Distinct Specialty Research Articles

Realities of Mental Health Nursing Practice in Rural Australia

Mental health nursing as a distinct speciality has been in decline in New South Wales (NSW), Australia, for two decades. Arguably, this decline has worsened both consumer outcomes and the workplace experiences of mental health nurses. This article reports on a study designed to ascertain the nature of contemporary mental health nursing practice in New South Wales. The study utilised focus group research methodology, with participants recounting the realities of their day-to-day professional practice and perceptions of their professional identity. The findings indicate a contracting, if not moribund, profession; a decrease in the value attached to mental health nursing; and a pattern of persistent underfunding by successive governments of mental health services. An analysis of present and historical trends reveals there is a pressing need for a restructure and re-formation of mental health nursing in rural areas. This article links the shortage of mental health nurses in NSW to the closure of the mental health nursing register, a shift to comprehensive/generalist nurse education models, a perceived lack of nurses’ professional standing, and natural attrition without suitably qualified replacements. Mental health nurses in this study perceived that they were not valued by other health professionals or by their own managers. Participants in this study reported mental health nursing in rural areas was an unattractive career choice. These findings are important to the understanding of recruitment and retention issues in rural mental health nursing in Australia.

The importance of the White Book of Radiation Oncology

The current issue of Clinical and Translational Oncology includes an article that summarises and contextualises the recently published Libro Blanco de la Oncologia Radioterapica, a book written by members of the Spanish Society of Radiation Oncology (SEOR). The White Book of Radiation Oncology is the fi rst of its kind in Spain and its importance cannot be overstated. The White Book consists of 13 chapters on a wide range of topics that cover all aspects of radiation oncology and its role in cancer care in Spain. The aim of the book is to give a comprehensive overview of the current state of radiation oncology in Spain and to serve as a reference for physicians, health care administrators and hospital managers. Although it may be hard to remember a time when radiation oncology did not exist as a distinct speciality, it was only just over three decades ago (in 1978, to be precise) that the Association of Radiotherapy and Oncology (AERO) was created. In 2006, the name of the association was changed to SEOR to refl ect the fact that specialists in our fi eld are oncologists fi rst and radiotherapy experts second. The SEOR has grown signifi cantly since its founding and now has more than 750 members. In addition, the SEOR is also active internationally and has signed numerous agreements for cooperation with other medical societies, including the European Society for Therapeutic Radiology and Oncology (ESTRO). The rapid technological progress that has been made in the last decade allows us to deliver radiation with increasing precision and effectiveness, thus increasing the number of tumour localisations amenable to treatment with radiation therapy. As a result, approximately half of all cancer patients are now treated with radiotherapy. While these technological advances are clearly welcome, they also present new challenges, as specialists must constantly strive to keep up to date with the latest techniques and equipment. Technologies that seemed cutting edge only a few years ago, for example intensity-modulated radiotherapy (IMRT), are now considered standard treatment for certain tumours. Still, many of the newer technologies–4D radiotherapy, image-guided RT (IGRT), breathing-synchronised RT, SBRT, radiosurgery and intraoperative RT (IORT)–have yet to be installed in smaller clinics, even as they become increasingly common in larger RT centres. In Spain, radiotherapy centres tend to purchase and incorporate “new” machinery slowly (for a myriad of reasons, not least of which is cost) and it seems clear that we need to fi nd ways to accelerate the purchase of newer, more effective technologies for the benefi t of our patients. Even as we recognise the importance of state of the art technologies, it is important to remember that we are physicians fi rst and our main priority is to provide the patient with the best care possible. Quality care in our fi eld depends not only on fi rst-rate technology, but also on the skill and training of the specialists responsible for treating patients. Radiation oncologists must be experts in both the technical and clinical aspects of radiotherapy. Cancer treatment in general has become more interdisciplinary, thus requiring the cooperation of a larger number of specialists. The growth of tumour boards, where complex cases are discussed, is a prime example. It is during these meetings that each specialist can share his/her specialised knowledge so that a well founded treatment decision can be made. Important changes have also occurred in training new specialists (residency) and continuing education for current staff. Spain, along with all other member countries of the European Union, has had to reorganise its university curriculum to bring it in line with the new European standards as established by the Bologna Agreement. As a result, students must now complete 360 European credits (9000 hours) to obtain a degree in medicine. Although the current transition period has been challenging, it also offers new opportunities for our fi eld, and several universities have proposed new courses that combine aspects of both medical and radiation oncology. These courses are intended for the fi fth or sixth year of the degree programme. F. Guedea ( ) Department of Radiation Oncology Catalan Institute of Oncology Gran via, s/n km 2,7 ES-08907 L’Hospitalet de Llobregat, Barcelona, Spain e-mail: guedea@iconcologia.net

