Search

The article offers information on topics related to international medical graduates (IMGs). Topics mentioned include the importance of IMG, the support of the National Health Service (NHS) Trust in the project that aims to help IMG, and the services for the IMGs. Also mentioned are the assessment for medical personnel, the physician training, and the importance of medical personnel retention rates.

Introduction: Suboptimal asthma care is related to increased morbidity and mortality. As a result, GP surgeries provide annual reviews for people with asthma. A high proportion of asthma patients do not attend their review but still collect asthma treatment from their community pharmacy. The aim of this proof-of-concept study was to evaluate the provision of patient non-attendance lists to community pharmacies who subsequently offered the review. Method: Five GP surgeries and ten community pharmacies were recruited in the east of England. Non-attender details were provided to community pharmacies from GP surgeries directly over a six-month period. Asthma reviews, funded by the medicines use review scheme, were delivered using standardised methodological approaches and electronic recording systems. Relevant routinely collected data were obtained before and after service provision. Stakeholder meetings were held to obtain feedback after service completion. Results: A total of 27 patients received the service, with data collected on 26 patients. High levels of satisfaction with the service were identified. Pharmacist training, pharmacy accessibility and pharmacist competence were seen as service enablers. The pharmacy consultation room, GP surgery organisation and different IT systems were seen as barriers. A high level of satisfaction was identified, with the recommendation that the service should be offered to all patients with asthma irrespective of attendance. Discussion and conclusion: This service model, which involved integrated working between GPs and community pharmacies and enabled asthma review non-attenders to be targeted, is in line with the recommendations of the Murray Review. Stakeholders recommended that community pharmacists should provide yearly asthma reviews and that these should be performed in close collaboration with GP surgeries. [ABSTRACT FROM AUTHOR]

In October 2017, as two semi-retired NHS doctors, we visited a local hospital and a health centre in Sumbawanga, a rural town in Tanzania. We were curious to find out how the healthcare system worked, to see what support might be helpful to the healthcare professionals themselves and whether and how ideas might be applied in the U.K. We found the health facilities we visited to be well organised and functioning with a small number of multi-skilled clinicians. However, we were aware that there are inadequate numbers of suitably trained healthcare professionals per head of the population in this area and that this could contribute to some of the poorer health outcomes. Our visit left us wondering whether the provision of support in the form of leadership coaching, educational consultancy and friendship with colleagues in the U.K. might enhance job satisfaction and, in turn, whether this might have a beneficial effect on staff recruitment and retention. These are ideas that we are now pursuing with a plan to return to Tanzania in the autumn of 2018. [ABSTRACT FROM AUTHOR]

Interprofessional education (IPE) approach allows learners from different health professions viz. - medical, dental, nursing, physiotherapy, psychotherapy, psychology etc., learn from, learn with, and learn about, each other. The scope of learning depends upon the requirements and curriculum. Interprofessional education can help in creating a workforce that learns to perform collaborative practice thereby ensuring better health-care outcomes. Medical educators' and practitioners' understanding about teaching, learning, and assessment of IPE is rudimentary. Strategies to incorporate IPE in regular curricula need to be debated and barriers associated with its implementation require to be identified. This review highlights the teaching-learning and assessment tools for IPE and discusses potential challenges in its implementation. [ABSTRACT FROM AUTHOR]

Randomised trials are a central component of all evidence-informed health care systems and the evidence coming from them helps to support health care users, health professionals and others to make more informed decisions about treatment. The evidence available to trialists to support decisions on design, conduct and reporting of randomised trials is, however, sparse. Trial Forge is an initiative that aims to increase the evidence base for trial decision-making and in doing so, to improve trial efficiency.One way to fill gaps in evidence is to run Studies Within A Trial, or SWATs. This guidance document provides a brief definition of SWATs, an explanation of why they are important and some practical 'top tips' that come from existing experience of doing SWATs. We hope the guidance will be useful to trialists, methodologists, funders, approvals agencies and others in making clear what a SWAT is, as well as what is involved in doing one. [ABSTRACT FROM AUTHOR]

