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Background: Despite a fast-paced environment, the emergency clinician has a duty to meet the palliative patient's needs. Despite suggested models and interventions, this remains challenging in practice. Aim: To raise awareness of these challenges by exploring the experience of palliative care patients and their families and informal carers attending the emergency department, and of the clinicians caring for them. Design: Qualitative systematic literature review and thematic synthesis. Search terms related to the population (palliative care patients, family carers, clinicians), exposure (the emergency department) and outcome (experience). The search was international but restricted to English and used a qualitative filter. Title, abstracts and, where retrieved, full texts were reviewed independently by two reviewers against predefined inclusion criteria arbitrated by a third reviewer. Studies were appraised for quality but not excluded on that basis. Data sources: MEDLINE [1946-], Embase[1947-], CINAHL [1981-] and PsycINFO [1987-] with a bibliography search. Results: 19 papers of 16 studies were included from Australia (n = 5), the United Kingdom (n = 5), and United States (n = 9) representing 482 clinical staff involved in the emergency department (doctors, nurses, paramedics, social workers, technicians), 61 patients and 36 carers. Nine descriptive themes formed three analytic themes: 'Environment and Purpose', 'Systems of Care and Interdisciplinary Working' and 'Education and Training'. Conclusion: In the included studies, provision of emergency palliative care is a necessary purpose of the emergency department. Failure to recognise this, gain the necessary skills or change to systems better suited to its delivery perpetuates poor implementation of palliative care in this environment. [ABSTRACT FROM AUTHOR]

Background: There has been rapid growth of chiropractors pursuing career opportunities in both public and private hospitals and other integrated care settings. Chiropractors that prosper in integrated care settings deliver patient-centered care, focus on the institutional mission, understand and adhere to organizational rules, and are proficient in navigating complex systems. The Council on Chiropractic Education Accreditation Standards do not outline specific meta-competencies for integrated care clinical training. Objective: The purpose of this study was to develop preliminary integrated health care competencies for DC programs to guide the advancement of clinical chiropractic education. Methods: A systematic literature search was performed. Articles were screened for eligibility and extracted in duplicate. Domains and seed statements were generated from this literature, piloted at a conference workshop, and evaluated via a modified Delphi consensus process. Of 42 invited, 36 chiropractors participated as panelists. Public comment period yielded 20 comments, none resulting in substantive changes to the competencies. Results: Of 1718 citations, 23 articles met eligibility criteria. After 2 modified Delphi rounds, consensus was reached on all competency statements. A total of 78 competency statements were agreed upon, which encompassed 4 domains and 11 subdomains. The 4 domains were: 1) Collaboration, (2) Clinical Excellence, (3) Communication, and (4) Systems Administration. Conclusion: We identified 78 preliminary competencies appropriate for preparing DC students and early career chiropractors for clinical practice in integrated healthcare settings. Educational programs may consider these competencies for curricular design and reform to strengthen DC program graduates for integrated practice, advanced training, and employment. [ABSTRACT FROM AUTHOR]

Studies of validation of domain-referenced tests (DRT) focus almost exclusively on content validation, while eminent researchers caution against neglecting construct validity. This paper discusses issues re lated to construct validation and reports the validation results for a DRT. Specifically, this study evaluates the substantive construct validity of DRT items. Items for objectives in clinical dietetics were administered to a national sample of students. An index of item response homogeneity was used as an indicator of substantive construct validity. Results suggest evidence for that type of validity. [ABSTRACT FROM PUBLISHER]

Background. Many diseases are linked to lifestyle in the United States, yet physicians receive little training in nutrition. Medical students' prior knowledge of nutrition and cooking is unknown. Objective. To determine incoming medical students' prior nutrition knowledge, culinary skills, and nutrition habits. Methods. A dual-methods study of first-year medical students. Cross-sectional survey assessing prior knowledge, self-efficacy, and previous education of cooking and nutrition. Interviews of second-year medical students explored cooking and nutrition in greater depth. Results. A total of 142 first-year medical students participated; 16% had taken a nutrition course, with majority (66%) learning outside classroom settings. Students had a mean score of 87% on the Nutritional Knowledge Questionnaire versus comparison group (64.9%). Mean cooking and food skills score were lower than comparison scores. Overall, students did not meet guidelines for fiber, fruit, vegetables, and whole grains. Interviews with second-year students revealed most learned to cook from their families; all believed it important for physicians to have this knowledge. Conclusions. Medical students were knowledgeable about nutrition, but typically self-taught. They were not as confident or skilled in cooking, and mostly learned from their family. They expressed interest in learning more about nutrition and cooking. [ABSTRACT FROM AUTHOR]

