Search Results for
"Humans"

Background: Hand dermatitis, including irritant and allergic contact dermatitis (ACD), is common. Objective: To evaluate allergens, relevant irritants, sources and occupations associated with hand contact dermatitis using North American Contact Dermatitis Group (NACDG) data. Methods: A cross-sectional analysis of 22,025 patients patch tested between 1994 and 2004. Results: Hand involvement was found in 6953 patients; 959 had ACD as the only diagnosis. In these 959 patients, the 12 most frequent relevant allergens were quaternium-15 (16.5%), formaldehyde (13.0%), nickel sulfate (12.2%), fragrance mix (11.3%), thiuram mix (10.2%), balsam of Peru (9.6%), carba mix (7.8%), neomycin sulfate (7.7%), bacitracin (7.4%), methyldibromoglutaronitrile/phenoxyethanol 2.0% (7.4%), cobalt chloride (6.5%), and methyldibromoglutaronitrile/phenoxyethanol 2.5% (6.3%). Rubber allergens were most commonly associated with occupation. One third of patients with hand ACD had identifiable relevant irritants. Limitations: Cross-sectional analyses prevent evaluation of causal associations. Conclusion: In NACDG patients with hand ACD, the most common allergens included preservatives, metals, fragrances, topical antibiotics, and rubber additives. © 2007 American Academy of Dermatology, Inc.

Title. Resilience in the operating room: developing and testing of a resilience model Aim. This paper is a report of a study to examine the relation of perceived competence, collaboration, control, self-efficacy, hope, coping, age, experience, education and years of employment to resilience in operating room (OR) nurses. Background. Resilience is viewed as a vital attribute for nurses because it augments adaptation in demanding and volatile clinical environments such as ORs. However, there has been little research into the utility of resilience as a means of dealing with workplace stress, and there is only limited understanding of variables that explain resilience in the context of nursing. Method. A correlational cross-sectional survey design was used. Of a national sample of 2860 Australian OR nurses, 1430 were selected by systematic random sampling and invited to complete a questionnaire in 2006. The instrument included scales measuring perceived competence, collaboration, control, self-efficacy, hope, coping and resilience, and gathered information about the demographic characteristics of respondents. Results. Two regression models were used to develop a model of resilience. An initial model tested the hypothesis that a set of 12 explanatory variables contributed to resilience in OR nurses. Five variables (hope, self-efficacy, coping, control and competence) explained resilience at statistically significant levels. Age, experience, education and years of employment did not contribute to resilience at statistically significant levels. The final model explained 60% of the variance. In both models, the strongest explanatory variables were hope, self-efficacy and coping. Conclusion. Identification of explanatory variables that contribute to resilience in ORs may assist in implementing strategies that promote these behaviours, and thus retain nurses in this specialty. © Blackwell Publishing Ltd.

This paper presents the results of a study comparing student learning in an inquiry-based and a traditional course in biotransport. Collaborating learning scientists and biomedical engineers designed and implemented an inquiry-based method of instruction that followed learning principles presented in the National Research Council report "How People Learn" (HPL). In this study, the intervention group was taught a core biomedical engineering course in biotransport following the HPL method. The control group was taught by traditional didactic lecture methods. A primary objective of the study was to identify instructional methods that facilitate the early development of adaptive expertise (AE). AE requires a combination of two types of engineering skills: subject knowledge and the ability to think innovatively in new contexts. Therefore, student learning in biotransport was measured in two dimensions: A pre and posttest measured knowledge acquisition in the domain and development of innovative problem-solving abilities. HPL and traditional students' test scores were compared. Results show that HPL and traditional students made equivalent knowledge gains, but that HPL students demonstrated significantly greater improvement in innovative thinking abilities. We discuss these results in terms of their implications for improving undergraduate engineering education. © 2007 Biomedical Engineering Society.