Background: Early detection of breast cancer is known to improve its prognosis. However, women in most low and middle income countries, including Uganda, do not detect it early hence present at an advanced stage. This study investigated the perceived barriers to early detection of breast cancer in Wakiso district, Uganda using a multilevel approach focused through a socioecological framework.Methods: Using qualitative methods, participants were purposively selected to take part in the study. 5 semi-structured interviews were conducted among the community members while two focus groups were conducted amongst women's group and community health workers (CHWs) in Ssisa sub county, Wakiso district. In addition, 7 key informant interviews with health professionals, policy makers and public health researchers were carried out.Results: Findings from the study revealed that barriers to early detection of breast cancer are multifaceted and complex, cutting across individual, interpersonal, organizational, community and policy barriers. The major themes that emerged from the study included: knowledge, attitudes, beliefs and practices (KABP); health system and policy constraints; and structural barriers. Prominent barriers associated with KABP were low knowledge, apathy, fear and poor health seeking behaviours. Barriers within the health systems and policy arenas were mostly centred around competing health care burdens within the country, lack of a cancer policy and weak primary health care capacity in Wakiso district. Distance, poverty and limited access to media were identified as the most prominent structural barriers.Conclusion: Barriers to early detection of breast cancer are complex and go beyond individual behaviours. These barriers interact across multiple levels of influence such as organizational, community and policy. The findings of this study could provide opportunities for investment in multi-level interventions. [ABSTRACT FROM AUTHOR]

Boeing and a team from NASA, the U.S. Army, DARPA, the U.S. Air Force, MIT, UCLA, and the University of Maryland have successfully completed a wind tunnel test of the Smart Material Actuated Rotor Technology (SMART) active flap rotor in the 40- × 80-FootWind Tunnel of the National Full-Scale Aerodynamics Complex at NASA Ames Research Center. The Boeing SMART active flap rotor is a full-scale, five-bladed bearingless MD900 helicopter rotor modified with a piezoelectricactuated trailing-edge flap on each blade. The 11-week test program evaluated the forward flight characteristics of the active flap rotor at speeds up to 155 kt, gathered data to validate state-of-the-art codes for rotor aeroacoustic analysis, and quantified the effects of open- and closed-loop active flap control on rotor loads, noise, and performance. The test demonstrated onblade smart material control of flaps on a full-scale rotor for the first time in a wind tunnel. The effectiveness of the active flap control on noise and vibration was conclusively demonstrated. Results showed reductions up to 6 dB in blade-vortex interaction and in-plane noise, as well as reductions in vibratory hub loads of about 80%. Trailing-edge flap deflections were controlled with less than 0.2 deg rms error for commanded harmonic profiles of up to 3 deg amplitude. The impact of the active flap on control power, rotor smoothing, and performance was also demonstrated. Finally, the reliability of the flap actuation system was successfully proven in more than 60 h of wind tunnel testing. [ABSTRACT FROM AUTHOR]

Human errors are considered as one of the main causes of incidents in the field of health care. it is very important to predict errors and identify the factors causing them. Chemotherapy ward is considered as one of the most dangerous working environment, where errors can cause severe damages in patients, psychological trauma in the service-provider cadre, declining credit and legal consequences. Since there is no study in this regard and according to the high number of chemotherapists in Iran, the present study was performed to identify and assess physician and nurse'errors during chemotherapy process, and to determine the corresponding risk and safety principles. A cross-sectional descriptive study was conducted in chemotherapy ward at Imam Reza hospital in Kermanshah. Different activities were carried out in this study, including: review literature, examining statistics and scientific resources, interviewing with physicians and nurses in chemotherapy, training the aim and research methodology, studying the instructions of chemotherapy, and monitoring activities and measures. Tasks were analyzed by (HTA) method, then errors were identified by SHERPA instruction, and their risks were evaluated, finally, appropriate control measures were presented to reduce the risks of errors. A total of 459 errors were identified among the 122 task, 10.46 percent of errors were unacceptable, and 42.11 percent were undesirable. Most of the errors were functional, and the fewest were retrieval. These errors occurred for some reasons including: lack of doctors and nurses in relation to the large number of patients, lack of comprehensive guidelines, lack of cooperation between doctors, lack of proper training. According to the results and assessment of obtained risks, functional errors should be prioritized to control and reduce errors, which is possible through the development of guidelines and training courses, the careful monitoring of supervisors and frequent checkup, registering errors and disclosing. [ABSTRACT FROM AUTHOR]

Purpose: Health professionals are an important source of information for teenage and young adult (TYA) cancer patients. However, little is known about health professionals' provision of lifestyle advice to young people with cancer who are in their care.Methods: An online survey was distributed to health professionals within the UK who identified themselves as working with TYA cancer patients. Health professional awareness of lifestyle guidance, provision of lifestyle advice to young people and views on lifestyle information format and delivery were explored.Results: Ninety-five health professionals (44% nurses; 28% allied health professionals; 17% physicians) completed the survey. The majority (72%) of respondents were aware of some lifestyle guidance for cancer patients. However, less than half of TYA health professionals (46%) were able to successfully recall the source of the guidelines and less than a third reported proving specific advice to the majority of their patients on weight management, smoking, alcohol consumption and sun safety. Many health professionals (38%) felt that they were not the right person to provide advice and cited lack of resources as a key barrier to advice provision. The majority (95%) reported being interested in a resource containing relevant lifestyle information that could be given to young people with cancer.Conclusions: TYA health professionals' awareness of lifestyle guidance and provision of advice regarding health behaviour is sub-optimal. Clear and comprehensive guidance written specifically for TYA health professionals could overcome the reported barriers and improve professionals' confidence in addressing and providing advice on lifestyle to young people with cancer. [ABSTRACT FROM AUTHOR]

