Use Of Training Research Articles

Terrorism response training for emergency medical technicians since september 11, 2001: A nation unprepared

Study objectives: The primary goal of this study is to assess the amount and type of terrorism-related training provided to emergency medical technicians (EMTs) in the 2 years since September 11, 2001. Methods: The Longitudinal Emergency Medical Technician Attitude and Demographic Study surveyed a nationally representative sample of EMTs in fall 2003 about terrorism-related training received since September 11, 2001. Responses between EMT–basics (EMT-Bs) and EMT–paramedics (EMT-Ps) were compared. A P value less than .05 was considered statistically significant. Results: Responses were received from 510 EMT-Bs and 862 EMT-Ps throughout the United States. Most providers wanted to be part of the emergency medical services (EMS) initial response team (73%) or EMS recovery team (67%). EMT-Bs were less likely than EMT-Ps to report that they had received training in use of an air-purifying respirator (30% versus 45%); recognition of nuclear, biological, and chemical (NBC) hazards (67% versus 79%); use of a Mark 1 antidote kit (17% versus 34%); or use of personal protective equipment against NBC hazards (59% versus 65%). EMT-Bs also reported less often than EMT-Ps that they had received training in treatment and management of patients injured by NBC exposure (58% versus 72%), incendiaries or explosives (43% versus 59%), or structural collapse (32% versus 39%). A significant number of EMT-Bs and EMT-Ps (23% and 15%) reported receiving no training in personal protective equipment use or recognition and treatment of hazardous material exposures. The median number of hours of such training was less than 1 hour for EMT-Bs and between 1 and 4 hours for EMT-Ps. Less than 1 hour of training for responding to terrorism was received by 51% of all EMTs. Length of training was also associated with community size, with 41% of urban EMTs reporting less than 1 hour, compared to 57% of rural EMTs. Conclusion: EMTs were eager to assist with the aftermath of September 11, 2001. Some training has occurred since then to prepare EMTs, but in the 2 years since September 11, 2001, EMT-Bs received significantly less training than paramedics, particularly in rural areas, and a majority of EMS providers received less than 1 hour of training related to terrorism response. Study objectives: The primary goal of this study is to assess the amount and type of terrorism-related training provided to emergency medical technicians (EMTs) in the 2 years since September 11, 2001. Methods: The Longitudinal Emergency Medical Technician Attitude and Demographic Study surveyed a nationally representative sample of EMTs in fall 2003 about terrorism-related training received since September 11, 2001. Responses between EMT–basics (EMT-Bs) and EMT–paramedics (EMT-Ps) were compared. A P value less than .05 was considered statistically significant. Results: Responses were received from 510 EMT-Bs and 862 EMT-Ps throughout the United States. Most providers wanted to be part of the emergency medical services (EMS) initial response team (73%) or EMS recovery team (67%). EMT-Bs were less likely than EMT-Ps to report that they had received training in use of an air-purifying respirator (30% versus 45%); recognition of nuclear, biological, and chemical (NBC) hazards (67% versus 79%); use of a Mark 1 antidote kit (17% versus 34%); or use of personal protective equipment against NBC hazards (59% versus 65%). EMT-Bs also reported less often than EMT-Ps that they had received training in treatment and management of patients injured by NBC exposure (58% versus 72%), incendiaries or explosives (43% versus 59%), or structural collapse (32% versus 39%). A significant number of EMT-Bs and EMT-Ps (23% and 15%) reported receiving no training in personal protective equipment use or recognition and treatment of hazardous material exposures. The median number of hours of such training was less than 1 hour for EMT-Bs and between 1 and 4 hours for EMT-Ps. Less than 1 hour of training for responding to terrorism was received by 51% of all EMTs. Length of training was also associated with community size, with 41% of urban EMTs reporting less than 1 hour, compared to 57% of rural EMTs. Conclusion: EMTs were eager to assist with the aftermath of September 11, 2001. Some training has occurred since then to prepare EMTs, but in the 2 years since September 11, 2001, EMT-Bs received significantly less training than paramedics, particularly in rural areas, and a majority of EMS providers received less than 1 hour of training related to terrorism response.