Objectives To ascertain the requirements in restorative dentistry that undergraduate dental students have to fulfil in order to sit the finals examinations in dental schools in the UK and Ireland and to compare those requirements with the competencies stipulated by the GDC in The first five years.Methods Fifteen anonymised questionnaires, of open and closed question design, were sent by post to academics in the university departments of restorative dentistry in each of the undergraduate dental schools in the UK and Ireland. The first section concerned numerical information regarding total numbers of procedures that were required to be completed in undergraduate restorative dentistry. The second section was designed to ascertain information as to how decisions are made with respect to an undergraduate's readiness to sit the finals examination in restorative dentistry (such as continual assessment and/or competency assessments).Results A total of 15 replies were received for analysis, a 100% response rate. Several institutions emphasised that they do not have 'requirements', but provide guidelines as to what should be achieved. Six institutions did not have set numerical requirements for direct placement restorations or bridges. The number of direct placement restorations required at the other nine institutions ranged from 50 to 160. Five institutions did not have numerical requirements for dentures; four institutions did not set numerical targets for crowns, veneers, inlays/onlays or endodontics. In institutions where numerical requirements were not used, forms of competency assessments were completed. The requirements across all institutions for periodontology, integrated treatment planning and completed cases were ill-defined.Conclusions This study shows that there is a wide disparity amongst institutions in the UK and Ireland with regards to finals requirements in restorative dentistry. Ideally, such requirements should be similar between institutions and should be closely mapped to the GDC's required learning outcomes (The first five years) for the UK institutions. © 2007 Nature Publishing Group.

Needlestick/sharp injuries (NSIs/SIs) are a serious threat to medical/nursing students in hospital internships. Education for preventing NSIs/SIs is important for healthcare workers but is rarely conducted and evaluated among vocational school nursing students. We conducted an educational intervention for such students after their internship rotations before graduation. This program consisted of a lecture to the students after the internship training and a self-study brochure for them to study before their graduation. This study used the pre-test questionnaires completed by all students and the post-test questionnaires completed by 107 graduates after work experience as licensed nurses to assess the effectiveness of the intervention. After educational intervention, the incidence of NSIs/SIs decreased significantly from 50.5% pre-test to 25.2% post-test, and the report rate increased from 37.0% to 55.6%, respectively. In conclusion, this intervention significantly reduced the incidence of NSIs/SIs and increased the report rate of such events.

Introduction: The purpose of this study was to assess the agreement of Emergency Department (ED) attendings, ED residents, and neurology residents compared with stroke neurologists in the assessment of intravenous rt-PA eligibility. Methods: A convenience sample of patients presenting with possible stroke symptoms to the University of Michigan Hospital ED from June 2003 to July 2004 was identified. A physician from each of four groups: ED attending, ED resident, neurology resident, and stroke neurology attending independently evaluated each patient for eligibility for intravenous (IV) rt-PA. Accuracy, sensitivity, and positive predictive value (PPV) with 95% confidence intervals (CI) were calculated by physician type, compared with the stroke neurologist, for eligibility for IV rt-PA. Results: Exactly 36 (49%) out of the 73 evaluated patients were diagnosed with acute ischemic stroke and 11 were deemed eligible for treatment with IV tPA by the stroke neurologist. Agreement with the stroke neurologist for rt-PA eligibility was 93% [95% CI: 84%, 98%] (sensitivity = 82% [48%, 98%], PPV = 82% [48%, 99%]) for the ED attendings, 79% [65%, 90%] (sensitivity = 75% [35%, 97%], PPV = 43% [18% 71%]) for the ED residents, and 84% [73%, 92%] (sensitivity = 100% [74%, 100%], PPV = 52% [31%, 73%]) for the neurology residents. There were two false positive cases identified by ED attendings, eight, by ED residents, and 11 by neurology residents. Conclusions: This study suggests that the agreement between ED attendings and stroke neurologists for determination of rt-PA eligibility is good. There is room for improvement, however, in the determination of acute stroke therapy eligibility in the ED setting especially among trainees. © Humana Press Inc. 2007.

