Graduate Health Professionals Research Articles

Rate of Muscle Force Development and Instability in Knee Osteoarthritis

People with knee OA experience pain and the sensation of buckling in their knees that leads to diminished function. Maximum quadriceps force production relates to high function in this group, however, maximum force is rarely used during daily activities. Rate of muscle force development (RFD) is important in maintaining balance and declines with age and disuse, but it is unclear what relationship RFD has with function in people with knee OA. PURPOSE: To examine the relationship between quadriceps RFD and knee function in 3 groups: people with knee OA whose knees were stable (OAS) unstable (OAU) and controls (C). METHODS: Knee joint stiffness and maximum volitional isometric force was measured in 28 people with knee OA (15 OAS and 13 OAU) and 21 C. Functional measures included the KOOS and stair climbing test. The peak instantaneous RFD (RFDi) and average RFD (RFDa) over the interval from 0-200 msec were compared between groups using a one-way ANOVA and post-hoc tests. Pearson's correlation coefficients were used to examine relationships. RESULTS: Significant differences between groups were found in the RFDa (F=5.563, p=.007) and in both relaxed short range and total stiffness (F=4.205, p=.022 and 4.916, p=.012). Post hoc tests revealed that the OAU subjects had higher RFDa and had a higher short range stiffness than controls (p=.006 and p=.021). OAU also had a greater relaxed total stiffness than the OA stable group (p=.010). RFDa correlated negatively with the stair climbing time (r= -0.544, p=.036) in the OAS group. The peak RFDi correlated positively with the KOOS -ADL scores in the OAU group only (r=0.570, p=.042). In the OAU group the peak RFDi and RFDa significantly correlated with the KOOS symptom scores (r=-0.622, p=.023, r=0.606, p=.028) respectively. CONCLUSION: The relationship between RFD and knee function and symptoms in people with knee OA who experience buckling suggests an attempt to stabilize the knee joint. Higher knee joint stiffness in the OAU subjects may allow for these increases in RFD. Accurately assessing and understanding the role of RFD in knee OA may indicate that rehabilitation should involve activities relating to speed in addition to the force of quadriceps contraction. Funded By: NIH P20 RR16458, NIH S10RR022396, ACR REF Health Professional Graduate Student Research Preceptorship

Medical ethics educational improvement, is it needed or not?! Survey for the assessment of the needed form, methods and topics of medical ethics teaching course amongst the final years medical students Faculty of Medicine Ain Shams University (ASU), Cairo, Egypt 2010

Introduction In the process of our faculty gaining accreditation, the debate concerning the necessity for initiating an integrated course in which medical ethics course is implemented have arouse. Arguments concerning what should this course include, the best timing for this course to be applied, how it should be taught, planned for and mostly for what the students are interested to get out of it. Goal The main purpose of this work is to identify the ethical needs and ethical dilemmas freshly graduated medical students face at the beginning of their training and their suggestions to seek better educational approaches that can be applied in teaching medical ethics proposed by the medical students themselves throughout the teaching process and after graduation. Methods It seemed rather appropriate at this stage to carry out an evaluation survey assessing the needs for medical ethics teaching course through the exploration of the opinions of medical students and freshly graduated doctors on ethical issues through a simple survey by using an open ended question questionnaire designed to fulfil the study targeted requirements. Results 100 volunteers (n = 100) randomly chosen from the fifth year students of our faculty of medicine ASU who had recently studied ethics course in the fourth year (n = 20), interns both junior and senior residents in El Demerdash hospitals (n = 80). 25 questionnaires were excluded due to inappropriate or missing answers resulting in 75% response rate. 60% of the surveyed group favored an integrated ethics course taught throughout the whole academic years study. 56% chose the practical teaching method with problem solving strategies for the daily arising confusing ethical issues to be the best way to teach the course. While 53.4% thought that stuff specialized in medico legal issues were best to teach this course. As regards the highly confusing ethical dilemmas in which they were interested in getting updated feedback about: Confidentiality, doctor-patient relationship and informed consent came first by 69.3%. Conclusions This study revealed the essential need for a model medical ethics curriculum that responds to students' concerns in addition to providing basic training in moral reasoning and ethical decision making to be applied both horizontally and vertically across the whole years of medical school. Recommendations A Simple booklet containing recent version of the Egyptian code of ethics, common ethical dilemmas and recently evolving ethical issues should be available for all newly graduated health professionals.