Condom use amongst men and women attending a genitourinary medicine clinic

ObjectivesTo assess the numbers of patients attending a large genitourinary medicine (GUM) clinic using condoms to reduce the risk of sexually transmitted infections (STIs), and to assess how many patients...

The language divide. The importance of training in the use of interpreters for outpatient practice.

Provision of interpreter services for non-English-speaking patients is a federal requirement. We surveyed clinicians to describe their experience using interpreters. In this cross-sectional study we surveyed clinicians in three academic outpatient settings in San Francisco (N = 194) regarding their most recent patient encounter which involved an interpreter. Questions about the visit included type of interpreter, satisfaction with content of clinical encounter, potential problems, and frequency of need. Previous training in interpreter use, languages spoken, and demographics were also asked. Questionnaires were self-administered in approximately 10 minutes. Of 194 questionnaires mailed, 158 were completed (81% response rate) and 67% were from resident physicians. Most respondents (78%) were very satisfied or satisfied with the medical care they provided, 85% felt satisfied with their ability to diagnose a disease and treat a disease, but only 45% were satisfied with their ability to empower the patient with knowledge about their disease, treatment, or medication. Even though 71% felt they were able to make a personal connection with their patient, only 33% felt they had learned about another culture as a result of the encounter. Clinicians reported difficulties eliciting exact symptoms (70%), explaining treatments (44%), and eliciting treatment preferences (51%). Clinicians perceived that lack of knowledge of a patient's culture hindered their ability to provide quality medical care and only 18% felt they were unable to establish trust or rapport. Previous training in interpreter use was associated with increased use of professional interpreters (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.4 to 7.5) and increased satisfaction with medical care provided (OR, 2.6; 95% CI, 1.1 to 6.6). Clinicians reported communication difficulties affecting their ability to understand symptoms and treat disease, as well as their ability to empower patients regarding their healthcare. Training in the use of interpreters may improve communication and clinical care, and thus health outcomes.

Comparison of 3 Methods of Detecting Acute Respiratory Distress Syndrome: Clinical Screening, Chart Review, and Diagnostic Coding

Although the incidence of acute respiratory distress syndrome has been studied, few researchers have prospectively assessed the search tool used to identify cases. For 5 months, all patients admitted to a medical intensive care unit in a teaching hospital were evaluated daily to determine whether criteria for acute respiratory distress syndrome were met, and physicians' progress notes and discharge summaries for these prospectively identified patients were reviewed for mention of the syndrome. Discharge forms were reviewed for the codes (International Classification of Diseases, Ninth Revision) specific to acute respiratory distress syndrome (518.82 or 518.85). Of 314 patients admitted, 65 prospectively met the criteria for acute respiratory distress syndrome. Of these 65 patients, 31 had acute respiratory distress syndrome mentioned in their progress notes, and 4 of the 31 were subsequently assigned a code of 518.82 or 518.85. Patients with a physician's notation for acute respiratory distress syndrome in their charts had a higher mortality (22/31 [71%]) than did the patients with no such notation (10/34 [29%]). This difference could not be accounted for by differences in length of stay, mean age, score on Acute Physiology and Chronic Health Evaluation III, or number of days in the unit before meeting the criteria. The incidence of acute respiratory distress syndrome is underestimated when based on either diagnostic coding or physicians' notes without testing of the accuracy of coding. Both physicians and medical record coding specialists may require training in use of terms related to acute respiratory distress syndrome.

Evaluation of control measures implemented in the severe acute respiratory syndrome outbreak in Beijing, 2003.