Background: Chronic (non-communicable) diseases (NCD) - principally cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes - are leading causes of death and disability. There is the need to adopt a core University curriculum which let students be taught by teachers who are experts of the four main NCD, for reaching the public health goals proposed by the UN and the WHO. Methods: Our aim was to assess whether all medical students, regardless of the Italian university of enrolment, have an equal opportunity to be educated by an expert teacher in each of the four NCD. We have used the search engine http://cercauniversita.cineca.it/php5/docenti/cerca.php. Results: In January 2016, for each of the 43 universities with a school of medicine, we have assessed the presence of professors / instructors for each of the four academic disciplines corresponding to the four NCD: a) Respiratory medicine; b) Cardiovascular medicine; c) Oncology; d) Endocrinology. Comparing university personnel between Respiratory medicine and each of the other NCD academic sectors, there were negative differences, much wider with the sector Cardiovascular medicine, regarding individual (number of professors/instructors) and collective indicators (number of Universities with various kinds of professors/instructors). Conclusions: Both national societies and ERS should promote periodic analyses of the academic situation of respiratory medicine in the European countries for advocating the EU in order to have recommendations/suggestions for the Member States to get the proper recognition of respiratory medicine, at the same level as the other disciplines involved in preventing and managing the four main NCD. [ABSTRACT FROM AUTHOR]

Aim and Objectives: The correct referral system will help in providing good health care to people and the patients will utilize the facilities of the primary health services in a better way. The main objectives of the study were to see the efficacy of referral system and to assess whether the available referral system is utilized by the patients in KPK. Materials& Methods: It is an observational qualitative research study. A questionnaire was developed to record the availability of referral form or other documentation of patient referred by the general practitioners or health workers in public health care centers of that areas. Result: A total number of 229 patients were referred from eye camps, amongst them 95(41.48%) patients were male and 134 (58.51%) were female but only 90(39.30%) male and 119(51.96%) female with full referral record came to the hospital for cataract surgery. However, 20 (8.73%) failed to report. On the other hand, 220 patients admitted in the eye ward for cataract surgery from different areas of KPK. did not bring the referral record. Among these 220 patients, 171(44.11%) males and 49(12.09%) females were operated. Conclusion: There is no proper referral system in public sector hospitals. Patients are free to seek health facilities at any level from any health center. Since no treatment grading of diseases exist therefore the patients avoid public sector health facilities. [ABSTRACT FROM AUTHOR]

Surgery is the most invasive intervention taken on behalf of health, but significant discrepancies exist between patient expectations and standard operating room practices, especially in teaching institutions. These discrepancies arise from the dual obligations of surgical faculty to present and future patients. On the one hand, in line with a patient's autonomous election of a procedure and choice of a doctor, faculty are charged with treating patients to the utmost capacity of their knowledge and skill; on the other, in support of a critical community good, they must prepare novice physicians to treat those who will require at least this level of knowledge and skill in the future. Within a broad, contrasting framework of approaches to knowledge, judgment, experience, and nature as described by Hume and Kant, this article explores the complicated concepts of trust, loyalty, assessment, and communications that presently exist between surgical patients, faculty surgeons, and surgical trainees within academic medical centers. [ABSTRACT FROM AUTHOR]

Neurosurgery at Bombay Hospital started in 1953 when Dr. Ram Ginde joined as the Honorary Neurosurgeon. Over the years, the Department of Neurosurgery has earned the reputation of providing contemporary medical services as well as of imparting excellent training to the neurosurgical residents. Professor S. N. Bhagwati started the prestigious annual 'Ginde oration' in 1991, that has been given by several illustrious orators from across the world and has become a precursor of various medical activities held thereafter. This article retraces the history and achievements of the Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, and also highlights the immense contributions made by its members in the field of Neurosurgery in India. [ABSTRACT FROM AUTHOR]