The effectiveness of interprofessional education in university-based health professional programs: A systematic review

Objective: The aim of this review is to appraise and synthesise the best available evidence on the effectiveness of university based IPE interventions as compared to uniprofessional educational interventions. Review Question: This review will systematically examine the evidence to answer the following question: What is the effectiveness of IPE in university based health professional programs? Inclusion criteria: Types of participants: The review will consider studies that include students of two or more undergraduate and post graduate health professions engaged in IPE regardless of gender, age and disciplines Types of intervention(s)/phenomena of interest: The review will consider studies that include any university based pedagogical approaches to IPE. Types of outcome: Any objectively measured or self-reported educational outcomes and/ professional competencies related to IPE assessed by validated instruments such as the Readiness for Interprofessional Learning Scale (RIPLS) and the Interdisciplinary Education Perception Scale (IEPS) will be included in the review.

A importância na inserção do nutricionista na Estratégia Saúde da Família

The Family Health Strategy has as its main purpose to reorganize the practice of attention to health in new bases and to substitute the traditional model existing in Brazil. The new curriculum guidelines to graduate health professionals propose a general formation as well as ethics, having as its main focus the largest approach to the local health services. However, Nutrition still does not present a regulation for an active participation in the Family Health Strategy. Considering this fact, the Family Health Strategy is directly linked to people's welfare in many aspects (social, nutritional, psychological, etc). Therefore, this work intends to present the importance of the insertion of a nutritionist in the Family Health Strategy for the integrality of health actions. The conclusion is that nutritionist is fully qualified to work in the Family Health Strategy, because the absence of this professional is against the principle of the integrality of the health actions, as it is evident that no other health professional possesses education to work with food and nutrition within the communities and this presence would contribute to promote people's health.

The effectiveness of interprofessional education in university-based health professional programs: A systematic review.

Background: A key responsibility of universities is to prepare health professional graduates for their roles as effective members of the health care team. Currently, most university-based health professional education is delivered in a traditional, discipline specific way. This approach is limited in its ability to equip graduates with the necessary knowledge, skills and attitudes for effective interprofessional collaboration and for working as part of a complex health care team. Interprofessional education occurs when learners from two or more professional groups learn about, from and with each other. The fundamental premise of interprofessional education is that if health professional students learn together they will be better prepared for interprofessional collaboration ultimately leading to improved patient outcomes.Objective -The objective of this systematic review was to identify the best available evidence for the effectiveness of university-based interprofessional education.Inclusion criteria -The review included all randomised controlled trials and quasi-experimental studies that assessed the effectiveness of interprofessional education in university-based health professional programs. All studies that included two or more undergraduate or post-graduate health professional groups engaged in interprofessional education were considered. Outcome measures included objectively measured or self-reported educational outcomes and/or professional competencies related to interprofessional education as assessed by validated instruments such as the Readiness for Interprofessional Learning Scale and the Interdisciplinary Education Perception Scale. A three-stage comprehensive search strategy was utilised to search across ten electronic databases. English language studies published between January 2000 and February 2011 were considered for inclusion.Methodological quality: Two independent reviewers assessed the methodological quality of each study selected for retrieval using standardised Joanna Briggs Institute critical appraisal tools.Data collection and synthesis: Data were extracted from studies using the standardised data extraction tool from the Joanna Briggs Institute. Meta-analysis was not possible because of the different outcomes, control groups and interventions of the selected studies; and the findings are therefore presented in narrative form. Nine published studies consisting of three randomised controlled trials, five controlled before and after studies and one controlled longitudinal study were eligible for inclusion in this review. Four studies reported significant improvement in attitudes and perceptions of interprofessional education. In addition, five studies reported a mixed set of outcomes related to interprofessional education interventions. Student's attitudes and perceptions towards interprofessional collaboration and clinical decision making can be potentially enhanced through interprofessional education. However, the evidence for using interprofessional education to teach interprofessional communication skills and clinical skills such as resuscitation to health professions students is inconclusive and needs further investigation IMPLICATIONS FOR RESEARCH: Future randomised controlled studies explicitly focused on interprofessional education with rigorous randomisation procedures and allocation concealment; larger sample sizes; and more appropriate control groups, would improve the evidence base of interprofessional education.