Beijing, China, experienced the world's largest outbreak of severe acute respiratory syndrome (SARS) beginning in March 2003, with the outbreak resolving rapidly, within 6 weeks of its peak in late April. Little is known about the control measures implemented during this outbreak. To describe and evaluate the measures undertaken to control the SARS outbreak. Data were reviewed from standardized surveillance forms from SARS cases (2521 probable cases) and their close contacts observed in Beijing between March 5, 2003, and May 29, 2003. Procedures implemented by health authorities were investigated through review of official documents and discussions with public health officials. Timeline of major control measures; number of cases and quarantined close contacts and attack rates, with changes in infection control measures, management, and triage of suspected cases; and time lag between illness onset and hospitalization with information dissemination. Health care worker training in use of personal protective equipment and management of patients with SARS and establishing fever clinics and designated SARS wards in hospitals predated the steepest decline in cases. During the outbreak, 30 178 persons were quarantined. Among 2195 quarantined close contacts in 5 districts, the attack rate was 6.3% (95% confidence interval [CI], 5.3%-7.3%), with a range of 15.4% (95% CI, 11.5%-19.2%) among spouses to 0.36% (95% CI, 0%-0.77%) among work and school contacts. The attack rate among quarantined household members increased with age from 5.0% (95% CI, 0%-10.5%) in children younger than 10 years to 27.6% (95% CI, 18.2%-37.0%) in adults aged 60 to 69 years. Among almost 14 million people screened for fever at the airport, train stations, and roadside checkpoints, only 12 were found to have probable SARS. The national and municipal governments held 13 press conferences about SARS. The time lag between illness onset and hospitalization decreased from a median of 5 to 6 days on or before April 20, 2003, the day the outbreak was announced to the public, to 2 days after April 20 (P<.001). The rapid resolution of the SARS outbreak was multifactorial, involving improvements in management and triage in hospitals and communities of patients with suspected SARS and the dissemination of information to health care workers and the public.

Training the knowledge worker: a descriptive study of training practices in Irish software companies

The IT workforce of a company may embody its most important strategic asset. Such an asset needs to be managed. At a company level, measures that support and encourage knowledge transfer amongst employees can help minimise the effect of the loss of skilled staff. This paper details the results of a survey administered to 200 employees across 39 software companies in Ireland. The study assessed the impact of training practices on employee retention, gathered data on the effects of training initiatives, the types of training in use, and the influence of training on knowledge retention. Results demonstrate that organisational attitudes and provision for training relate positively to employee expectations and requirements. Well‐engineered training initiatives lead to increased organisational strength, job‐related employee competencies, and job satisfaction. Training helps in retaining knowledge within the organisation, but may not help in retaining employees. Almost one third of respondents believe that training received has not helped to reduce job‐related stress and more than one quarter indicate that their organisation does not structure training based on employee feedback on requirements.

Effects of brief training on application of the Global Assessment of Functioning Scale.

31 staff members within one VA medical center were briefly trained in using the Global Assessment of Functioning scale. At both pre- and posttraining participants provided Global Assessment of Functioning scores and identified their GAF-derivation strategies for two vignettes describing hypothetical patients. Analysis showed that initially there was inter- and intrarater inconsistency in strategy for deriving scores and that training increased consistency. Participants persisted in giving ratings that exceeded the criterion score. However, training significantly reduced Global Assessment of Functioning scores for one vignette, bringing scores closer to the criterion, and a significant number of people gave lower ratings after training. The study highlights common errors and points to the need for formal training in use of the scale.