The experience of chronic pain is universal, yet pain management services delivered by health professionals vary substantially, depending on the context and patient. This review is a part of a series that has examined the issue of chronic non-cancer pain services and management in different global cities. The review is structured as a case study of the availability of management services for people living with chronic non-cancer pain within the context of the Kuwaiti health systems, and the cases are built from evidence in the published literature identified through a comprehensive review process. The evolution of the organizational structure of the public and private health systems in Kuwait is described. These are discussed in terms of their impact on the delivery of comprehensive chronic pain management service by health professionals in Kuwait. This review also includes a description of chronic pain patient personas to highlight expected barriers as well as compliance issues with services likely to be encountered in Kuwait. The case study analysis and persona descriptions illustrate a need to move beyond pain symptom management towards considering the entire person and his/her individual experience of pain such that health care success is judged by enhancement of patient well-being rather than access to services. A road map for improving integrative chronic pain management in Kuwait is discussed. [ABSTRACT FROM AUTHOR]

Since January 2008-de facto 2012-medical physics experts (MPEs) are, by law, to be involved in the optimisation process of radiological diagnostic procedures in Switzerland. Computed tomography, fluoroscopy and nuclear medicine imaging units have been assessed for patient exposure and image quality. Large spreads in clinical practice have been observed. For example, the number of scans per abdominal CT examination went from 1 to 9. Fluoroscopy units showed, for the same device settings, dose rate variations up to a factor of 3 to 7. Quantitative image quality for positron emission tomography (PET)/CT examinations varied significantly depending on the local image reconstruction algorithms. Future work will be focused on promoting team cooperation between MPEs, radiologists and radiographers and on implementing task-oriented objective image quality indicators. [ABSTRACT FROM AUTHOR]

The French regulations concerning the involvement of medical physicists in medical imaging procedures are relatively vague. In May 2013, the ASN and the SFPM issued recommendations regarding Medical Physics Personnel for Medical Imaging: Requirements, Conditions of Involvement and Staffing Levels. In these recommendations, the various areas of activity of medical physicists in radiology and nuclear medicine have been identified and described, and the time required to perform each task has been evaluated. Criteria for defining medical physics staffing levels are thus proposed. These criteria are defined according to the technical platform, the procedures and techniques practised on it, the number of patients treated and the number of persons in the medical and paramedical teams requiring periodic training. The result of this work is an aid available to each medical establishment to determine their own needs in terms of medical physics. [ABSTRACT FROM AUTHOR]

Background: In their article on "Evidence-based de-implementation for contradicted, unproven, and aspiring healthcare practices," Prasad and Ioannidis (IS 9:1, 2014) referred to extra-scientific "entrenched practices and other biases" that hinder evidence-based de-implementation. Discussion: Using the case example of the de-implementation of radical mastectomy, we disaggregated "entrenched practices and other biases" and analyzed the historical, economic, professional, and social forces that presented resistance to de-implementation. We found that these extra-scientific factors operated to sustain a commitment to radical mastectomy, even after the evidence slated the procedure for de-implementation, because the factors holding radical mastectomy in place were beyond the control of individual clinicians. Summary: We propose to expand de-implementation theory through the inclusion of extra-scientific factors. If the outcome to which we aim is appropriate and timely de-implementation, social scientific analysis will illuminate the context within which the healthcare practitioner practices and, in doing so, facilitate de-implementation by pointing to avenues that lead to systems change. The implications of our analysis lead us to contend that intervening in the broader context in which clinicians work--the social, political, and economic realms--rather than focusing on healthcare professionals' behavior, may indeed be a fruitful approach to effect change. [ABSTRACT FROM AUTHOR]

The authors reflect on the institutional support for health care professionals (HCPs) in the U.S. who provide service to African countries with Ebola epidemic. Topics discussed include the restriction of service by some academic medical centers (AMCs) in the U.S., the HCPs compliance to the guidelines created by the U.S. Centers for Disease Control and Prevention (CDC), and the ethical responsibilities of health care institutions.

