How can experience in clinical and community settings contribute to early medical education? A BEME systematic review

Review date: Review period January 1992-December 2001. Final analysis July 2004-January 2005. Background and review context: There has been no rigorous systematic review of the outcomes of early exposure to clinical and community settings in medical education. Objectives of review: (1) Identify published empirical evidence of the effects of early experience in medical education, analyse it, and synthesize conclusions from it. (2) Identify the strengths and limitations of the research effort to date, and identify objectives for future research. Search strategy: Ovid search of. BEI, ERIC, Medline, CIATAHL and EMBASE Additional electronic searches of: Psychinfo, Timelit, EBM reviews, SIGLE, and the Cochrane databases. Hand-searches of: Medical Education, Medical Teacher, Academic Medicine, Teaching and Learning in Medicine, Advances in Health Sciences Education, Journal of Educational Psychology. Criteria: Definitions: Experience: Authentic (real as opposed to simulated) human contact in a social or clinical context that enhances learning of health, illness and/or disease, and the role of the health professional. Early: What would traditionally have been regarded as the preclinical phase, usually the first 2 years. Inclusions: All empirical studies (verifiable, observational data) of early experience in the basic education of health professionals, whatever their design or methodology, including papers not in English. Evidence from other health care professions that could be applied to medicine was included. Exclusions: Not empirical; not early; post-basic; simulated rather than 'authentic' experience. Data collection: Careful validation of selection processes. Coding by two reviewers onto an extensively modified version of the standard BEME coding sheet. Accumulation into an Access database. Secondary coding and synthesis of an interpretation. Headline results: A total of 73 studies met the selection criteria and yielded 277 educational outcomes; 116 of those outcomes (from 38 studies) were rated strong and important enough to include in a narrative synthesis of results; 76% of those outcomes were from descriptive studies and 24% from comparative studies. Early experience motivated and satisfied students of the health professions and helped them acclimatize to clinical environments, develop professionally, interact with patients with more confidence and less stress, develop self-reflection and appraisal skill, and develop a professional identity. It strengthened their learning and made it more real and relevant to clinical practice. It helped students learn about the structure and function of the healthcare system, and about preventive care and the role of health professionals. It supported the learning of both biomedical and behavioural/social sciences and helped students acquire communication and basic clinical skills. There were outcomes for beneficiaries other than students, including teachers, patients, populations, organizations and specialties. Early experience increased recruitment to primary care/rural medical practice, though mainly in US studies which introduced it for that specific purpose as part of a complex intervention. Conclusions: Early experience helps medical students socialize to their chosen profession. It. helps them acquire a range of subject matter and makes their learning more real and relevant. It has potential benefits for other stakeholders, notably teachers and patients. It can influence career choices.

Heart failure management programmes in Europe

Background The ESC guidelines recommend that an organised system of specialist heart failure (HF) care should be established to improve outcomes of HF patients. The aim of this study was therefore to identify the number and the content of HF management programmes in Europe. Method A two-phase descriptive study was conducted: an initial screening to identify the existence of HF management programmes; and a survey to describe the content in countries where at least 30% of the hospitals had a programme. Results Of the 43 European countries approached, 26 (60%) estimated the percentage of HF management programmes. Seven countries reported that they had such programmes in more than 30% of their hospitals. Of the 673 hospitals responding to the questionnaire, 426 (63%) had a HF management programme. Half of the programmes (n = 205) were located in an outpatient clinic. In the UK a combination of hospital and home-based programmes was common (75%). The most programmes included physical examination, telephone consultation, patient education, drug titration and diagnostic testing. Most (89%) programmes involved nurses and physicians. Multi-disciplinary teams were active in 56% of the HF programmes. The most prominent differences between the 7 countries were the degree of collaboration with home care and GP's, the role in palliative care and the funding. Conclusion Only a few European countries have a large number of organised programmes for HF care and follow up. To improve outcomes of HF patients throughout Europe more effort should be taken to increase the number of these programmes in all countries.