Evaluation of the Presence of Sacroiliac Joint Region Dysfunction Using a Combination of Tests: A Multicenter Intertester Reliability Study

The authors examined the intertester reliability of assessments made based on a composite of 4 tests of pelvic symmetry or sacroiliac joint (SIJ) movement that are advocated in the literature for identifying people with SIJ region dysfunction. "Sacroiliac joint region dysfunction" is a term used to describe pain in or around the region of the joint that is presumed to be due to malalignment or abnormal movement of the SIJs. Sixty-five patients with low back pain and unilateral buttock pain were seen in 1 of 11 outpatient clinics. Thirty-four therapists, randomly paired for each subject, served as examiners. Kappa coefficients and observed proportions of positive (Ppos) and negative (Pneg) agreement were calculated to estimate reliability. For the composite test results, percentages of agreement ranged from 60% to 69%, kappa coefficients varied from.11 to.23, and Ppos was lower than 50%. Reliability of measurements obtained with the 4 tests appears to be too low for clinical use. Given the measurement error found in this study, the authors suspect it is likely that either the proper treatment technique will not be chosen based on the test results or the intervention will be applied to the wrong side. The 4 tests probably should not be used to examine patients suspected of having SIJ region dysfunction, although the role of therapist training in use of the procedures is unclear.

Pressurised metered-dose inhalers versus all other hand-held inhalers devices to deliver bronchodilators for chronic obstructive pulmonary disease.

Bronchodilator therapy for COPD may be delivered by a number of different inhaler devices. To determine the efficacy of pressurised metered dose inhalers (pMDI) compared to any other handheld inhaler device for the delivery of bronchodilators in non-acute COPD. The Cochrane Collaboration, Asthma and Wheeze Randomised Controlled Clinical Trials register was searched for studies. The UK pharmaceutical companies who manufacture inhaled COPD medication were also contacted. Two reviewers independently reviewed the results of computerised search and any potentially relevant articles were obtained in full. One reviewer extracted details of each trial and a second reviewer checked all extracted data. Dichotomous outcomes such as exacerbation rate were assessed using relative risk, with 95% confidence interval (CI). Fourteen studies appeared potentially relevant but only three studies (61 patients) met the entry criteria. Two studies compared a dry powder device (Turbuhaler or Rotahaler) with a pMDI for beta2-agonist delivery, and one (36 patients cross-over design) the Respimat (soft mist device for ipratropium) vs a pMDI. For the Turbuhaler and Rotahaler, none of the reported outcome measures were significantly different. The Rotahaler study used a high and low dose of medication with or without large volume spacer. The study using the Respimat showed significant increases in FEV1 when compared to a pMDI (difference in change from base line 70 ml, 95% CI 10, 130 ml). The effect on change in FVC was of similar size. There were no differences between these two devices for any other reported outcomes. Although none of the included studies required prior patient ability to use any of the inhalers (and no study mentioned device training), it was assumed that all patients randomised into the study would have undergone training in use of the study inhalers and were capable of using those devices. In patients with stable COPD, pMDI produced similar outcomes to a dry powder device for delivering beta2-agonists, but the very small number of studies and included patients does not permit firm conclusions to be drawn. The soft mist device for ipratropium was more effective than a pMDI, but the data come from one small study. There need to be further well designed randomised controlled trials to define the role of inhaler devices using bronchodilators in stable COPD.

The NIH Stroke Scale is unreliable in untrained hands

Background and Purpose: The NIH (National Institutes of Health) Stroke Scale helps to define candidates for thrombolytic treatment and other important clinical decisions. We evaluated its use by last-year medical students who had no specific training in use of this scale. Methods: The scale (principles, utilization, methods for scoring, main pitfalls) was presented between 2 stroke lectures. Following a 30-minute study period, a case from the NIH training videotape (case 1, tape 2, total score 4) was presented, and the 13 items were scored by 42 voluntary students. The analysis focused on possible errors of potential clinical relevance. Results: Only 15 students (36%) scored all items correctly. Twenty (48%) gave results at least 2 points apart from the correct total score, and 14 students had scores ≥6, which could lead to the inappropriate use of recombinant tissue-type plasminogen activator (rt-PA). At least 10% of the students made mistakes in most (8 of 13) items of the scale. Conclusions: Graduating medical students are not ready to use the NIH Stroke Scale without specific training. The magnitude of the mistakes found in this study is enough to inappropriately include or exclude patients from rt-PA treatment. Training programs should be considered a sine qua non for qualification for rt-PA use in daily clinical practice. Copyright © 2002 by National Stroke Association

Asthma management and perceptions in rural South Africa.