The effectiveness of interprofessional education in university based health professional programs: A systematic review

The effectiveness of interprofessional education in university based health professional programs: A systematic review

The effectiveness of interprofessional education in university based health professional programs: A systematic review.

The effectiveness of interprofessional education in university based health professional programs: A systematic review.

THE NATIONAL TUBERCULOSIS CURRICULUM CONSORTIUM: A MULTI-DISCIPLINARY WEB-BASED APPROACH FOR TUBERCULOSIS EDUCATION FOR HEALTH-PROFESSIONAL STUDENTS

PURPOSE: The National Tuberculosis Curriculum Consortium (NTCC) is a multidisciplinary project whose main objective is to instill knowledge, skills, and appropriate attitudes in the management and control of active and latent tuberculosis (TB) among undergraduate and graduate health professions students (medical, nursing, pharmacy, public health, respiratory therapy, clinical laboratory sciences, and physician assistant) in their formative years and thereafter.

New Graduate Students??? Baseline Knowledge of the Responsible Conduct of Research

To assess (1) new biomedical science graduate students' baseline knowledge of core concepts and standards in responsible conduct of research (RCR), (2) differences in graduate students' baseline knowledge overall and across the Office of Research Integrity's nine core areas, and (3) demographic and educational factors in these differences. A 30-question, computer-scored multiple-choice test on core concepts and standards of RCR was developed following content analysis of 20 United States-published RCR texts, and combined with demographic questions on undergraduate experience with RCR developed from graduate student focus groups. Four hundred two new graduate students at three health science universities were recruited for Scantron and online testing before beginning RCR instruction. Two hundred fifty-one of 402 eligible trainees (62%) at three universities completed the test; scores ranged from 26.7% to 83.3%, with a mean of 59.5%. Only seven (3%) participants scored 80% or above. Students who received their undergraduate education outside the United States scored significantly lower (mean 52.0%) than those with U.S. bachelor's degrees (mean 60.5%, P < .001). Participants with prior graduate biomedical or health professions education scored marginally higher than new students, but both groups' mean scores were well below 80%. The mean score of 16 participants who reported previous graduate-level RCR instruction was 67.7%. Participants' specific knowledge varied, but overall scores were universally low. New graduate biomedical sciences students have inadequate and inconsistent knowledge of RCR, irrespective of their prior education or experience. Incoming trainees with previous graduate RCR education may also have gaps in core knowledge.

Peculiaridades do controle da tuberculose em um cenário de violência urbana de uma comunidade carente do Rio de Janeiro

To describe the difficulties and peculiarities encountered by health professionals during the treatment and investigation of contacts of tuberculosis (TB) patients in disadvantaged communities. A qualitative study carried out at health care facilities in Health Programming Area 1.0, located in the city of Rio de Janeiro, Brazil, which has a TB incidence rate of 240/100,000 inhabitants. From among the professionals responsible for visiting and treating TB cases and their contacts, two home visit agents and one clinical nurse were selected to be interviewed for the study. Data were transcribed and structured in the form of quotations, emphasizing the predominant ideas. The central ideas focus on the issue of violence, one significant facet of which is the set of rules imposed by narcotraffickers, and on the barriers to the movement of patients/health professionals for TB treatment, as well as on public safety (police). This study provides public health officials, as well as institutions that graduate health professionals, data for reflection and analysis of the difficulties that urban violence creates for the control of TB in a disadvantaged community.