Interorganizational innovation and collaboration in the UK medical device sector

Interorganizational team research is a growing body of literature and research has started toexamine team related factors such as interorganizational trust (i.e. Stock, 2006) in theinterorganizational setting. This research applies insights from the intraorganizational teamfield into the interorganizational team setting in order to determine the team related factorspertaining to effective collaboration in medical device innovation projects.Interorganizational collaboration has been a persistent feature within the interorganizationalrelations literature, due to the added benefits that can come with working collaborativelytowards a common goal (Berg-Weger & Schnieder, 1998). While much research has exploredthe structures and performance outcomes of engaging in this cross-boundary working, theliterature is sparse with respect to interpersonal relationships, practices and processes leadingto effective collaboration (Bergenholtz & Waldstrom, 2011; Majchrzak, Jarvenpaa & Bargherz,2015). An interpretivist perspective has informed an exploratory mixed methods approach to datacollection, with contextual insights informing each phase of data collection. Three exploratoryphases of data collection have provided (1) qualitative ethnography data, (1i) qualitativeinterview data and (2) quantitative survey data. The NHS has recently set out agendas to increase innovative procurement (Department ofHealth, 2008), work more closely with industry and SMEs (Innovation and Procurement Plan:Department of Health, 2009) and to increase innovative practice (IHW: NHS, 2011). SMEsdeveloping novel medical devices require input from the NHS to ensure that their devices areclinically applicable and therefore will be adopted by the NHS. These contextual insightsprovide the backdrop for Studies 1i and 2. The findings suggest that the intraorganizational team literature can be extended into theinterorganizational collaboration literature, whilst also explaining the factors relating toeffectiveness and success of interorganizational team innovation.

Differences among undergraduate and graduate nursing students' cultural competency

This study examined differences in cultural competency levels between undergraduate and graduate nursing students (age, ethnicity, gender, language at home, education level, program standing, program track, diversity encounters, and previous diversity training). Participants were 83% women, aged 20 to 62; 50% Hispanic/Latino; with a Bachelor of Science in Nursing (n = 82) and a Master of Science in Nursing (n = 62). Degrees included high school diplomas, associate/diplomas, bachelors' degrees in or out of nursing, and medical doctorate degrees from outside the United States. Students spoke English (n = 82) or Spanish ( n = 54). The study used a cross-sectional design guided by the three-dimensional cultural competency model. The Cultural Competency Assessment (CCA) tool is composed of two subscales: Cultural Awareness and Sensitivity (CAS) and Culturally Competent Behaviors (CCB). Multiple regressions, Pearson's correlations, and ANOVAs determined relationships and differences among undergraduate and graduate students. Findings showed significant differences between undergraduate and graduate nursing students in CAS, p <.016. Students of Hispanic/White/European ethnicity scored higher on the CAS, while White/non-Hispanic students scored lower on the CAS, p < .05. One-way ANOVAs revealed cultural competency differences by program standing (grade-point averages), and by program tracks, between Master of Science in Nursing Advanced Registered Nurse Practitioners and both Traditional Bachelor of Science in Nursing and Registered Nurse-Bachelor of Science in Nursing. Univariate analysis revealed that higher cultural competency was associated with having previous diversity training and participation in diversity training as continuing education. After controlling for all predictors, multiple regression analysis found program level, program standing, and diversity training explained a significant amount of variance in overall cultural competency (p = .027; R2 = .18). Continuing education is crucial in achieving students' cultural competency. Previous diversity training, graduate education, and higher grade-point average were correlated with higher cultural competency levels. However, increased diversity encounters were not associated with higher cultural competency levels.^

Avaliação da atividade anti-Helicobacter pylori e citotóxica in vitro de extratos orgânicos obtidos das folhas de Encholirium spectabile e Syzygium cumini