Great Hospitals of Asia: Neurosurgery at Prince of Wales Hospital

Prince of Wales Hospital, a 1400-bed regional referral center, was established in 1984 as the primary teaching hospital of the second medical school in Hong Kong at the Chinese University of Hong Kong. The Academic Division of Neurosurgery was given an autonomous status, the support of 40 acute beds, and a well-equipped and well-staffed intensive care unit (ICU), in developing neurosurgery as a distinct surgical specialty. Over this short 26-year history, we have gone through the difficult time of one-man-band neurosurgery, excelled in emergency neurosurgery, and evolved to an era of organized neurosurgical practice, where clinical services, teaching of undergraduate and postgraduate students, and clinical and translational research have been brought up to international standards.

Development of Emergency Medicine as Academic and Distinct Clinical Discipline in Bosnia and Herzegovina

Emergency medicine is a new academic discipline, as well as a recent independent clinical specialization with the specific principles of practice, education and research. It is also a very important segment of the overall health care and health system. Emergency medicine as a distinct specialty was introduced in the U.S. in 1970. Ten years later and relatively quickly emergency medicine was introduced in the health system in Bosnia and Herzegovina as a specialty with a special education program for specialist and a final exam. Compare the development of emergency medicine in Bosnia and Herzegovina with the trends of development of this discipline in the world as a specialization and an academic discipline. Identify specific problems and possible solutions and learn lessons from other countries. Reviewed are the literature data on the development of emergency medicine in the world, programs of undergraduate and postgraduate teaching, the organizational scheme of emergency centers and residency. This is then compared with data of the current status of emergency medicine as an academic discipline and a recognized specialization, in Bosnia and Herzegovina. There are substantial differences in the development of emergency medicine in the United States, European Union and Bosnia and Herzegovina. Although Bosnia and Herzegovina relatively early recognized specialty of emergency medicine in academia, it failed to mach the academic progress with the practical implementation. A&E departments in the Community Health Centers failed to meet the desired objectives even though they were led by specialists in emergency medicine. The main reason being the lack of space and equipment as well as staff needed to meet set standards of good clinical practice, education and research. Furthermore the Curriculum of undergraduate education and specialization does not match modern concept of educational programs that meet the principles set out in emergency medicine and learning through practice. The Development of emergency medicine as a separate specialization and independent academic discipline has had different way and pace of development, and there is no ideal model that can be applied in all countries. However experiences from countries with well developed emergency medicine, suggest that the model of the simultaneous development of emergency medicine as a distinct academic discipline on independent recognized residencies with a strong national association is the best way for the formation of an efficient health system. The establishment of Emergency centers--departments for emergency medicine at university and cantonal hospitals, introduction of emergency medicine as an academic discipline, implementation of specific post-graduate teaching and continuing medical education through appropriate courses, as well as academic development program for the teaching staff is the most important element of future development of this discipline. It would also contribute to it achieving the appropriate status in both the academic institutions and in practice within the health system of Bosnia and Herzegovina.

Analysis of sex and gender-specific research reveals a common increase in publications and marked differences between disciplines