Doing Time: Clinical Psychologists' Experience of Community Service in a Prison Placement

In South Africa, graduating health professionals are required to do a compulsory year of community service before being able to register with their respective professional boards as independent practitioners. Community service posts for clinical psychologists were introduced in the Department of Correctional Services in 2005. The authors were among the first batch of clinical psychologists doing their community service within the Department of Correctional Services. Most publications on psychology in prisons tend to focus on diagnostic issues, models of therapeutic intervention, and forensic theory, with few articles focusing on organisational issues. The existing literature describes work within these organisations as particularly challenging. This article presents the authors' reflections on their experience of working in correctional centres. They highlight the institutional challenges faced, namely working with limited resources, in an unsafe environment, with an unclear professional role, and a lack of institutional support. They go on to discuss the emotional challenges faced, as they dealt with high levels of anxiety, fear, isolation, anger, and helplessness. The authors raise concerns about using newly qualified, inexperienced professionals to expand the health care service in South Africa without providing adequate institutional support and supervision. Reservations are presented about the appropriateness of placing community service psychologists in prisons, without appropriate supervision and institutional support.

Starting out in rural New South Wales: the experiences of new graduate occupational therapists

The current shortage of health personnel in rural Australia is compounded by the difficulty in recruiting and retaining new graduate health professionals in rural practice. This qualitative study aimed to explore the experiences of five new graduate occupational therapists who began their careers in rural New South Wales (NSW). Data were collected via semi-structured, individual interviews. Results indicated that new graduates were attracted to their rural positions by multiple factors, especially their previous rural experience. Participants experienced low self-confidence during their transition from student to therapist. Rewarding and challenging aspects of rural practice were identified. New graduates valued challenging aspects of rural practice as opportunities for skill development. Results suggest that increasing the number of occupational therapy graduates with rural experience may attract more graduates to rural practice. Furthermore, enhancing the support available to new graduates in rural positions may help retain graduates in rural practice.

Graduate health professions education: an interdisciplinary university - community partnership model 1996 - 2001.

In 1996, East Tennessee State University (ETSU) reinforced its historical commitment to multidisciplinary community engagement by developing a graduate level community partnerships program in the Division of Health Sciences. While the university's earlier health partnership efforts relied primarily on curricular innovation, the approach to graduate health professions education was to seed a series of curricular enhancements and interdisciplinary, community-based learning experiences and service into traditional curricula. This paper presents the experience of one school in crafting a regional network that became the basis of a division-wide graduate level teaching and learning initiative. Carefully selected planning and implementation techniques enabled multidisciplinary practitioners and community members from across a 20-county region to participate with university faculty in training ETSU learners in community-based medical care. By year four of the project, curricular "enhancements" were institutionalized in over five departments across the Division and engaged 1160 medical residents and graduate learners in a give - get model of health education. Programme evaluation methodology was collaboratively defined and documentation of programme effort and outcomes regularly reported and strategically reviewed. Programme evaluation demonstrates mutual benefit to community and university. Faculty involvement in programme activity increased fourfold and community involvement in training of health professions graduate learners increased threefold by year four. Educational innovations were adopted into traditional curricula, thousands of hours of clinical services were provided to underserved communities and the university-community team forged by network links continues to promote multidisciplinary interests through joint public policy endeavors.

Solving inequities in provider distribution: loan repayment.

The distribution of primary health care professionals in England and Wales is inequitable, with relatively lower concentrations of professionals in deprived areas. The objective of the present study was to determine whether graduate health professionals would be willing to work in under-served areas in return for educational loan repayment. The study group consisted of a convenience sample of 50 newly qualified and trainee general practitioners, and 50 newly qualified community nurses and health visitors in mid- and west Wales. At interview, the subjects were presented with descriptions of general practices and asked to indicate their preferred practice. Practice descriptions varied systematically in terms of location (i.e. urban, suburban and rural), population deprivation (i.e. deprived or mixed affluent/deprived) and availability of loan repayment (i.e. none or loans paid off over a period of between one and 4 years). The main outcome was the probability that a practice with loan repayment was chosen. Compared with a suburban practice, a one-year loan repayment option made the rural and urban deprived practices 1.6 times and 1.2 times more likely to be chosen, respectively. Nurses were generally more willing than doctors to work in a deprived area in return for loan repayment. The findings suggest that loan repayment may offset health professionals' aversion to working in deprived areas. Such a scheme needs to be piloted to see whether it does offer value for money in recruiting health professionals to under-served areas.