Helicobacter pylori is a spiral, Gram negative, mobile, and microaerophilic bacteria recognized as a major cause of gastritis, ulcer, gastric cancer, and gastric low grade, B cell, mucosa – associated lymphoid tissue (MALT) lymphoma, constituting an important microorganism in medical microbiology. Its importance comes from the difficulty of treatment because the requirement of multiple drugs use, besides the increasing emergence of resistant and multiresistant strains to antibiotics used in th e clinic. In order to expand safe and effective therapeutic options , chemical studies on medicinal plants by obtaining extracts, fractions, isolated compounds or essential oils with some biological activity has been intensified . Given the above, the objective was to evaluate the inhi bitory activity of organic extracts derived from Syzygium cumini and Encholirium spectabile, with antiulcer history, and the essential oil, obtained from S. cumini, against H. pylori (ATCC 43504) by the disk diffusion method, for qualitative evaluation, an d determination of minimum inhibitory concentration (MIC) using the broth microdilution method, for quantitative analysis. Also was evaluated the extracts in vitro toxicity by a hemolytic assay using sheep red blood cells, and VERO and HeLa cells using the MTT assay to analyze cell viability. The extracts of both plant used in antimicrobial assays did not inhibit bacterial growth, however the essential oil of S. cumini (SCFO) proved effective, showing MIC value of 205 μg/mL (0.024 % dilution of the original oil). In the hemolytic assay, the same oil shows moderate toxicity, by promote 25% hemolysis at 1000 μg/mL. Regarding the cytotoxicity in cell culture, the SCFO, at 260 μg/mL, affected the cell viability around 80% of HeLa and 50% of VERO cells. So the oi l obtained from S. cumini leaves has antimicrobial activity against H. pylori and cytotoxicity potential, suggesting a source of new molecule drug candidates, since new stages of toxicity in vitro and in vivo, as well, chemical characterization be evaluate d. Moreover, the development of a prospective drug delivery system can result in a prototype to be used in preclinical tests.

Automated Assessment of Image Quality and Dose Attributes in Clinical CT Images

Computed tomography (CT) is a valuable technology to the healthcare enterprise as evidenced by the more than 70 million CT exams performed every year. As a result, CT has become the largest contributor to population doses amongst all medical imaging modalities that utilize man-made ionizing radiation. Acknowledging the fact that ionizing radiation poses a health risk, there exists the need to strike a balance between diagnostic benefit and radiation dose. Thus, to ensure that CT scanners are optimally used in the clinic, an understanding and characterization of image quality and radiation dose are essential.

The state-of-the-art in both image quality characterization and radiation dose estimation in CT are dependent on phantom based measurements reflective of systems and protocols. For image quality characterization, measurements are performed on inserts imbedded in static phantoms and the results are ascribed to clinical CT images. However, the key objective for image quality assessment should be its quantification in clinical images; that is the only characterization of image quality that clinically matters as it is most directly related to the actual quality of clinical images. Moreover, for dose estimation, phantom based dose metrics, such as CT dose index (CTDI) and size specific dose estimates (SSDE), are measured by the scanner and referenced as an indicator for radiation exposure. However, CTDI and SSDE are surrogates for dose, rather than dose per-se.

Currently there are several software packages that track the CTDI and SSDE associated with individual CT examinations. This is primarily the result of two causes. The first is due to bureaucracies and governments pressuring clinics and hospitals to monitor the radiation exposure to individuals in our society. The second is due to the personal concerns of patients who are curious about the health risks associated with the ionizing radiation exposure they receive as a result of their diagnostic procedures.

An idea that resonates with clinical imaging physicists is that patients come to the clinic to acquire quality images so they can receive a proper diagnosis, not to be exposed to ionizing radiation. Thus, while it is important to monitor the dose to patients undergoing CT examinations, it is equally, if not more important to monitor the image quality of the clinical images generated by the CT scanners throughout the hospital.

The purposes of the work presented in this thesis are threefold: (1) to develop and validate a fully automated technique to measure spatial resolution in clinical CT images, (2) to develop and validate a fully automated technique to measure image contrast in clinical CT images, and (3) to develop a fully automated technique to estimate radiation dose (not surrogates for dose) from a variety of clinical CT protocols.

Cooperative or collaborative learning: Is there a difference in university students’ perceptions?

The hypothesis that the same educational objective, raised as cooperative or collaborative learning in university teaching does not affect students’ perceptions of the learning model, leads this study. It analyses the reflections of two students groups of engineering that shared the same educational goals implemented through two different methodological active learning strategies: Simulation as cooperative learning strategy and Problem-based Learning as a collaborative one. The different number of participants per group (eighty-five and sixty-five, respectively) as well as the use of two active learning strategies, either collaborative or cooperative, did not show differences in the results from a qualitative perspective.