Background Maternal depression carries a major public health burden for mothers and their infants, yet there is a substantial treatment gap for this condition in low-resourced regions such as sub- Saharan Africa. To address this treatment gap, the strategy of "task sharing" has been proposed, involving the delivery of interventions by non-specialist health workers trained and supervised by specialists in routine healthcare delivery systems. Several psychological interventions have shown benefit in treating maternal depression, but few have been rigorously evaluated using a task sharing approach. The proposed trial will be the first randomised controlled trial (RCT) evaluating a task sharing model of delivering care for women with maternal depression in sub-Saharan Africa. The objective of this RCT is to determine the effectiveness and cost-effectiveness of a task sharing counseling intervention for maternal depression in South Africa. Methods/Design The study is an individual-level two-arm RCT. A total of 420 depressed pregnant women will be recruited from two ante-natal clinics in a low-income township area of Cape Town, using the Edinburgh Postnatal Depression Scale to screen for depression; 210 women will be randomly allocated to each of the intervention and control arms. The intervention group will be given six sessions of basic counseling over a period of 3 to 4 months, provided by trained community health workers (CHW)s. The control group will receive three monthly phone calls from a CHW trained to conduct phone calls but not basic counseling. The primary outcome measure is the 17-Item Hamilton Depression Rating Scale (HDRS-17). The outcome measures will be applied at the baseline assessment, and at three follow-up points: 1 month before delivery, and 3 and 12 months after delivery. The primary analysis will be by intention-to-treat and secondary analyses will be on a per protocol population. The primary outcome measure will be analyzed using linear regression adjusting for baseline symptom severity measured using the HDRS-17. Discussion The findings of this trial can provide policy makers with evidence regarding the effectiveness and cost-effectiveness of structured psychological interventions for maternal depression delivered by appropriately trained and supervised non-specialist CHWs in sub- Saharan Africa. Trial registration Clinical Trials (ClinicalTrials.gov): NCT01977326, registered on 24/10/2013; Pan African Clinical Trials Registry (www.pactr.org): PACTR201403000676264, registered on 11/10/2013. [ABSTRACT FROM AUTHOR]

The article discusses a guideline from the British Committee for Standards in Haematology, focusing on the non-coumarin anticoagulants and its effect on haemostasis. It states that the guideline was designed to provide a clear guidance for healthcare professionals on issues relative to laboratory assessment of non-coumarin anticoagulants. Other topics include effect of dabigatran on haemostasis tests, monitoring of unfractionated heparin, and the use of bivalirudin as an alternative heparin.

Aim: The discharge summary is a vital component of patient care. It is a means by which information is conveyed to clinicians and community mental health team who will be involved in follow-up patient care. This calls for accuracy as well as completeness of information as these are vital components that can directly impact patient care. Timing of discharge letter/summary reaching the follow-up physician, general practitioner or community mental health team, from point of discharge can also play a key role in patient management. This audit looks at the content and timing of discharge summaries from The Mount, Old Age Psychiatry hospital as to whether it adheres to the local Trust guidelines. Methods: Discharge summaries from electronic database were reviewed. In cycle 1 of the audit, adherence to local Trust guidelines in relation to the content, accuracy and timing of discharge summaries were studied. In the follow-up audit cycle, changes in clinical practice brought about following recommendations were studied. Results: Recommendations and feedback were found to be effective in significantly improving adherence to inclusion of family history (p<0.001), social history (p<0.001), premorbid history (p=0.036), progress and treatment during hospital stay (p=0.049) in the discharge summary. Significant decrease was observed in inclusion of follow-up arrangements (p=0.007). Other significant improvements included lesser spelling errors (p<0.001), dictation (p<0.001) and typing (p<0.001) of discharge letter within 5 working days of discharge of patient. Conclusions: This study adds to importance of accuracy and timing of discharge summaries to ensure good medical practice and continuity of care. It also establishes scope for improvement and recommendations that can further improve clinical practice. Furthermore, key decisions on patient care can be made by follow-up health professionals, at the earliest and with the help of appropriate information. [ABSTRACT FROM AUTHOR]

Emergency medicine services and training in Emergency Medicine (EM) has developed to a large extent in developed countries but its establishment is far from optimal in developing countries. In India, Medical Council of India (MCI) has taken great steps by notifying EM as a separate specialty and so far 20 medical colleges have already initiated 3-year training program in EM. However, there has been shortage of trained faculty, and ambiguity regarding curriculum, rotation policy, infrastructure, teachers' eligibility qualifications and scheme of examination. Academic College of Emergency Experts in India (ACEE-India) has been a powerful advocate for developing Academic EM in India. The ACEE's Education Development Committee (EDC) was created to chalk out guidelines for staffing, infrastructure, resources, curriculum, and training which may be of help to the MCI and the National Board of Examinations (NBE) to set standards for starting 3-year training program in EM and develop the departments of EM as centers of quality education, research, and treatment across India. This paper has made an attempt to give recommendations so as to provide a uniform framework to the institutions, thus guiding them towards establishing an academic Department of EM for starting the 3-year training program in the specialty of EM. [ABSTRACT FROM AUTHOR]

This project explored one of the issues affecting access to health care services by Gypsy Travellers, namely the cultural competence of health professionals. The aim of the project was to support the development of cultural competence in health professionals through an exploration of staff attitudes, knowledge, and understanding of the cultural identity and health needs of Gypsy Travellers. Participants were drawn from community nursing services and members of the Irish Traveller community. The data collated from staff suggested there was limited understanding of Gypsy Traveller culture, health needs, or issues affecting the community, and the perceptions held were informed largely by negative media stereotypes. The benefits of honest, nonjudgmental, open discussion within professional forums about the existence and impact of bias and prejudice on practice were highlighted alongside the need for an improved understanding of the issues faced by Gypsy Travellers to improve access to care by this often excluded and marginalized community. [ABSTRACT FROM AUTHOR]