Introduction: An estimated 38 million people are living with human immunodeficiency virus (HIV) worldwide. Pharmacists are well positioned to provide care to patients with HIV, but gaps in HIV education among pharmacists exist. Recognizing the need to educate and prepare future pharmacists, a 2-credit advanced HIV elective course was created for Doctor of Pharmacy students at Washington State University College of Pharmacy and Pharmaceutical Sciences in the United States, and Masters of Clinical Pharmacy students from University of Western Cape School of Pharmacy in South Africa. Methods: Course topics included diagnosis and treatment of HIV in children and adults, management of common comorbidities, pre-exposure prophylaxis, pharmacogenetic applications, and antiretroviral drug-drug interactions. Course effectiveness was evaluated using student examination results. Student perceptions were evaluated using pre- and post-course self-assessments involving abilities, confidence, and attitudes toward caring for people living with HIV. Results: Student pharmacists demonstrated competency in HIV knowledge, demonstrated skills in application to clinical-based scenarios, and reported significantly improved confidence and abilities as well as positive changes in attitudes toward people with HIV. Conclusion: This course contributed to student learning across different student cohorts in an institutional program in the United States including successful execution of distance learning and clinical application for students at a program in South Africa. [ABSTRACT FROM AUTHOR]

Objectives: For decades, there have been calls to action to change the status quo of public health education in the United States to respond to workforce needs and help reinforce capacity. During the last 10 years, schools and programs of public health have planned and implemented programmatic and curricular changes. This study explored the focus of master of public health (MPH) education in the United States today. Methods: We used a 3-phase mixed-methods study to compile data to describe the current state and focus of MPH education in the United States via survey data collection (November–December 2019), semistructured interviews (January–February 2020), and document reviews. Results: Survey responses represented at least 43% (93/215) of eligible MPH programs in the United States. Most respondents (86%, 99/115) reported that the primary focus of MPH education in the United States is to prepare graduates for public health practice and employment linked to public health, and 54% (59/109) reported that their MPH programs adopted this focus in the last 5 years. MPH programs invested in student learning, competence development, and supporting workforce readiness, including a focus on leadership abilities. Programs noted that they seek to develop strategic thinkers and engaged leaders with abilities to understand and address emergent public health needs. Conclusions: Public health education in the United States is in a period of change. MPH programs reported responding to workforce needs by closing gaps in workforce capacity and developing compassionate and professional leaders who can understand needs, collaborating with communities, and facilitating action that will ameliorate health disparities and promote social injustice by practicing public health in new ways. [ABSTRACT FROM AUTHOR]

This qualitative study evaluates physician training and experience with treatment and prevention services for people who inject drugs (PWID) including medications for opioid use disorder (MOUD) and HIV pre-exposure prophylaxis (PrEP). The Behavioral Model of Healthcare Utilization for Vulnerable Populations was applied as a framework for data analysis and interpretation. Two focus groups were conducted, one with early career physicians (n = 6) and one with mid- to late career physicians (n = 3). Focus group transcripts were coded and analyzed using thematic analysis to identify factors affecting implementation of treatment and prevention services for PWID. Respondents identified that increasing the availability of providers prescribing MOUD was a critical enabling factor for PWID seeking and receiving care. Integrated, interdisciplinary services were identified as an additional resource although these remain fragmented in the current healthcare system. Barriers to care included provider awareness, stigma associated with substance use, and access limitations. Providers identified the interwoven risk factors associated with injection drug use that must be addressed, including the risk of HIV acquisition, notably more at the forefront in the minds of early career physicians. Additional research is needed addressing the medical education curriculum, health system, and healthcare policy to address the addiction and HIV crises in the U.S. South. [ABSTRACT FROM AUTHOR]

