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Necessary Skills (necessary + skill)
Selected AbstractsThe Status of Bedside Ultrasonography Training in Emergency Medicine Residency ProgramsACADEMIC EMERGENCY MEDICINE, Issue 1 2003Francis L. Counselman MD Abstract Bedside ultrasonography (BU) is rapidly being incorporated into emergency medicine (EM) training programs and clinical practice. In the past decade, several organizations in EM have issued position statements on the use of this technology. Program training content is currently driven by the recently published "Model of the Clinical Practice of Emergency Medicine," which includes BU as a necessary skill. Objective: The authors sought to determine the current status of BU training in EM residency programs. Methods: A survey was mailed in early 2001 to all 122 Accreditation Council for Graduate Medical Education (ACGME)-accredited EM residency programs. The survey instrument asked whether BU was currently being taught, how much didactic and hands-on training time was incorporated into the curriculum, and what specialty representation was present in the faculty instructors. In addition, questions concerning the type of tests performed, the number considered necessary for competency, the role of BU in clinical decision making, and the type of quality assurance program were included in the survey. Results: A total of 96 out of 122 surveys were completed (response rate of 79%). Ninety-one EM programs (95% of respondents) reported they teach BU, either clinically and/or didactically, as part of their formal residency curriculum. Eighty-one (89%) respondents reported their residency program or primary hospital emergency department (ED) had a dedicated ultrasound machine. BU was performed most commonly for the following: the FAST scan (focused abdominal sonography for trauma, 79/87%); cardiac examination (for tamponade, pulseless electrical activity, etc., 65/71%); transabdominal (for intrauterine pregnancy, ectopic pregnancy, etc., 58/64%); and transvaginal (for intrauterine pregnancy, ectopic pregnancy, etc., 45/49%). One to ten hours of lecture on BU was provided in 43%, and one to ten hours of hands-on clinical instruction was provided in 48% of the EM programs. Emergency physicians were identified as the faculty most commonly involved in teaching BU to EM residents (86/95%). Sixty-one (69%) programs reported that EM faculty and/or residents made clinical decisions and patient dispositions based on the ED BU interpretation alone. Fourteen (19%) programs reported that no formal quality assurance program was in place. Conclusions: The majority of ACGME-accredited EM residency programs currently incorporate BU training as part of their curriculum. The majority of BU instruction is done by EM faculty. The most commonly performed BU study is the FAST scan. The didactic component and clinical time devoted to BU instruction are variable between programs. Further standardization of training requirements between programs may promote increasing standardization of BU in future EM practice. [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] Scaling up Participatory Watershed Development in IndiaDEVELOPMENT AND CHANGE, Issue 2 2002Shashi Kolavalli ,Participation' is widely accepted as a prerequisite to successful watershed development in India, but there is no shared understanding of its meaning, nor of how to make it operational. Meaningful participation, in which communities work collectively, help make decisions and share costs, is limited primarily to projects implemented by non-governmental organizations (NGOs). Participation in government projects is more superficial because staff lack the skills and incentive to engage in meaningful participation. Strategies to scale up meaningful participation require a large number of NGOs. However, the number of NGOs with the necessary skills and values is limited, so a realistic strategy must seek to improve the capabilities and incentives of government agencies. Their performance may improve by making them accountable through transparent processes and participatory monitoring and evaluation. NGO-facilitated access to information for communities can potentially change power relations and initiate political processes that make both community leaders and government agencies more accountable to communities. [source] Parent-Identified Barriers to Pediatric Health Care: A Process-Oriented ModelHEALTH SERVICES RESEARCH, Issue 1 2006Elisa J. Sobo Objective. To further understand barriers to care as experienced by health care consumers, and to demonstrate the importance of conjoining qualitative and quantitative health services research. Data Sources. Transcripts from focus groups conducted in San Diego with English- and Spanish-speaking parents of children with special health care needs. Study Design. Participants were asked about the barriers to care they had experienced or perceived, and their strategies for overcoming these barriers. Using elementary anthropological discourse analysis techniques, a process-based conceptual model of the parent experience was devised. Principal Findings. The analysis revealed a parent-motivated model of barriers to care that enriched our understanding of quantitative findings regarding the population from which the focus group sample was