BackgroundThe incorporation of sex and gender-specific analysis in medical research is increasing due to pressure from public agencies, funding bodies, and the clinical and research community. However, generations of knowledge and publication trends in this discipline are currently spread over distinct specialties and are difficult to analyze comparatively.MethodsUsing a text-mining approach, we have analysed sex and gender aspects in research within nine clinical subspecialties - Cardiology, Pulmonology, Nephrology, Endocrinology, Gastroenterology, Haematology, Oncology, Rheumatology, Neurology - using six paradigmatic diseases in each one. Articles have been classified into five pre-determined research categories - Epidemiology, Pathophysiology, Clinical research, Management and Outcomes. Additional information has been collected on the type of study (human/animal) and the number of subjects included. Of the 8,836 articles initially retrieved, 3,466 (39%) included sex and gender-specific research and have been further analysed.ResultsLiterature incorporating sex/gender analysis increased over time and displays a stronger trend if compared to overall publication increase. All disciplines, but cardiology (22%), demonstrated an underrepresentation of research about gender differences in management, which ranges from 3 to 14%. While the use of animal models for identification of sex differences in basic research varies greatly among disciplines, studies involving human subjects are frequently conducted in large cohorts with more than 1,000 patients (24% of all human studies).ConclusionsHeterogeneity characterizes sex and gender-specific research. Although large cohorts are often analysed, sex and gender differences in clinical management are insufficiently investigated leading to potential inequalities in health provision and outcomes.

The First National Pain Medicine Summit—Final Summary Report

The First National Pain Medicine Summit—Final Summary Report

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Responding to Failure: An Introduction to Forensic Structural Engineering

SummaryForensic structural engineering is a distinct specialty that identifies the causes of structural failures, sometimes in a legal context. Its application is not limited to catastrophic failure, but is applicable in any situation where there is an unacceptable difference between expected and observed structural performance. This paper introduces forensic structural engineering by reviewing the formation of forensic engineering as a speciality in the US; introducing the principles and implementation of forensic investigations; presenting the technical and forensic attributes of the forensic engineer; and discussing its contribution to the wider Australian engineering profession. The paper concludes with a presentation of the resources available to the Australian engineer wishing to pursue a career in forensics.

Can we talk? How the cognitive neuroscience of attention emerged from neurobiology and psychology, 1980–2005

This study uses author co-citation analysis to trace prospectively the development of the cognitive neuroscience of attention between 1980 and 2005 from its precursor disciplines: cognitive psychology, single cell neurophysiology, neuropsychology, and evoked potential research. The author set consists of 28 authors highly active in attentional research in the mid-1980s. PFNETS are used to present the co-citation networks. Authors are clustered via the single-link clustering intrinsic to the PFNET algorithm. By 1990 a distinct cognitive neuroscience specialty cluster emerges, dominated by authors engaged in brain imaging research.

From mechanical ventilation to intensive care medicine: a challenge for Bosnia and Herzegovina.

Intensive care medicine is a relatively new specialty, which was created in the 1950's, after invent of mechanical ventilation, which allowed caring for critically ill patients who otherwise would have died. First created for treating mechanically ventilated patients, ICUs extended their scope and care to all patients with life threatening conditions. Over the years, intensive care medicine developed further and became a truly multidisciplinary speciality, encompassing patients from various fields of medicine and involving specialists from a range of base specialties, with additional (subspecialty) training in intensive care medicine. In Bosnia and Herzegovina, the founding of the society of intensive care medicine in 2006, the introduction of non invasive ventilation in 2007, and opening of a multidisciplinary ICUs in Banja Luka and Sarajevo heralded a new age of intensive care medicine. The number of admissions, high severity scores and needs for mechanical ventilation during the first several months in the medical ICU in Banja Luka confirmed the need of these kinds of units in the country. In spite of still suboptimal personnel training, creation of ICUs in Bosnia and Herzegovina may serve as example for other developing countries in the region. However, in order to achieve modern ICU standards and follow European trends toward harmonisation of medicine, Bosnia and Herzegovina needs to take up this challenge by recognizing intensive care medicine as a distinctive specialty, by implementing a specific training program and by setting up multidisciplinary ICUs in acute care hospitals.

Five Decades of Indian Nephrology: A Personal Journey

Impressive accomplishments have been made in Indian nephrology during the last 5 decades. The first renal biopsy performed in 1956 ushered in a new era of modern nephrology practice in India and led to the recognition of nephrology as a distinct specialty. The first hemodialysis facility was established in 1961; presently, there are 950 nephrologists, 850 hospitals equipped with dialysis facilities, and 170 institutions recognized for kidney transplantation, with approximately 3,500 transplantations performed every year. The majority of dialysis units are small minimal-care facilities with fewer than 5 dialysis stations, and more than 85% are in the private sector. Government hospitals provide free treatment to poor patients with chronic kidney disease; however, inadequate funding and lack of health insurance schemes pose serious hurdles in providing renal replacement therapy. In contrast, private/corporate hospitals located in big cities have large units with state-of-the-art dialysis and transplantation facilities, similar to advanced centers of the world, but are accessible to only upper-income groups. Of the estimated 175,000 new patients who develop end-stage renal disease annually, less than 10% are able to gain access to renal replacement therapy. Research in the field of renal diseases has evolved slowly and is focused primarily on tropical conditions. The availability of structured nephrology training programs coupled with excellent diagnostic and therapeutic facilities in some academic institutions and tertiary-care private/corporate hospitals have diminished the need for foreign travel by students, patients, and consultants to a considerable extent. The expansion of therapeutic facilities in India is hampered by only economic constraints, not lack of expertise.