Physical therapists and physical therapist assistants are a subset of health care providers taking on new roles in global health through international clinical experiences (ICE). During ICE, clinicians and students often work with patients and families. Each party brings with them health beliefs and interaction styles obtained from their families and communities. The revised code of ethics for physical therapists and the standards of practice for physical therapist assistants challenge us to be respectful of all patients we work with and to identify our own biases with regard to those we serve. Strategies used by clinicians have potential to greatly help or harm patients and families depending on the interaction approach used. It is important to be attentive to patients, families, family dynamics, and the expectations of the patient and family if the physical therapy interventions are to be optimally effective. An understanding of one's own culture and personal values as well as the ability to detach oneself from personal views are essential to providing appropriate family-centered health care that empowers families rather than diminishes their ability to care for their children. This article discusses strategies of moving from not-knowing into knowing as we engage and empower the patients and families we encounter in the ICE setting through a reflective "I CAN DO" model to promote sustainable care. Several case examples are provided which illustrate engaging families and communities in a culturally respectful manner which empowers families long after we leave the ICE setting. [ABSTRACT FROM AUTHOR]

In 2006 the Brooklands' Adapted Sex Offender Treatment Programme (ASOTP) was adopted by Calderstones Partnership NHS Foundation Trust. To date, two groups of men (n = 10) have completed the programme and one group (n = 6) is currently in progress. This treatment model uses a cognitive behavioural framework and is a nurse-led initiative, utilising trained ward staff. This paper discusses experiences of initiating and delivering the ASOTP programme. Several issues were encountered, including staff retention, clients discontinuing the group, the length of the group, the length of wait for clients to commence their treatment and high levels of administration. As a result of these, and developments to the Brooklands' model, several changes were made before the commencement of the second wave in 2008.The paper discusses how the ASOTP were able to overcome some, but not all, of the initial difficulties and highlights potential pitfalls for future groups. [ABSTRACT FROM AUTHOR]

BACKGROUND: Respiratory therapists (RTs) are often involved in treating seriously ill and dying patients, but receive little instruction in end-of-life care. Prompted by several difficult cases, we developed an interdisciplinary program to introduce practicing RTs to ethical and end-of-life issues, and evaluated the program with a dedicated survey instrument. METHODS: A convenience sample of RTs from a university hospital and nearby community hospitals participated in a one-day interactive program, in 2005 (n = 49) and in 2008 (n = 36), that included role-play and didactic components. The questionnaire completed before and after the program included scales on comfort with end-of-life care and role in end-of-life care, and knowledge indices. RESULTS: Nearly all the RTs had recently encountered end-of-life situations, yet most had not received dedicated training and felt ill-prepared to deal with these situations; one third reported distress related to withdrawal of treatment. The 78 participants who completed both the before and after surveys had increased comfort with end-of-life care (P < .001) and their perception of their role in end-of-life care (P < .001). Knowledge about end-of-life care also increased (P < .001). CONCLUSIONS: A one-day interactive educational intervention can improve short-term RT comfort and role perception concerning end-of-life care. Evaluation of longer-term clinical outcomes and implementation in other venues is needed. [ABSTRACT FROM AUTHOR]

The article provides tips on how healthcare professionals can technically find online, evidence-based information that will help them manage a particular clinical problem. Searching databases including Medline is ideal when there is enough time but Drug Abuse Resistance Education (DARE) website is one of the best resources when the time is limited. Formulating a population, intervention, comparison, outcome (PICO) question is necessary in identifying high quality information on the Internet.

Objectives: The research objectives were to (1) describe the current and future roles of hospital librarians and the challenges they face and (2) find evidence supporting the hypothesis that librarians are essential to hospitals in achieving the organizations' mission-critical goals. Method: The authors used results from a previous research study that identified the five organizational mission-critical goals important to hospital administrators and then searched the literature and solicited examples from hospital librarians to describe the librarian's role in helping hospitals achieve these goals. Results: The literature supports the hypothesis that hospital librarians play important roles in the success of the hospital. Librarians support quality clinical care, efficient and effective hospital operations, continuing education for staff, research and innovation, and patient, family, and community health information needs. Conclusion: Hospital librarians fulfill many mission-critical roles in today's hospital, providing the right information at the right time in a variety of ways to enhance hospital and medical staff effectiveness, optimize patient care, improve patient outcomes, and increase patient and family satisfaction with the hospital and its services. Because hospital librarians and their services provide an excellent return on investment for the hospital and help the hospital keep its competitive edge, hospital staff should have access to the services of a professional librarian. [ABSTRACT FROM AUTHOR]