drawn. Parent-identified barriers were grouped into the following six temporally and spatially sequenced categories: necessary skills and prerequisites for gaining access to the system; realizing access once it is gained; front office experiences; interactions with physicians; system arbitrariness and fragmentation; outcomes that affect future interaction with the system. Key to the successful navigation of the system was parents' functional biomedical acculturation; this construct likens the biomedical health services system to a cultural system within which all parents/patients must learn to function competently. Conclusions. Qualitative analysis of focus group data enabled a deeper understanding of barriers to care,one that went beyond the traditional association of marker variables with poor outcomes ("what") to reveal an understanding of the processes by which parents experience the health care system ("how,""why") and by which disparities may arise. Development of such process-oriented models furthers the provision of patient-centered care and the creation of interventions, programs, and curricula to enhance such care. Qualitative discourse analysis, for example using this project's widely applicable protocol for generating experientially based models, can enhance our knowledge of the parent/patient experience and aid in the development of more powerful conceptualizations of key health care constructs. [source] Interpreting three-dimensional structures from two-dimensional images: a web-based interactive 3D teaching model of surgical liver anatomyHPB, Issue 6 2009Jodi L. Crossingham Abstract Background:, Given the increasing number of indications for liver surgery and the growing complexity of operations, many trainees in surgical, imaging and related subspecialties require a good working knowledge of the complex intrahepatic anatomy. Computed tomography (CT), the most commonly used liver imaging modality, enhances our understanding of liver anatomy, but comprises a two-dimensional (2D) representation of a complex 3D organ. It is challenging for trainees to acquire the necessary skills for converting these 2D images into 3D mental reconstructions because learning opportunities are limited and internal hepatic anatomy is complicated, asymmetrical and variable. We have created a website that uses interactive 3D models of the liver to assist trainees in understanding the complex spatial anatomy of the liver and to help them create a 3D mental interpretation of this anatomy when viewing CT scans. Methods:, Computed tomography scans were imported into DICOM imaging software (OsiriXÔ) to obtain 3D surface renderings of the liver and its internal structures. Using these 3D renderings as a reference, 3D models of the liver surface and the intrahepatic structures, portal veins, hepatic veins, hepatic arteries and the biliary system were created using 3D modelling software (Cinema 4DÔ). Results:, Using current best practices for creating multimedia tools, a unique, freely available, online learning resource has been developed, entitled Visual Interactive Resource for Teaching, Understanding And Learning Liver Anatomy (VIRTUAL Liver) (http://pie.med.utoronto.ca/VLiver). This website uses interactive 3D models to provide trainees with a constructive resource for learning common liver anatomy and liver segmentation, and facilitates the development of the skills required to mentally reconstruct a 3D version of this anatomy from 2D CT scans. Discussion:, Although the intended audience for VIRTUAL Liver consists of residents in various medical and surgical specialties, the website will also be useful for other health care professionals (i.e. radiologists, nurses, hepatologists, radiation oncologists, family doctors) and educators because it provides a comprehensive resource for teaching liver anatomy. [source] Evaluating the context within which continence care is provided in rehabilitation units for older peopleINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 1 2007Jayne Wright Aim., This paper presents the first phase of an all Ireland 2-year study between the University of Ulster and University College Cork, to determine the contextual indicators that enable or hinder person centred continence care and management in rehabilitation settings for older people. The primary outcome of the study was the development of a tool to enable practitioners to assess the practice context within which continence care is provided. The main focus of this paper is the value of understanding practice ,context' (culture, leadership and evaluation) and its impact to the provision of person centred continence care. Background., The literature highlights the effect of continence problems on the quality of life of older people. Incontinence is often seen by health care professionals and older people as an inevitable consequence of ageing and difficult to treat. Furthermore, health care professionals do not always have the necessary skills and knowledge of best practice in continence care and treatments. The Promoting Action on Research Implementation in Health Services (PARIHS) framework utilized in the study proposes that successful implementation of evidence in practice is dependent on the inter-relationship of three key elements; the nature of the evidence, the quality of the context