Many First World countries have endeavored to measure the impact of asthma on individuals with asthma and, in addition to this quality of life evaluation, have attempted to define the quality of care for this common chronic illness. The primary objective of this research probe was to assist the National Asthma Program in South Africa with the formulation and delivery of its outreach program to rural asthmatic patients. A discussion/questionnaire document was compiled by Partners in Research from established literature. All interviews were conducted in either the clinics, hospitals, or respondents' homes. Both adult asthmatic patients and parents of pediatric asthmatic patients were interviewed. Interviewing took place at seven rural health clinics across South Africa. Each interview included extensive demographic details, questions on asthma definition, symptoms and symptom triggers, family history, age at diagnosis, frequency of symptoms, and treatment. Thirty-five adult asthmatic patients and 27 parents of pediatric asthmatic patients were interviewed. Of the adults, 40% reported wheezing at least once a week (despite diagnosis and treatment) and 19% of children reported similar symptom exacerbations. Fifty-one percent of adults and 56% of children were awakened at least once a week by cough or wheeze. Quality of life measurement reflected that, on average, 37% of responders were frightened during an acute asthma attack, and 68% of parents reported fearing the death of their asthmatic children. Fifty-one percent of adults and 33% of children had been hospitalized at least once for asthma. Although respondents claimed regular training in use of inhaler device, only 43% of adults completed each step correctly. There is a great deal of fear and ignorance surrounding asthma and, therefore, there is a real need for a greater level of patient education even in the rural areas of South Africa. In rural South Africa, attention should be paid to nurses, because they play a greater role than doctors in management and education of asthma.

Training in use of inhaled corticosteriod in adult patients with bronchial asthma

Training in use of inhaled corticosteriod in adult patients with bronchial asthma

Measuring functional outcomes in stroke trials: Improving inter-rater reliability of the Modified Rankin Scale using a structured interview

P227 Background &amp; aims: The Modified Rankin Scale (MRS) (van Swieten et al, 1988) is widely used in clinical trials to rate disability and handicap after stroke. Although the MRS is a popular measure of functional outcome the categories of the scale are very broadly defined and open to interpretation by raters. Previous work with the Glasgow Outcome Scale indicates that the reliability of functional rating scales may be improved by use of a structured interview (Wilson et al, 1998). The purpose of the present study was to compare the inter-rater reliability of the conventional MRS with the inter-rater reliability of a newly developed structured interview for the MRS (MRS-SI) Methods: A structured interview was devised for the MRS covering five areas of everyday function. 63 patients with stable functional state after stroke (stroke 6 to 24 months previously) were recruited to the study and scored on the conventional MRS by two independent observers. These observers then underwent training in use of the MRS-SI. Eight weeks after the first assessment the same observers reassessed 58 of these patients using the MRS-SI. Results: To allow comparison between the assessments the analysis of results was restricted to the 58 patients who were rated on both the MRS and MRS-SI. Inter-rater reliability was measured using the kappa statistic (unweighted and weighted using quadratic weights). For the MRS, overall agreement between the two raters was 57% (unweighted kappa 0.44, weighted kappa 0.78); using the MRS-SI, overall agreement was 78% (unweighted kappa 0.70, weighted kappa 0.93). Conclusions: Variability between raters in assigning patients to Rankin grades appears to be reduced when using a structured interview for the Modified Rankin Scale. The use of the MRS-SI could potentially improve the quality of results from clinical studies in stroke. A multi-centre study to further establish the improvement in inter-rater reliability is ongoing.