Introduction: The high rate of maternal mortality among Black women in the United States continues to gain attention; yet research has not yet fully illuminated the precursors to these events, most impactful among them being "maternal near misses." A maternal near miss occurs when a woman nearly dies but survives a complication that occurred during pregnancy, childbirth, or within 42 days of termination of pregnancy. Researchers have focused on reviewing patient medical records after sentinel maternal events to help determine major contributors to them; however, qualitative studies with near-miss survivors, especially among Black women, may be a more useful approach. Methods: Using a qualitative methodology, we conducted semi-structured interviews with 12 Black women to explore how they perceived the care provided to them during their near-miss experiences. Our study also employed a phenomenology framework to understand the lived experience of Black women who had a maternal near miss in the context of a hospital setting. Results: We interviewed 12 women between October 2020 and March 2021. All participants had a maternal near miss between the years 2010 and 2020 and were aged between 19 and 41 years when they had their near-miss experience. These women identified communication, patient–provider relationship, skills/competency of staff, provider discrimination, systems issues, and emotional distress as major contributors to their experiences. Conclusion: Maternal near misses serve as a precursor to maternal mortality events. By listening to patients and their families recount their perspectives on what leads up to these near misses, we can unearth valuable lessons that can aid in the development of strategies and interventions to decrease the numbers of pregnancy-related deaths; especially among Black women who suffer disproportionately from maternal morbidity and mortality. Based on these findings, we recommend that hospitals and OB-GYN practices consider the unique predispositions of their Black patients; account for their own personal biases, revisit the near-miss experiences of past patients to keep patients central to care and build rapport between patients and hospital birthing support staff; and center discussions about improvements in care around racist structures and systems. [ABSTRACT FROM AUTHOR]

This study investigated factors influencing success of physician scientists in Academic Medical Centers. These organizations and individuals drive healthcare in the United States. Translation of scientific discovery to medical practice moves at an astoundingly slow and ineffective rate. We must understand what contributes to physician scientist success to speed up translation. Through a lens of dialectic process theory, a grounded theory approach identified emergent factors from lived experiences of 31 individuals, at various experience levels, with MD and PhD degrees. Role balance, autonomy, organizational support, teamwork, life-cycle mentorship, and relational capacity were relevant factors impacting success. Role balance was important for success. Teamwork, organizational support, and life-cycle mentorship helped individuals grow, achieve balance, and respect, but relational capacity emerged as a critical driver for realizing both individual and organizational success. One person cannot execute these complex roles on their own, but development of deep and meaningful relationships through teamwork, collaboration, and life-cycle mentorship are essential for life satisfaction and success. [ABSTRACT FROM AUTHOR]

A clinician's perceived competence determines his or her ability to attain clinical outcomes and persevere through challenging situations. This study examined the perceived competence of 337 speech-language pathologists (SLPs), including monolingual and bilingual, working with culturally and linguistically diverse (CLD) clients within the United States. Results indicated comparable competence levels of both monolingual and bilingual SLPs in their service delivery to monolingual English-speaking clients. However, bilingual SLPs reported significantly higher competency than monolingual SLPs while working with non-English-speaking clients in different areas of service delivery, including speech and language assessment, dealing with challenging clinical situations, and responding to questions regarding intervention outcomes. It is likely that language concordance, awareness, and understanding of linguistic and cultural expectations of non-English-speakers help surpass communication barriers leading to increased perceived competence among bilingual SLPs. This study summarizes persisting challenges in service delivery of CLD populations and possible recommendations for preservice training of SLPs. [ABSTRACT FROM AUTHOR]

The article offers medical related news briefs in the U.S. The format of the Clinical Skills Assessment from December 2010 have some changes on data collection, clinical management and interpersonal skills on every cases. The latest version of Essential Knowledge Updates has now three new e-learning courses on drug misuse, relationship issues and sexual health. The oil painting by Dutch painter Pieter Bruegel entitled "The Blind Leading the Blind" in 1568 correlates with clinical guidelines.