Markov decision process applied to the control of hospital elective admissions

To present a decision model for elective (non-emergency) patient admissions control for distinct specialties on a periodic basis. The purpose of controlling patient admissions is to promote a more efficient utilization of hospital resources, thereby preventing idleness or excessive use of these resources, while considering their relative importance. The patient admission control is modeled as a Markov decision process. A hypothetical prototype is implemented, applying the value iteration algorithm. The model is able to generate an optimal admission control policy that maintains resource consumption close to the desired levels of utilization, while optimizing the established deviation costs. This is a complex model due to its stochastic dynamic and dimensionality. The model has great potential for application, and requires the development of customized solution methods.

The Science and Practice of Pain Medicine: A Needed Meeting of Our Minds and Skills

The American Academy of Pain Medicine (AAPM) and members of the pain community have a good reason for optimism in 2009. Important developments are occurring simultaneously on many fronts. The success of our annual meeting this year reflects a satisfying confluence of excitement about our rapidly developing translational science and hope about our growing evidence-based practices. We—our specialty, our patients, and our science—are on a roll, and there is much to be accomplished to maintain our momentum. Advances in public understanding of the societal burden of chronic pain and appreciation for the issues affecting pain treatment progressively galvanize public support for better treatment. Resulting legislation will lead to policy changes that ultimately will improve the training of providers and the care of patients. Congressional pain bills recently signed into law are now being implemented in the Veterans Health Administration and the Department of Defense. We anticipate that a strong cooperative effort with our Pain Care Coalition (PCC) partners and organizations, such as the American Pain Foundation, the Pain Care Forum, and the American Cancer Society, will lead to passage of HR 756 in Congress (see below) and increased National Institutes of Health (NIH) funding for pain research and education. The AAPM continues its collaboration with other professional organizations such as the International Spine Intervention Society (ISIS), the North American Spine Society (NASS), and the American Society of Anesthesiologists (ASA) to improve understanding of the value of pain treatments and reimbursements for our treatments. There is growing recognition within and outside medicine that, for our society as a whole, responsibility for improved pain care, presently an orphan of several specialties whose primary interests lie elsewhere, will improve significantly only with the advent and development of pain medicine as a distinct specialty, unencumbered by its parent specialties' primary interests and attention to …

Teamwork in pediatric heart care

Pediatric cardiac specialties, pediatric cardiology (pediatric cardiac surgery and pediatric cardiac anesthesiology and intensive care) are only now being recognized as distinct specialties in most parts of the world. There has been a tremendous growth in knowledge in these specialties in the last 30-40 years with dramatic improvements in outcome.Pediatric cardiac care thrives on team work. The cohesiveness of the team of caregivers has a direct impact on the patient outcomes and efficiency of the system. The development of hybrid heart procedures in pediatric heart care represents an important benchmark in a team-based approach to patient care where a group of specialists with specific skills work closely together for ensuring the best possible patient outcome. Establishment of a cohesive team requires organization of group of team members with diverse skills to come together through good mutual understanding, under a leadership that actively promotes team harmony. Excellent communication among team members is a core requirement. The barriers for development and sustenance of a successful team must be recognized and overcome. They include egos of key team members as a source of conflict, time for interactions, disproportionate rewards and recognition for members of the team and traditional hierarchical arrangements. Special attention must be paid to motivating non-physician staff.