Peer Tutors’ Effects on Activity Levels of Deaf Students in Inclusive Elementary Physical Education

The purpose of this study was to analyze the effect of trained peer tutors on the physical activity levels of deaf students1 in inclusive elementary physical education classes. A single subject delayed multiple baseline design across 8 deaf participants (4 boys and 4 girls) ages 10 to 12 was used. Eight typically developing, trained peers of the same age and gender served as peer tutors following training in use of sign language and basic teaching strategies. The dependent variable was moderate to vigorous physical activity (MVPA) determined by McKenzie, Sallis and Nader’s (1991) System for Observing Fitness Instruction Time (SOFIT). The study included 3–4 sessions of baseline, 11–14 sessions of intervention, and 1–3 sessions of maintenance. Results revealed that after the introduction of peer tutoring, deaf students increased their MVPA from to 22% to 41.5%, and peer tutors increased their MVPA from 19% to 37.9%.

Cyclophosphamide in the Treatment of Pulmonary Diseases: Survey of Use, Training, and Practitioner Knowledge Base

To assess pulmonologists' use, training in the use, and knowledge base of the drug cyclophosphamide. Survey through questionnaire. Testing of knowledge base before and after instructional conference. Pulmonologists (94 attendings, 31 fellows), selected randomly at the 1996 and 1997 annual meetings of The American Thoracic Society, completed surveys of their use and training in the use of cyclophosphamide. Thirty-five attending at the 1998 meeting completed a test of knowledge base of the drug. Members of the pulmonary teaching service at The University of Chicago Hospitals completed the test before and after a case-based conference designed to educate pulmonologists in the use of the drug. Forty-three percent of the attending pulmonologists and 55% of the fellows were currently using the drug in the management of their patients; 77% of the attending pulmonologists had prescribed the drug in the past. Nonmalignant diseases for which the drug was prescribed included usual interstitial pneumonitis/desquamative interstitial pneumonitis, vasculitis, collagen vascular disease, constrictive bronchiolitis, sarcoid, and Goodpasture's disease. Sixty-eight percent of attending pulmonologists and 81% of fellows had no training in the drug's use. Of the attending pulmonologists who made use of the drug, 64% were prescribing and managing its use themselves. Of those who prescribed and managed the drug's use themselves, 65% had had no training in its use. Of those fellows who prescribed and managed the drug's use themselves, 73% had had no training in the drug's use. On knowledge-based testing, the average correct score was 30 +/- 10%. With an educational conference, average pre- and post-test scores rose from 40 +/- 10% to 80 +/- 10% (p < 0.001). Cyclophosphamide had been used by the vast majority of pulmonologists, either currently or in the past, for a wide variety of lung diseases. Its use is commonly managed by physicians who have no specific training relevant to this agent. Practitioner knowledge base of the drug is poor, and case-based conferences in fellowship may be an effective means of imparting information concerning this drug.

One year follow-up of an emergency department protocol for abused women

ObjectiveTo evaluate if the positive effects of an initially successful emergency department protocol of care for victims of partner abuse (PA) were maintained at one year follow-up. MethodA community intervention trial compared two public hospital EDs in Auckland, NZ, at baseline (BL), following implementation of a PA intervention (PI), and at one year follow-up (FU). The initial intervention involved training staff at one ED in a protocol for the identification and acute management of abused women. Later, an on-site protocol co-ordinator worked to ensure that new staff received training in protocol use. Outcomes were assessed by reviewing a random sample of women's medical records. Identification of PA was assessed for each record on a yes/no basis. Identified cases were classified as ‘confirmed’ or ‘suspected’ PA. Acute management was assessed by ascertaining staff use of interventions and documentation of abuse. ResultsApproximately equal numbers of records were reviewed at each ED at BL, PI and FU (total n= 10,961). Significant interactions were found for classification of PA and acute management offered to victims between EDs over the different study phases. However, the increase in identification of confirmed cases and the improved acute management offered to identified victims found at the intervention ED in the PI phase were not maintained at follow-up. ConclusionAlthough staff training in the use of protocols for victims of partner abuse can result in improved care, these effects were not maintained. ImplicationsMore intensive institutional efforts are needed if protocol benefits are to be maintained.