and expert facilitation. Kitson et al. propose that for successful implementation, evidence needs to be robust, the context receptive to change and appropriate facilitation is needed. Consequently understanding practice ,context' and its impact on the provision of person centred continence care is of value. Methods., Case study methodology with several data collection methods was utilized to measure all aspects of ,context' as identified by the PARIHS framework. Methods include: Royal College of Physicians Audit Scheme, Staff Knowledge questionnaire, semi-structured observation of practice and multidisciplinary focus groups. Findings., The data were analysed in two stages. Stage 1 using both qualitative and quantitative (SPSS 12) methods. Stage 2 analysed all the data utilizing the characteristics of context from the PARIHS framework in order to identify the strong and weak characteristics of the context within which continence care was provided. Continence care and management in this study was found to be focused on continence containment rather than proactive management. The evidence suggests that the context (leadership, culture and evaluation) was weak and not conducive to person centred continence care and management. Conclusion., An analysis of the data using the context framework provided a picture of the context within the units and the identification of the specific contextual issues hindering and enabling the delivery of person centred continence care. This process has thus, added to our understanding of the importance of context to the provision of person-centred care. [source] An exploration of mothers' and fathers' views of their identities in chronic-kidney-disease management: parents as students?JOURNAL OF CLINICAL NURSING, Issue 23 2008Veronica Swallow Aim., To explore parents' views of their identities as they learn to manage their child's chronic kidney disease. Background., Parents are expected to participate in management and usually learn necessary skills from the multidisciplinary team. Research highlights the importance of professionals defining parents' management roles in chronic disease; but little is known about parents' views on their own identities as the complex and dynamic process of teaching and learning unfolds around their child's condition. According to positioning theory, identity development is a dynamic and fluid process that occurs during interaction, with each person positioning themselves while simultaneously positioning the other person, yet this concept has not been considered in relation to parents' contributions to disease management. Design., A longitudinal, grounded theory study conducted in a UK Children's Kidney Unit. Method., This paper focuses on one aspect of a larger study exploring family learning in disease management. Six mothers and two fathers of six children with a recently diagnosed chronic kidney disease participated in a total of 21 semi-structured interviews during the 18 months after referral to the unit. Interviews included discussion about the parts they played in relation to professionals during the management process. Findings were interpreted within a framework of positioning theory. Results., Parents participated in teaching/learning/assessment that was both planned (involving allocated clinical lessons and tasks) and spontaneous (in response to current situations), to facilitate their participation. They positioned multidisciplinary team members as teachers as well as professionals, simultaneously positioning themselves as students as well as parents. Conclusion., Parents' clinical duties and obligations are not an automatic part of parenting but become part of the broader process of sharing disease management, this can lead to them assuming the additional identity of a ,student'. Relevance to clinical practice., Involving parents in ongoing discussions about their positions in management may help promote their active and informed participation. [source] China's booming livestock industry: household income, specialization, and exitAGRICULTURAL ECONOMICS, Issue 6 2009Allan N. Rae China; Livestock industry; Specialization; Exit Abstract China's production of livestock products has generally kept pace with her rapidly increasing demand. Over-supply and market corrections for various livestock products took place over the latter part of the 1990s and large numbers of householders exited this type of production. Using household survey data, we estimate the relationship between a household's specialization in livestock production and household net income in 1995, and use a logit model to explore some predictors of household exit from livestock production over the following decade of market instability. We conclude that specialist livestock households with access to necessary skills, technologies, and markets increase their incomes from further livestock specialization in the base year, whereas those to whom livestock production is relatively unimportant can increase household incomes by diverting their resources away from animal husbandry. It was specialist rather than diversified livestock households that tended to bear the brunt of the adjustment to unfavorable price movements over the decade post-1995. Policy concerns include the exit of larger-scale specialized producers who tended to earn