Context: Graduate medical education is currently facing major educational reforms. There is a lack of empirical evidence in the literature about the learning processes of residents in the clinical workplace. This qualitative study uses a 'grounded theory' approach to continue the development of a theoretical framework of learning in the clinical workplace by adding the perspective of attending doctors. Methods: A total of 21 Dutch attending doctors involved in the training of residents in obstetrics and gynaecology participated in 1 of 3 focus group sessions. They discussed their perceptions of how residents learn and what factors influence residents' learning. A grounded theory approach was used to analyse the transcribed discussions. Results: Three related themes emerged. The first concerned the central role of participation in work-related activities: according to attending doctors, residents learn by tackling the everyday challenges of clinical work. The second involved the ways in which attending doctors influence what residents learn from work-related activities. The final theme focused on attending doctors' views of the essential characteristics of residents and their development during residency. Conclusions: Attending doctors' perspectives complement current insights derived from similar research among residents and from related literature. As part of an ongoing effort to further develop understanding of how residents learn, this study adds several ways in which attending doctors strive to combine guidance in both patient care and resident training. Furthermore, attending doctors' perspectives draw attention to other aspects of learning in the clinical workplace, such as the role of confidence and the balance between supervision and independence. © 2007 Blackwell Publishing Ltd.

Objective: The aim of this study was to test the hypothesis that pediatric residents would display similar levels of asthma interpersonal and communication skills in announced versus unannounced adolescent standardized patient (SP) encounters. Methods: We conducted a prospective repeat measures experimental study at a pediatric residency program at an inner-city children's hospital. A cohort of residents (N = 18) was subjected at random to 3 SP exercises: announced and being directly observed by faculty, announced and not observed by faculty, and unannounced and unobserved. Six adolescent SPs were trained to complete checklists that included items like asthma daytime and nighttime symptoms, exercise-induced symptoms, triggers, and asthma education. For the unannounced exercises, SPs were inserted into residents' regularly scheduled clinics. Standardized patients rated residents immediately following each exercise. Residents were rated by faculty following the observed encounter. Faculty rating validated SP ratings on the observed encounter. Differences in proportions of categorical variables were tested by chi-square analyses. Results: Fifty-four resident-SP encounters were analyzed. Residents consistently displayed significantly lower levels of desired behaviors in interpersonal and communication skills in the unannounced SP encounters on 10 of 14 checklist items. For example, residents asked about exercise-induced symptoms 90% of the time in announced/observed encounters versus 95% in announced/unobserved encounters versus 72% in unannounced/unobserved encounters (P = .001). There were no significant differences in residents' behaviors in the announced SP exercises (whether observed or unobserved). Conclusion: In this study, residents demonstrated lower levels of asthma communication skills during unannounced SP exercises. By using unannounced SPs, we were able to assess residents' interpersonal and communication skills in real clinical settings. © 2007 Ambulatory Pediatric Association.

Background: There has been concern that trainees are seldom observed, assessed, and given feedback during their workplace-based education. This has led to an increasing interest in a variety of formative assessment methods that require observation and offer the opportunity for feedback. Aims: To review some of the literature on the efficacy and prevalence of formative feedback, describe the common formative assessment methods, characterize the nature of feedback, examine the effect of faculty development on its quality, and summarize the challenges still faced. Results: The research literature on formative assessment and feedback suggests that it is a powerful means for changing the behaviour of trainees. Several methods for assessing it have been developed and there is preliminary evidence of their reliability and validity. A variety of factors enhance the efficacy of workplace-based assessment including the provision of feedback that is consistent with the needs of the learner and focused on important aspects of the performance. Faculty plays a critical role and successful implementation requires that they receive training. Conclusions: There is a need for formative assessment which offers trainees the opportunity for feedback. Several good methods exist and feedback has been shown to have a major influence on learning. The critical role of faculty is highlighted, as is the need for strategies to enhance their participation and training.

This study explores whether a clinical teaching effectiveness (CTE) instrument provides valid scores for summative faculty assessment. The sample included all CTE instruments (n = 10,087) that learners (N = 1,194) completed to assess clinical teachers (N = 872) during 1 academic year. The authors investigated response processes (e.g., missing data, straight-line responses, level of learner), internal structure (e.g., confirmatory and exploratory factor analysis), teaching ratings by learner group (medical student or resident), and relation to other variables (e.g., correlation with global rating). Response processes identified a high prevalence of straight-line responses (same rating across all items) and differential patterns of missing data by learner group. Medical students rated their teachers higher than residents, and CTE scores had different factor structures depending on learner group. High correlation coefficients of CTE items with a single rating of overall teaching performance suggest that learners consider global performance when assessing clinical teaching performance. © 2007 Sage Publications.