The Del Rio project: a case for community-campus partnership.

Interdisciplinary teams of graduate health professions students and faculty were provided with experiential learning opportunities while assisting a small rural community address critical health-related issues. To establish an effective partnership with community leaders and area residents to assist in determining the feasibility of a new primary care clinic and to remediate a water borne disease threat. To create interdisciplinary clinical learning experiences and to develop future longitudinal learning opportunities, emphasizing primary prevention. To create a community-campus partnership with control originating in and sustained by the community. An interdisciplinary team of health professions students and faculty worked with community leaders and residents to develop leadership skills, enhance infrastructure and coordinate efforts to address health concerns. A health marketing analysis and a series of year-long environmental assessments of surface and ground water were completed. The community was assisted with reaching consensus for future actions, emphasizing local control, enhanced county-based ownership, and sustainability of intervention efforts. The Del Rio and East Tennessee State University partnership was instrumental in accomplishing its short-term objectives with the remediation of two major health issues. The more important long-term objectives of enhancing citizen leadership skills and developing a more action-oriented community infrastructure were also met. Using an experiential learning model, students practiced community organization skills, conflict resolution and problem-solving strategies. The campus-community partnership illustrated the advantages of experiential, multidisciplinary education and accentuated the positive aspects of collaborative planning and action. The partnership continues to provide expanded learning opportunities for students and contributes to the empowerment and self-sufficiency of the community. The ripple effects of the model have become evident, with dramatic increases in university-wide efforts to increase partnership opportunities and enhanced support for service learning throughout the region.

Interdisciplinary Graduate Health Professions Education

National Coordinator, Community Partnerships for Graduate Medical and Nursing Education, a W.K. Kellogg Initiative, George Mason University, Fairfax, VA

Principles of Pharmacology: Basic Concepts and Clinical Applications

<i>Principles of Pharmacology</i>is intended as a concise reference book for medical and graduate students, residents, postdoctoral fellows, faculty members, and health professionals in medicine, pharmacy, dentistry, veterinary medicine, nursing, and public health. The volume is divided into sections, each the primary responsibility of a section editor or coeditors. As such, the strength of the text depends on the quality of the section editors and their selected authors. Many outstanding clinicians and scientists appear in the listing of "Editors, Authors, and Advisors"; this list is truly international and includes representatives from around the world. The international flavor is reflected in a supplement to the text about new drug approval in Japan. Most of this 1796-page text, however, is devoted to scientific and clinical aspects of pharmacology and therapeutics. The first section on general principles includes a comprehensive review of pharmacodynamics and pharmacokinetics and a discussion of drug development and the

The case for including medical informatics in medical, nursing, and public health school curricula

It is difficult to find time in the medical curriculum for teaching medical informatics in the face of ever expanding course requirements. Horizontal integration with current topics appears to be the most realistic way to include it. Since medical informatics teaches health professionals to streamline the handling of voluminous medical information, it may have claim to a special priority. In several European countries, medical informatics is federally mandated as a part of the medical curriculum. Without it, the ever increasing extent to which clinics, wards, and offices are being computerized can pose problems for newly graduated health professionals. This is especially true for nurses who often have to face patient-monitoring equipment on their own. In spite of the excellent efforts of the National Library of Medicine to train medical informatics professionals, the lack of teaching staff is still a factor in the slow adoption of the discipline. An inclusion of a specialization in medical informatics in more schools of public health curricula could be helpful in this regard.

Perceptions of the value of hospital residency and clinical medicine in dental education

A survey of the outlook of 81 participating dental undergraduates concerning the value of a general hospital residency programme has been compared with the perceptions of 240 graduate health professionals (dental and medical practitioners, registered nurses and others). There is convincing statistical evidence of pan-professional support for such a general hospital residency. Better medical preparation of the dental student prior to residency is strongly favoured. Closer links between medicine and dentistry are inevitable as well as being essential for both professions and the community.