relatively high household incomes in 1995, barriers to the effective formation and operation of horizontal and vertical integration options to help mitigate market instability, the further development of insurance programs and markets for livestock producers, and development assistance to livestock households that for various reasons cannot increase scale and specialization. [source] Emergency case admissions at a large animal tertiary university referral hospital during a 12-month periodJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 3 2008Brett A. Dolente VMD, DACVIM Abstract Objective: To collate and describe emergency admissions to a large animal tertiary university referral hospital during a 12-month period. Design: Prospective clinical study. Setting: Large animal tertiary university referral hospital. Animals: Large animal emergency patient admissions. Interventions: None. Measurements and main results: Information obtained from the medical record included the presenting complaint, clinical problem, admission time, duration of clinical signs before presentation, diagnostic procedures performed, therapies administered, and therapeutic procedures performed during the first 24 hours following admission, and survival to discharge. The most common category listed for the presenting complaint and clinical problem categories was gastrointestinal. Most emergency cases were admitted during the evening and in late spring, summer, and early fall. Most cases had a duration of clinical signs before presentation of >2 hours and ,8 hours (27%) or >8 hours and ,24 hours (29%). The most common diagnostic procedures performed during the first 24 hours were palpation per rectum, ultrasonographic examination, radiographs, and abdominocentesis. Antimicrobials, fluids, and nonsteroidal anti-inflammatory drugs were the most common therapies administered. Approximately 25% of cases required surgery. An exploratory celiotomy was performed in approximately 15% of cases. Enterotomy, intestinal resection and anastomosis, cesarean section, or joint or sheath lavage was each performed in <5% of cases. Overall survival to discharge was 74%. Conclusions: Large animal emergency clinicians are required to have knowledge on a wide range of diseases and should be proficient at performing numerous procedures on an emergency basis. Gastrointestinal disease is the most common type of emergency and the diagnostic and therapeutic procedures performed during the first 24 hours following admission are a reflection of this type of case. Only 25% of cases required surgery. Additional research in the form of a multicenter study and surveying both private and university practitioners needs to be performed to further define the necessary skills for an ,ideal' large animal emergency clinician. [source] Training to Provide for Healthy Rural AgingTHE JOURNAL OF RURAL HEALTH, Issue 4 2001B.A.(Hons), Joseph Troisi Ph.D., M. Phil., M.A.(Soc), M.Th. ABSTRACT: More than 60 percent of the world's aged population is in developing countries, the majority living in rural and remote areas. Resources in these areas are scarce and there is a lack of services and programs, especially in the areas of health, housing and social welfare. The most serious deficiency faced by many countries in meeting the challenges of population aging is the pronounced scarcity of trained caregivers. Little attention has been given to developing effective training policies and programs. Most of the people providing a service to older people lack basic training and this is more so in rural and remote areas. The processes for extending liealthy aging and postponing the onset of chronic diseases and disabling conditions exist already. Unfortunately, these processes are not disseminated in appropriate ways. It is therefore imperative to disseminate this information by training people at the grass roots level to reach the most vulnerable and isolated older people. Primary care workers should have the necessary skills, knowledge and techniques to facilitate good care of older people in their environment. This article reviews and analyzes attempts being made by a number of countries to meet this need. Though the basic issues dealt with are often the same, the approach used differs. [source] Training in minimally invasive surgery: An Asian perspectiveASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 3 2009D Lomanto Abstract Minimally invasive surgery, which requires a different approach than used in the past, has created a revolution not only in surgical practice but also in surgical education. To overcome the challenges and difficulties of minimally invasive surgery, training needs to be done outside the operating room and away from the patient. New educational tools have emerged in the form of surgical simulators, including trainer boxes, virtual reality simulators and hybrid simulators. Many studies have confirmed the effectiveness of both box trainers and virtual reality simulators for surgical education. The integration of simulators into a structured laparoscopic skills curriculum creates an ideal training ground for acquiring the necessary skills for minimally invasive surgery. It has also been proven that this training model is effective for transferring acquired skills into the clinical setting. [source] | |||||||||||||||||||