Single-switch control versus powered wheelchair for training cause-effect relationships: case studies

Objectives. Traditional habilitation recommends the use of single switch control and simple computer games as pre-training of cause-effect relationships and joystick control before training in use of a powered wheelchair. Findings from studies of individuals at an early developmental level driving a powered wheelchair suggest it may be more effective to reverse order. Methods. We studied the outcome of powered wheelchair activity in context (self-directed locomotion). Participants included 40 disabled individuals and 17 typically developed infants functioning at an early developmental level. The activity in the wheelchair was paralleled with the use of single switch controls connected both to toys and to a computer with simple ``press-action'' software. Results. The cognitive understanding of the simple cause-effect (use of joystick causes the effect of motion of the wheelchair) developed earlier than the understanding (press on single switch causes activation of toy or apparatus). Conclusion. The recommendation to use single switch controls as pre-training for driving a powered wheelchair corresponds with individuals with quite good cognitive function but not with individuals who function at an early developmental level. For individuals with severe or profound mental retardation the possibilities to understand cause-effect relationships are found in tools that affect all their senses, their whole body. A powered wheelchair is such a tool. When the individual activates the joystick, the wheelchair moves, affecting all senses and the individual's position in space. This event provides arousal, interest and motivation to further manipulate and explore the cause of the effect. (Less)

Naturalistic Decision Making and Training the Incident Commander

ABSTRACT For years, the U.S. Coast Guard and other pollution response organizations have relied on traditional (analytical) decision making models as a basis for training their On-Scene Coordinators. With the Coast Guard's adoption of the Incident Command System (ICS), a more appropriate basis for a training program may be found using naturalistic decision making (NDM) models. This paper will describe both the traditional and naturalistic decision making models, compare them, explain why naturalistic decision making is more appropriate for training Incident Commanders, and propose a program for such training for use by the Coast Guard or other response organizations.

Using Telerehabilitation to Support Assistive Technology

Telerehabilitation—the use of telecommunications technology to provide rehabilitation and long-term support to people with disabilities—offers exciting possibilities for the delivery and support of assistive technology services. This article describes the experiences of a specialty hospital serving persons with disabilities in exploring telerehabilitation to support assistive technology use in the home. Four case studies are presented to illustrate how telerehabilitation may be used in relation to seating evaluation, evaluation of home accessibility, setup of computer access systems, and training in use of augmentative communication devices.

Technology transfer for women entrepreneurs: issues for consideration.

This article discusses the effectiveness of technology transfers to women entrepreneurs in developing countries. Most women's enterprises share common characteristics: very small businesses, employment of women owners and maybe some family members, limited working capital, low profit margins, and flexible or part-time work. Many enterprises do not plan for growth. Women tend to diversify and use risk-avoidance strategies. Support for women's enterprises ignores the characteristics of women's enterprises. Support mechanisms could be offered that would perfect risk-spreading strategies and dynamic enterprise management through other means than growth. Many initiatives, since the 1970s, have transferred technologies to women. Technologies were applied to only a few domains and were viewed as appropriate based on their small size, low level of complexity, low cost, and environmental friendliness. Technology transfers may not be viewed by beneficiaries as the appropriate answer to needs. The bottleneck in transfers to women is not in the development of prototypes, but in the dissemination of technology that is sustainable, appropriate, and accessible. Key features for determining appropriateness include baseline studies, consumer linkages, and a repetitive process. Institutional factors may limit appropriateness. There is a need for long-term outputs, better links with users, training in use of the technology, grouping of women into larger units, and technology availability in quantities large enough to meet demand. Guidelines need to be developed that include appropriate content and training that ensures transfer of knowledge to practice.