Digitalization is the future and, simultaneously, a challenge for nursing. In addition, health literacy is increasingly associated with the use of technology. Older adults are greatly underrepresented in the use of digital technology and regarded as a vulnerable group. Consequently, training programs for technological knowledge and improving technological competencies are indispensable to promote equal opportunities and health literacy. The researchers inquire what characterizes nursing informatics as an expanding field in relation to the roles and competencies of nurses in technical appropriation processes of older adults. We conducted a scoping review based on a systematic literature search. We identified 23 relevant studies and developed a modular system to characterize the potential of nursing informatics: nursing informatics as a profession, competencies of nurses and nursing informatics, assessments, and eHealth literacy. Nursing informatics is a new field in some countries, but competence profiles and role descriptions clearly show that nurses act as educators, supporters, advocates, and mediators. [ABSTRACT FROM AUTHOR]

Background: Older adults with cognitive impairment may have difficulty understanding and complying with medical or medication instructions provided during hospitalization which may adversely impact patient outcomes. Objective: To evaluate the prevalence of cognitive impairment among patients aged 65 years and older within 24 hours of hospital admission using Mini-Cog™ assessments performed by advanced pharmacy practice experience (APPE) students. Methods: Students on APPE rotations were trained to perform Mini-Cog™ assessments during routine medication education sessions from February 2017 to April 2017. The primary end point was the prevalence of cognitive impairment indicated by a Mini-Cog™ score of ≤3. Secondary end points were the average number of observed Mini-Cog™ practice assessments required for APPE students to meet competency requirements, caregiver identification, and 30-day hospital readmissions. Results: Twelve APPE students completed the training program after an average of 4.4 (standard deviation [SD] = 1.0) graded Mini-Cog™ assessments. Of the 1159 admissions screened, 273 were included in the analysis. The prevalence of cognitive impairment was 55% (n = 149, 95% confidence interval [CI]: 48%-61%). A caregiver was identified for 41% (n = 113, 95% CI: 35%-47%) of patients, and 79 patients had a caregiver present at bedside during the visit. Hospital readmission within 30 days of discharge was 15% (n = 41, 95% CI: 11%-20%). Conclusion: Cognitive impairment could substantially impair a patient's ability to comprehend education provided during hospitalization. Pharmacy students can feasibly perform Mini-Cog™ assessments to evaluate cognitive function, thereby allowing them to tailor education content and involve caregivers when necessary. [ABSTRACT FROM AUTHOR]

Over 2 million adults in the United States are incarcerated and over 650,000 return to the community each year. This disparate population is known to have an elevated burden of chronic disease and lower socioeconomic status. Medical residency training about care of incarcerated or previously incarcerated patients is significantly lacking in the United States. Curriculum can be developed and implemented in residency programs to help physicians learn how to work with this population, be sensitive to their unique needs, and achieve positive health outcomes. This article describes a method for “educating the educators” based on a workshop presented at a peer-reviewed national conference during the fall of 2016. Attendees participated in exercises addressing assumptions, expectations, bias, and worldview and increased their ability for self-reflection when interacting with patients who are or have experienced incarceration. In this session, strategies were identified that engaged the patient with the goal to aid in patient retention and compliance. Future steps include development of a formal curriculum for training in this area, incorporation into existing community medicine rotations or electives, and establishment of structured transition clinics where residents can be exposed to this population on a more regular basis and improve their overall health outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety and efficacy of a novel optical coherence tomography (OCT)-guided atherectomy catheter in treating patients with symptomatic femoropopliteal disease.Methods: The VISION trial ( ClinicalTrials.gov identifier NCT01937351) was a single-arm, multicenter, global investigational device exemption study enrolling 158 subjects (mean age 67.2±10.5 years; 87 men) across 20 participating sites. In this cohort, 198 lesions were treated with an average length of 53±40 mm using the Pantheris catheter alone or Pantheris + adjunctive therapy. The primary safety endpoint was the composite of major adverse events (MAEs) through 6 months (objective performance goal 43.2%). Technical success (primary efficacy outcome) was defined as the percent of target lesions with a residual diameter stenosis ≤50% after treatment with the Pantheris device alone (objective performance goal 87.0%). Procedural success was defined as reduction in stenosis to ≤30% after Pantheris ± adjunctive therapy. Tissue specimens retrieved from each treated lesion were histologically analyzed to evaluate the accuracy and precision of OCT image guidance.Results: The primary efficacy outcome was achieved in 192 (97.0%) of the 198 lesions treated with the Pantheris catheter. Across all lesions, mean diameter stenosis was reduced from 78.7%±15.1% at baseline to 30.3%±11.8% after Pantheris alone (p<0.001) and to 22.4%±9.9% after Pantheris ± adjunctive therapy (p<0.001). Of the 198 target lesions, 104 (52.5%) were treated with the Pantheris alone, 84 (42.4%) were treated with Pantheris + adjunctive angioplasty, and 10 (5.1%) with Pantheris + angioplasty + stenting. The composite MAE outcome through 6 months occurred in 25 (16.6%) of 151 subjects. There were no clinically significant perforations, 1 (0.5%) catheter-related dissection, 4 (2%) embolic events, and a 6.4% clinically driven target lesion revascularization rate at 6 months. The 40-lesion chronic total occlusion (CTO) subset (mean lesion length 82±38 mm) achieved a similar significant reduction in stenosis to 35.5%±13.6% after Pantheris alone (p<0.001). Histological analysis of atherectomy specimens confirmed <1% adventitia in 82.1% of the samples, highlighting the precision of OCT guidance. Characterization of the OCT-guided lesions revealed evidence of an underestimation of disease burden when using fluoroscopy.Conclusion: OCT-guided atherectomy for femoropopliteal disease is safe and effective. Additionally, the precision afforded by OCT guidance leads to greater removal of plaque during atherectomy while sparing the adventitia. [ABSTRACT FROM AUTHOR]