Does video feedback analysis improve CPR performance in phase 5 medical students?

Background The use of simulation in medical education is increasing, with students taught and assessed using simulated patients and manikins. Medical students at Queen’s University of Belfast are taught advanced life support cardiopulmonary resuscitation as part of the undergraduate curriculum. Teaching and feedback in these skills have been developed in Queen’s University with high-fidelity manikins. This study aimed to evaluate the effectiveness of video compared to verbal feedback in assessment of student cardiopulmonary resuscitation performance Methods Final year students participated in this study using a high-fidelity manikin, in the Clinical Skills Centre, Queen’s University Belfast. Cohort A received verbal feedback only on their performance and cohort B received video feedback only. Video analysis using ‘StudioCode’ software was distributed to students. Each group returned for a second scenario and evaluation 4 weeks later. An assessment tool was created for performance assessment, which included individual skill and global score evaluation. Results One hundred thirty eight final year medical students completed the study. 62 % were female and the mean age was 23.9 years. Students having video feedback had significantly greater improvement in overall scores compared to those receiving verbal feedback (p = 0.006, 95 % CI: 2.8–15.8). Individual skills, including ventilation quality and global score were significantly better with video feedback (p = 0.002 and p < 0.001, respectively) when compared with cohort A. There was a positive change in overall score for cohort B from session one to session two (p < 0.001, 95 % CI: 6.3–15.8) indicating video feedback significantly benefited skill retention. In addition, using video feedback showed a significant improvement in the global score (p < 0.001, 95 % CI: 3.3–7.2) and drug administration timing (p = 0.004, 95 % CI: 0.7–3.8) of cohort B participants, from session one to session two. Conclusions There is increased use of simulation in medicine but a paucity of published data comparing feedback methods in cardiopulmonary resuscitation training. Our study shows the use of video feedback when teaching cardiopulmonary resuscitation is more effective than verbal feedback, and enhances skill retention. This is one of the first studies to demonstrate the benefit of video feedback in cardiopulmonary resuscitation teaching.

Exploring Forensic Nursing Ethics and Practice: Roles, Loyalties and Photodocumentation Practices

Thesis (Ph.D.)--University of Washington, 2016-08

Non-medical prescribers and benzodiazepines: A qualitative study.

Benzodiazepines continue to be widely prescribed in primary care for longer than guidelines advise and can cause adverse consequences for those who have long-term prescriptions. The aim of this study was to explore the experience of nonmedical prescribers (NMPs) in relation to their role in improving benzodiazepine prescribing management in primary care. A qualitative study using a thematic analysis framework, in which face-to-face interviews with eight NMPs from the disciplines of nursing and pharmacy were conducted in their areas of practice in 2011 in rural localities in southern Scotland. The NMPs view their qualification as rigorous in its capacity to promote more focused and confident practice, and provide detailed knowledge about medications and the ability to question the appropriateness of medicines. As medication review is an integral part of the role of the NMP they are suited to contribute positively to benzodiazepine prescribing management. Although several obstacles to the successful integration and full utilization of non-medical prescribing currently exist, more training in the recognition of mild-to-moderate mental health problems, psychopharmacology and alternative interventions would allow this role to be assumed with confidence. NMPs may have a useful role to play in benzodiazepine prescribing. NMPs have regular contact with patients in the older age group and those with chronic illnesses, and are in a prime position to utilize opportunistic medication review to improve concordance in this area of prescribing.

Labour stress in nursing

Based on evidence found during the empirical study we can affirm that the nursing profession is affected by work stress. Objective: Evaluate stress and engagement levels among nurses in health units in Portugal and Spain and describe the stress-generating factors among the surveyed nurses. Methods: A comparative study on a transversal level. Sample of 867 nurses (504 Portuguese, 363 Spanish), female 83.6 % (78.6 % in Portugal, 90.6 % in Spain) and average age of 37. 77.2 % of the Portuguese and 39.4 % of the Spanish nurses work on average 40 hours per week. 60.6 % and 57.7 % of the Spanish and Portuguese respectively have exercised their profession for 10 years. Pamela Gray-Toft’s Nurs- ing Stress Scale (1981) [1] and Schaufeli & Bakker’s Utrecht Work En- gagement Scale (2003) [2] were used. Results: Globally, Portuguese nurses experience higher stress levels although the difference with Spanish nurses is not statistically significant. There are statistically significant differences between Portugal and Spain in “Lack of help from colleagues” and also in the psychological domain in general. Concerning Engagement, there are statistically significant differences in the three dimensions, the p-value of the Student t-test was under 5 %, highlighting that Spanish nurses are more vigorous, dedicated and absorbed by their work. Conclusions: Portuguese nurses perceive more psychological stress and mention having less help from colleagues. Spanish nurses feel more vigorous, dedicated and absorbed by their work.