Vascular surgery training in the United States: A half-century of evolution

The purpose of this report is to succinctly review the history, evolution, and accreditation process of postgraduate surgical training programs in the United States, with emphasis on recent dramatic changes in vascular surgery training. Vascular surgery became a distinct specialty of surgery on March 17, 2005, when the American Board of Surgery (ABS) received approval from the American Board of Medical Specialties (ABMS) to offer a Primary Certificate in Vascular Surgery. The traditional requirement for 5 years of training and certification in general surgery was eliminated. Effective July 1, 2006, the ABS converted its certificate in vascular surgery from a subspecialty certificate to a specialty (primary) certificate. These landmark changes allowed the simultaneous development of new training paradigms. Multiple flexible training pathways leading to either dual certification (Traditional 5-2; Early Specialization Program 4-2) or vascular surgery certification alone (Integrated 0-5; Independent 3-3) now exist. New pathways require a minimum of 2 years of core surgery training and 3 years of advanced vascular training. There are currently 96 accredited traditional 5-2 programs, five 4-2 programs, and 11 0-5 integrated programs, with multiple additional institutions in the process of submitting 0-5 applications. The main obstacle preventing more rapid transition to the new pathways seems to be difficulty in obtaining funding for additional resident positions. Multiple flexible training paradigms are likely to coexist as vascular surgery continues to evolve.

Clinical Nurse Specialist Practice in a Care Coordination Model

The goal of care coordination is to facilitate and enhance positive patient outcomes. The contribution that the clinical nurse specialist (CNS) can make toward the achievement of this goal is supported in the literature. The CNS can impact patient outcomes by influencing nursing practice and organizational systems for the delivery of quality, cost-effective patient care. These CNS practice activities can be uniquely tailored to specialty populations. Three CNSs within the Department of Care Coordination report how they have developed their own individual practices within their distinct specialties. Although the approach varied, the outcomes of influencing the quality of nursing care, patient education, and safe, uncomplicated transition from the hospital to next disposition were the same.

The use of biographies and stories in paediatric palliative care education

Paediatric palliative care has emerged as a distinct specialty over recent years and, as a consequence, robust and innovative educational programmes are required to further develop the exisitng attitudes and skills of practitioners working within this field. Understanding the experiences of children and families is key to providing quality care in this context and a number of teaching and learning activities have been reported in the literature. This article discusses one such learning activity--the use of parent biographies and stories by students undertaking the paediatric palliative care programme at Queen's University Belfast, UK. Feedback from students indicated that this was a positive learning experience that was both interesting and useful from a practice perspective.

‘Only the British Appear to be Making a Fuss’: The Science of Success and the Myth of Amateurism at the Mexico Olympiad, 1968

In the autumn of 1965 the British Olympic Association organised a party of doctors, scientists and athletes to investigate the effects of altitude on athletic performance. As the first major example of ‘sports medicine’ research in the history of the BOA, the Mexican Research Project is multiply symbolic. This paper explores the significance of the research project, and the rich rhetoric of ‘amateurism’ that was used both to support and attack the IOC's decision to hold the 1968 Olympic Games at altitude. As well as being a significant moment in the formation of sports medicine as a distinct specialty in the UK, the Mexican Research Project also demonstrates the tensions and trends in the international sporting and political scenes.

The anesthesiologist in prehospital and hospital emergency medicine

The German emergency medical system is different from the Anglo-American system. Emergency medicine is no distinct specialty in Germany. Physicians are involved in prehospital emergency medicine. This review highlights the historic development of prehospital and hospital emergency medicine in Germany and describes future trends. Studies have shown that involvement of specially trained prehospital emergency physicians can result in reduced patient mortality. The in-hospital emergency medicine structure is important for the 'chain of survival' for patients with life-threatening medical conditions. In-hospital emergency medicine has been reorganized in many hospitals during the last few years. New qualification criteria for physicians in emergency departments, therefore, need to be developed. Economic and quality arguments have initiated the development of departments for emergency medicine in Germany. In the future, this will lead to new qualification criteria for physicians working in these departments.

A brief history of minimally invasive plastic surgery.

It could be argued that a basic principle establishing plastic surgery as a distinct specialty always has been minimal invasive surgery. Although perhaps lagging behind the other surgical specialties specifically in adopting the surgical endoscope, this merely is a new tool to better achieve just that objective. Outcome enhancements initially predominated in aesthetic applications, but widespread use also in reconstructive endeavors has proved that there is indeed today a broad role for minimally invasive plastic surgery.