Objectives: This research studied hospital administrators' and hospital-based health care providers' (collectively, the target group) perceived value of consumer health information resources and of librarians' roles in promoting health information literacy in their institutions. Methods: A web-based needs survey was developed and administered to hospital administrators and health care providers. Multiple health information literacy curricula were developed. One was pilot-tested by nine hospital libraries in the United States and Canada. Quantitative and qualitative methods were used to evaluate the curriculum and its impact on the target group. Results: A majority of survey respondents believed that providing consumer health information resources was critically important to fulfilling their institutions' missions and that their hospitals could improve health information literacy by increasing awareness of its impact on patient care and by training staff to become more knowledgeable about health literacy barriers. The study showed that a librarian-taught health information literacy curriculum did raise awareness about the issue among the target group and increased both the use of National Library of Medicine consumer health resources and referrals to librarians for health information literacy support. Conclusions: It is hoped that many hospital administrators and health care providers will take the health information literacy curricula and recognize that librarians can educate about the topic and that providers will use related consumer health services and resources. [ABSTRACT FROM AUTHOR]

This article describes a specialized program facilitated by the Employee Assistance Program (EAP), focused on the needs of married house staff (residents and fellows) within an academic medical center. This program was developed in conjunction with the Vanderbilt House Staff Alliance, facilitated by Work/Life Connections-EAP, the internal Employee Assistance Program, and Medical Staff Special Events at Vanderbilt University in Nashville, Tennessee. The program is sponsored by the Vice Chancellor for Health Affairs and his wife, the driving force behind the project. Given the unique stressors faced by married couples during medical training, the Matters of the Heart series was developed to help house staff and their spouses manage the challenges that affect their relationships during this stressful time. [ABSTRACT FROM AUTHOR]

The article focuses on the accountability system of Emergency Medical Services (EMS), which include the tag-based system and dry-erase boards. It states that the system is used to improve the safety of personnel who respond and operate at the emergency scene by keeping track of the locations and assignments of responders. It also notes that the system is necessary for large-scale incidents such as traffic accidents, disasters, and building collapses.

The article reports on Health Disparities, the largest national quality improvement (QI) initiatives in community health centers. It states that incentives and assistance personnel are the factors necessary to sustain QI, while lack of resources, time and staff burnout are considered the barriers. Furthermore, the highest funding priorities are direct patient care services, data entry and staff time for QI.

The article discusses the perceptions of hospital librarians regarding the importance of evidence-based medicine. The support provided by medical librarians for clinicians practicing evidence-based health care (EBHC) is explored. Obstacles to supporting EBHC are examined and include lack of time and a lack of familiarity with statistical concepts. The importance of EBHC among nursing staff at Magnet hospitals is also explored. The authors focus on the influence hospital librarians can contribute to the use of EBHC through their status as information providers.

Venous leg ulcers account for a large percentage of the financial and healthcare burden of chronic wounds, they are costly to treat both financially and in nursing time. The prerequisites for any healthcare professional to be able to provide safe, effective compression therapy bandaging for any patient must include knowledge, ability and proven competence. Without such competence the patient is vulnerable to harm and the nurse is open to criticism, disciplinary action by the Nursing and Midwifery Council or even litigation. Pressure damage to patients' skin under compression therapy can occur due to a number of factors and it is the responsibility of a registered nurse to ensure compression bandaging is safely and expertly applied. [ABSTRACT FROM AUTHOR]

Objectives: This paper reports an evaluation, carried out for London Health Libraries, of the impact of outreach services to primary care and mental health workers in 13 different settings. The main aims of the project were to identify the impact being made by the service, and to produce best-practice guidelines for outreach services in this kind of community setting. Methods: Analysis of documents, analysis of any evaluation already carried out, interviews with outreach librarians, survey of a representative sample of users (eight services). The services evaluated were very diverse in terms of setting, structure, functions and activities. The evaluation was therefore largely qualitative. Emphasis was placed on trying to identify critical incidents, where it could be shown unambiguously that the outreach services made a difference to practice. Findings: Service recipients felt better informed, more up to date, more aware of resources, more confident and supported in their work, and saved time. Direct impacts, such as improved patient care, cost savings, etc., were more difficult to establish. Conclusions: The study identified the main areas of impact, and the main factors which affected this. Recommendations for good practice in such outreach services are made. Lessons of this evaluation for impact studies in general are presented, in particular the difficulty of assessing ‘direct’ impacts. [ABSTRACT FROM AUTHOR]