Cuidados de enfermagem à pessoa em situação neurocrítica, potencial dadora de órgãos/tecidos.

Relatório de Trabalho de Projeto apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Enfermagem Médico-Cirúrgica

Differences Among Undergraduate and Graduate Nursing Students’ Cultural Competency

This study examined differences in cultural competency levels between undergraduate and graduate nursing students (age, ethnicity, gender, language at home, education level, program standing, program track, diversity encounters, and previous diversity training). Participants were 83% women, aged 20 to 62; 50% Hispanic/Latino; with a Bachelor of Science in Nursing (n = 82) and a Master of Science in Nursing (n = 62). Degrees included high school diplomas, associate/diplomas, bachelors’ degrees in or out of nursing, and medical doctorate degrees from outside the United States. Students spoke English (n = 82) or Spanish (n = 54). The study used a cross-sectional design guided by the three-dimensional cultural competency model. The Cultural Competency Assessment (CCA) tool is composed of two subscales: Cultural Awareness and Sensitivity (CAS) and Culturally Competent Behaviors (CCB). Multiple regressions, Pearson’s correlations, and ANOVAs determined relationships and differences among undergraduate and graduate students. Findings showed significant differences between undergraduate and graduate nursing students in CAS, p <.016. Students of Hispanic/White/European ethnicity scored higher on the CAS, while White/non-Hispanic students scored lower on the CAS, p < .05. One-way ANOVAs revealed cultural competency differences by program standing (grade-point averages), and by program tracks, between Master of Science in Nursing Advanced Registered Nurse Practitioners and both Traditional Bachelor of Science in Nursing and Registered Nurse-Bachelor of Science in Nursing. Univariate analysis revealed that higher cultural competency was associated with having previous diversity training and participation in diversity training as continuing education. After controlling for all predictors, multiple regression analysis found program level, program standing, and diversity training explained a significant amount of variance in overall cultural competency (p = .027; R2 = .18). Continuing education is crucial in achieving students’ cultural competency. Previous diversity training, graduate education, and higher grade-point average were correlated with higher cultural competency levels. However, increased diversity encounters were not associated with higher cultural competency levels.

Management and outcome of cholesterol embolus identified in a diabetic retinopathy screening program

Purpose. We examined the incidence, management, and outcomes of patients known to be at high cardiovascular risk, and to assess whether specialist referral to an ophthalmic medical clinic is worthwhile. Methods. Patients in the East Birmingham area with cholesterolembolus who were identified on digital diabetic retinopathy screening over a 3-year period were referred to a specialist ophthalmic medicine clinic within Heart of England NHS Trust for management and investigation. Results. A total of 33 patients were referred for clinical management.(male:female = 22:11, mean age 72 years). A total of 28 patients were known to be receiving medication: 14 anti hypertensive therapy(42%), 19 aspirin (59%), and 21 statin (64%). A total of 18 patients had known cardiovascular disease, 10 of whom had received carotid stenting or coronary artery bypass surgery. Ten patients diagnosed with embolus required and consented to carotid Doppler studies. Six patients were confirmed with significant carotid stenosis and 2 (6%)of these patients required carotid endarterectomy surgery. Overall, 4patients died, a mortality rate of 12% over 3 years. Conclusions. Annual diabetic retinopathy screening provide sopportunistic identification of asymptomatic cholesterol emboli and provides an opportunity for review of medical management in the high-risk patient group with appropriate identification and referral for carotid stenosis surgery. A total of 11 patients were identified with sub optimal cardiovascular risk management: e.g., statin use.