The article discusses a study on the perception of nursing students/ educators on the contribution of ethics education to ethical competence of nursing students. It addresses questions including how they look at general contribution of ethics education, contribution of ethics education to ethical competence and features of ethics education needed to promote ethical competence. It suggests that ethics education adds to the ethical awareness and ethical reasoning competencies of nursing students.

This article presents a quantitative assessment of the impact of an epilepsy-focused training program on school nurses. The Epilepsy Foundation and the National Association of School Nurses (NASN) created a training program titled ‘‘Managing Students with Seizures’’ to educate school nurses on strategies and resources that they can use to handle emergency situations effectively and to create a safe and supportive school environment for children with epilepsy and seizures. Before and after the training sessions, nurses answered questionnaires that measured their confidence levels in providing care for students with epilepsy and seizures; these questionnaires showed an improvement in nurses’ confidence levels across all measures. Analysis was also carried out to identify program components and nurse subgroups associated with statistically significant improvements. An evaluation of satisfaction indicated overall satisfaction with the program. This article presents results from 1,080 complete surveys associated with the training in 2007. [ABSTRACT FROM PUBLISHER]

Reprints the article Canine or Chameleon (Revisited): A Never-Ending Challenge in Perpetually Changing World," by Kim J. Hodgson, which appeared in a 2004 issue of the "Journal of Vascular Surgery." Conditions that must be met for an organization to be successful; Lessons learned from being an endovascular surgeon; Changes in medical societies.

Many health professions include written examinations among their licensing procedures, and constructing these examinations poses special difficulties. For physician licensure the central dilemma is manifested by the longstanding tradition of undifferentiated licensure contrasting with the strong specialty orientation of contemporary physician training. This article details the authors' response to this problem and describes the resulting design of a new physician licensure examination. Using a combination of empirical data and expert judgment, descriptions of selected clinical encounters have been assembled as a practice model of a physician licensed for the delivery of general health care of patients. Application of an explicitly situational framework to the design of a physician licensure examination is unusual, and the approach is advocated for use with other health professions. [ABSTRACT FROM AUTHOR]

Examines the clinical competence in psychology graduate students in the U.S. Impact of evaluation on teaching and reliability of measuring clinical competence; Description of the competence examination; Positive effect of the review process on clinical skills of faculty.

In this article the author offers his opinions on health care reform in the U.S. and discuses the impact that it will have on pharmacy practitioners in the U.S. The role that competence, communication and confidence can play in helping pharmacy practitioners to become successful in their careers is discussed.

A letter to the editor is presented in response to the article "Increasing Hospital Pharmacist Clinical Competence in Intensive Pharmacotherapeutics Using a Novel Pharmacist Clinical Educational Program" in October 2015 issue.