Objectives: Assessment of the usage of medical library services before and after the implementation of several new services, as well as assessment of the clinical impact of the information provided by the medical library. Methods: A sample of employees, residents and physicians were surveyed using a stratified, random selection process in two surveys 4 years apart. The response rate for the first survey was 52% and the response rate for the second survey was 35.2%. Results: Differences in usage included increased overall use of the librarians and library services, decreased use of the Internet as a source of information, and direct and indirect impacts upon patient care. Information needs of respondents also increased to where 65% of employees and 94% of physicians require information at least once a week. Patient management was the main reason for needing information. The top two specific uses were to find out about a condition and determine a treatment plan. Conclusions: These findings parallel some of the findings of other researchers, and contradict the findings of others. Possible explanations for these findings and implications for future research are discussed. [ABSTRACT FROM AUTHOR]

Objectives: To explore how the library service expectations and perceptions of users might differ across health-related libraries as against major research libraries not operating in a medical context; to determine whether users of medical libraries demand better library service quality, because the inability of users to access needed literature promptly may lead to a patient who cannot be properly diagnosed, or a diagnosis that cannot be properly treated. Methodology: We compared LibQUAL+® total and subscale scores across three groups of US, Canadian and British libraries for this purpose. Results: Anticipated differences in expectations for health as other library settings did not emerge. Conclusions: The expectations and perceptions are similar across different types of health science library settings, hospital and academic, and across other general research libraries. [ABSTRACT FROM AUTHOR]

Objectives: To summarize the context, history and results of research studies conducted on the value and impact of health library and information services by the author since 1975 and to use this as a basis for examining ongoing developments related to evaluation research. To provide a comprehensive bibliography of library value and impact studies. Methods: Literature review and background based on personal involvement in the studies under discussion. Results: The author's studies demonstrate an ongoing evolution of value and impact studies since the mid-1970s. In health sciences libraries, the approach taken to measuring value and impact has been strongly influenced by the type of research being conducted in the health sciences field as a whole. As a result, health sciences library researchers have become early adopters of methods that incorporate outcome and impact measures and rigorous research designs, and the concept of evidence-based library and information practice. The paper recommends that a range of research approaches from various disciplines be used to guide future evaluation research. Conclusions: Value and impact studies will continue to be important resources for evidence-based practice as health information professionals deal with evolving user needs and new ways of delivering information to a variety of audiences. [ABSTRACT FROM AUTHOR]

The aim of this study was to design a culture-sensitive scale to measure caregiver's burden for the purpose of identifying their needs in Taiwan. In this study, four factors were identified as caregiver's top priority needs: “personal factors,”“relation factors,”“financial factors,” and “reward factors.” Definitions for each factor are also discussed. The total variances explained by the four factors are 34%, 13%, 9%, and 8%, respectively. The results show caregivers in Taiwan place more emphasis on their physical and emotional interaction with the care-receivers than is found in other cultures. Policy recommendations inferred from these findings are made. It is necessary for the government or organizations to provide services to fulfill caregivers' needs to promote a healthy aging process of the caregivers themselves. Participants who cared for their elderly parents or relatives were selected randomly from the island of Taiwan. The total selected sample size of caregivers is 2524, who were caring for 3504 persons. Data were analyzed by univariate, bivariate, and multivariate methods. Maximum Likelihood Extraction Factors Analysis and LISREL for Structural Equation Modeling methods were used to confirm and make final the structure of the scale. Recommendations and suggestions are provided for further studies on culturally sensitive projects. [ABSTRACT FROM AUTHOR]

This article discusses the necessity of establishing trust with family members of patients who are children, in addition to maintaining good communication with colleagues, for medical personal. These qualities must also accompany strict attention to detail during medical emergencies. The article presents a case study involving a toddler who suffered a severe head injury after being struck by a car. The article examines medical personal response to the emotional and informational needs of the toddler's family. It also discusses the importance of support for the medical personal who aid these families during tragic events.

The article presents information related to the interactive Web based tutorial "Introduction to Evidence-Based Medicine." It is reported that two librarians and a curriculum support specialist worked together during 1999 to create the tutorial which aims at providing an introduction to evidence-based medicine (EBM) and the steps in the EBM process. "EBM from the Office," one of the nine units of the tutorial, explains the basic equipment, services, and resources a health care provider may require in his/her office. The tutorial, which is available at the Web address www.hsl.unc.edu/ebm/index.htm, offers information that can be used for educational purposes by anyone who wishes to link it with their Web pages.

The article discusses the trends in medical artificial intelligence (AI). It highlights the potential for general practice in medicine industry. It mentions the increasing number of AI in healthcare industry as well as other sector of the economy worldwide. An overview won the statistical methods in clinical decision making, is also emphasized.