research on the quality of care older people over 65 years old receive in prehospital emergency care. Older people often present with multiple pathology and diverse needs that nurses are well equipped to deal with, but presently there is no clearly defined role for nurses in prehospital emergency care in the United Kingdom, although other countries such as Sweden and Norway are developing an ambulance nurse role. Conclusions., If the multiple needs of older people were addressed in the prehospital field, a reduction in readmissions and increased functional ability might be achieved. Comprehensive training is required for ambulance staff to enable them to meet such needs. While nurses have a great foundation for this care, additional specialist ambulance training is required alongside a need for education on older people's needs and attitudes to older people. Relevance to clinical practice., The introduction of ambulance nurses will result in role differentiation between paramedics and ambulance nurses, which has the potential for creating role conflict. To ensure a smooth transition appropriate training and education for nurses and paramedics should be provided. The end result is a potentially greatly enhanced ambulance care provision, enabling high quality care to all patients. [source] Clinical Practice Guidelines for the Use of Axillary Sentinel Lymph Node Biopsy in Carcinoma of the Breast: Current UpdateTHE BREAST JOURNAL, Issue 2 2004Gordon F. Schwartz MD, MBAArticle first published online: 10 MAR 200 Abstract: Axillary sentinel lymph node biopsy (SLNB) has been adopted as a suitable alternative to traditional level I and II axillary dissection in the management of clinically node-negative (N0) breast cancers. There are two current techniques used to identify the sentinel node(s): radiopharmaceutical, technetium sulfur colloid, and isosulfan blue dye (used in the United States) and technetium-labeled albumin and patent blue dye (used in Europe). (The labeled albumin is not U.S. Food and Drug Administration [FDA] approved in the United States.) SLNB to replace axillary dissection should only be performed by surgeons and patient management teams with appropriate training and experience. Although both radiocolloid and blue dye are used together by most surgeons, and training should be in both techniques, some experienced surgeons use one or the other almost exclusively. In addition, surgical pathologists must recognize the need to examine these small specimens with great care, using a generally adopted protocol. Imprint cytology or frozen sections may be used, followed by additional sections for light microscopy. Immunochemical staining with cytokeratin or other techniques to identify "submicroscopic" metastasis is often used, but the results should not be used to influence clinical decisions with respect to adjuvant therapy. "Failed" SLNB implies the surgeon's failure to identify the sentinel nodes, in which case a complete dissection is performed. A "false-negative" SLNB implies the finding of metastasis in the excised sentinel nodes by light microscopy after a negative frozen section examination. Whether a false-negative SLNB mandates completion axillary dissection is controversial, with clinical trials currently under way to answer this question. Although SLNB was initiated to accompany breast-conserving treatment, it is equally useful in patients undergoing mastectomy. It is more difficult to perform with mastectomy. When using blue dye only, SLNB may require a separate incision because of time constraints between injection and identification of the blue-stained nodes; radiocolloid usually does not. Completion axillary dissection after false-negative SLNB is more difficult after mastectomy. SLNB is a useful procedure that may save 70% of women with clinically negative (N0) axillae and all of those with pathologically negative axillae from the morbidity of complete axillary dissection. Ideally the sentinel nodes should be able to identified in more than 95% of patients, with a false-negative rate of less than 5%. Until these rates can be achieved consistently, however, surgeons should not abandon traditional axillary dissection., [source] Performance of colposcopy in five sub-Saharan African countriesBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2009R Muwonge Objective, The performance of colposcopy provided in a screening study in five African countries was evaluated. Design, Cross-sectional study. Setting, Burkina Faso, Congo Brazzaville, Guinea Conakry, Mali and Niger. Population, Women aged 25,59 years. Methods, A total of 29 294 women participated in a cervical screening study in the five study sites, and newly trained local doctors performed colposcopy and directed biopsies as indicated. Using meta-analytical tools, four measures of colposcopy performance at different thresholds of colposcopic abnormalities were assessed. Sources of heterogeneity were also assessed. Main outcome measures, Proportions of women receiving biopsies, adequate biopsies and women diagnosed with cervical intraepithelial neoplasia (CIN). Results, Among 28 553 women with satisfactory colposcopy, 3101 had a colposcopic diagnosis of probable low-grade or worse lesions and 1128 probable high-grade or worse lesions. Overall, the measures that reached the set standards were proportion of biopsy taken at colposcopy threshold of probable high-grade or worse lesions (95%, 95% CI 90,100%) and proportion of adequate biopsy samples. The set standards were not met for the proportions of women diagnosed with CIN at different colposcopic abnormality thresholds. Detection of CIN2 or worse lesions increased with increasing colposcopic abnormality. Conclusions, The performance of colposcopy in some of the African sites studied was comparable to that previously observed in other studies. With appropriate training, monitoring, continuing practice and quality assurance, adequate standards of colposcopy can be attained in sub-Saharan Africa. [source] No sign of harm: issues for disabled children communicating about abuseCHILD ABUSE REVIEW, Issue 4 2001Rebecca Oosterhoorn Abstract While all children may be the victims of abuse, disabled children are particularly vulnerable. This paper explores the views of professionals working with children using alternative/augmented communication systems on the issues relating to communication about abuse. Interviews were carried out with 20 staff from eight establishments for disabled children across Scotland. It describes the range of alternative/augmented communication systems used and the barriers to communication about abuse. Staff generally accepted the importance of providing the appropriate vocabulary in augmented communication systems, but systems that provide such vocabulary were not widely used. Staff considered that a major difficulty concerned the level of understanding disabled children might have about concepts of abuse. They were unsure how the appropriate vocabulary could be introduced in a natural way and how links could be made between the signs and their meanings. Staff saw themselves as those most able to protect the children, but it was felt that discovery of abuse was more likely to come from them noticing physical signs, behaviour or mood changes than from the child communicating explicitly about abuse. The need for appropriate training and increased coordination between social work, health and education is highlighted. Copyright Š 2001 John Wiley & Sons, Ltd. [source] Legal dilemmas for clinicians involved in the care and treatment of children and young people with mental disorderCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 4 2010M. Bowers Abstract Background The 2008 revised Mental Health Act Code of Practice describes the legal framework governing the admission to hospital and treatment of children and young people for mental disorders as complex. Clinicians are required to be conversant with common law principles as well as the Mental Health Act (MHA), Children Act, Mental Capacity Act (MCA), Family Law Reform Act, Human Rights Act, and the United Nations Convention on the Rights of the Child. Professionals working with the MHA and the MCA have a legal duty to have regard to the respective Codes of Practice (MHA Code and MCA Code). In addition there is a need to keep up-to-date with developments in case law. The recent guidance from the National Institute for Mental Health in England, ,The Legal Aspects of the Care and Treatment of Children and Young People with Mental Disorder' draws all of the legal regimes together and suggests pointers on the most appropriate course of action when the regimes overlap. Discussion This paper will aim to highlight legal dilemmas relating to the care and treatment of under 18-year-olds for mental disorder and to discuss the impact of these on clinical practice. The new legal framework will be discussed with reference to hypothetical cases. Key issues include age and maturity, capacity, deprivation of liberty and the zone of parental control (ZPC). Conclusions It is essential that clinicians are aware of their responsibilities within the new legal framework in order to avoid becoming a target for litigation. This paper is aimed at meeting the recommendation for clinicians to be aware of their responsibilities and engage in appropriate training. [source] | |||||||||||||