Errors in Patient Positioning for Bone Mineral Density Assessment by Dual X-Ray Absorptiometry: Effect of Technologist Retraining

Improper positioning is one of the factors that can lead to incorrect bone mineral density (BMD) results. This study aimed to assess the frequencies of erroneous positioning during three periods: before retraining of the technologists (BR), after retraining (AR), and at the current timepoint 8 years after retraining (C). The BMD images of the first 150 consecutive patients who underwent DXA of the lumbar spine and hip during each of the three periods were retrospectively reviewed. Patients were excluded if they had severe scoliosis, rendering proper positioning impossible. Each BMD image was assessed by an International Society of Clinical Densitometry certified clinical densitometrist who was blinded to the date of the initial examination. For the lumbar spine in the BR group, the criteria frequently not met were inclusion of both iliac crests (33.8%), straightness (30.3%), and midline positioning (20.4%); the respective frequencies were significantly reduced to 0.8%-5.6%, 2.1%-3.0%, and 0%-2.8% in the AR and C groups (p < 0.05). For the hip in the BR group, the criteria frequently not met were straightness (52.8%) and internal rotation (21.8%); the respective frequencies were significantly reduced to 0%-4.2% and 8.3%-8.4% in the AR and C groups (p < 0.05). Overall improper positioning in the BR group was 49.3% and 57.3% at the lumbar spine and the hip, respectively; the respective frequencies were reduced to 9.3% and 12.7% in the AR group, and to 2.7% and 7.3% in the C group. The least significant change values for the lumbar spine, femoral neck, and total hip also became smaller after retraining. Retraining the technologists improved patient positioning, as evidenced by the decreased frequencies of erroneous positioning and the improved least significant change values after the retraining.

Nurses' Fears and Professional Obligations Concerning Possible Human-to-Human Avian Flu

This survey aimed to illustrate factors that contribute to nurses' fear when faced with a possible human-to-human avian flu pandemic and their willingness to care for patients with avian flu in Taiwan. The participants were nursing students with a lesser nursing credential who were currently enrolled in a bachelor degree program in a private university in southern Taiwan. Nearly 42% of the nurses did not think that, if there were an outbreak of avian flu, their working hospitals would have sufficient infection control measures and equipment to prevent nosocomial infection in their working environment. About 57% of the nurse participants indicated that they were willing to care for patients infected with avian influenza. Nurses' fear about an unknown infectious disease, such as the H5N1 influenza virus, could easily be heightened to levels above those occurring during the 2003 severe acute respiratory syndrome outbreak in Taiwan.

A multifactorial conceptual model of peripheral neuromusculoskeletal predisposing factors in task-specific focal hand dystonia in musicians: etiologic and therapeutic implications

A model is presented showing how peripheral factors may cause a process of movement adaptation that leads to task-specific focal hand dystonia in musicians (FHDM). To acquire a playing technique, the hand must find effective and physiologically sustainable movements within a complex set of functional demands and anatomic, ergonomic, and physiological constraints. In doing so, individually discriminating constraints may become effective, such as limited anatomic independence of finger muscles/tendons, limited joint ranges of motion, or (subclinical) neuromusculoskeletal defects. These factors may, depending on the instrument-specific playing requirements, compromise or exclude functional playing movements. The controller (i.e., the brain) then needs to develop alternative motions to execute the task, which is called compensation. We hypothesize that, if this compensation process does not converge to physiologically sustainable muscle activation patterns that satisfy all constraints, compensation could increase indefinitely under the pressure of practice. Dystonic symptoms would become manifest when overcompensation occurs, resulting in motor patterns that fail in proper task execution. The model presented in this paper only concerns the compensatory processes preceding such overcompensations and does not aim to explain the nature of the dystonic motions themselves. While the model considers normal learning processes in the development of compensations, neurological predispositions could facilitate developing overcompensations or further abnormal motor programs. The model predicts that if peripheral factors are involved, FHDM symptoms would be preceded by long-term gradual changes in playing movements, which could be validated by prospective studies. Furthermore, the model implies that treatment success might be enhanced by addressing the conflict between peripheral factors and playing tasks before decompensating/retraining the affected movements.

Clinical experience does not correlate with the perceived need for cardiopulmonary resuscitation training

BACKGROUND

The efficiency of cardiopulmonary resuscitation (CPR) training is dependent upon different influencing factors, such as the presented concepts, the participants' willingness to learn, and the interval between training sessions. However, the optimal interval for refreshing CPR training is less clear.

OBJECTIVE

We evaluated the perceived need of simulator-based CPR training for nurses and correlated it with their clinical experience.

METHODS

The 60 invited nurses were trained in simulator-based CPR. Knowledge about adult advanced life support was evaluated using a questionnaire after training, and participants rated their desired individual frequency of simulator-based training as well as the value of the presented training using a six-point Likert scale. The same questions were asked again after 1 year.

RESULTS

All participants agreed about the usefulness of this type of simulator-based training. The average number of correct answers about typical facts in adult advanced life support showed an almost bell-shaped distribution, with the highest point at 6-15 years of clinical experience and the lowest points at≤5 and≥21 years. The desired training-frequency need was inversely correlated with clinical experience.

CONCLUSIONS

There is a high interest in CPR training among nursing staff. Self-assessment about the training-frequency need was inversely correlated with clinical experience. However, the average number of correct answers on resuscitation questions decreased with clinical experience. Therefore, the training effectiveness seems to be extremely dependent on clinical experience, and therefore, training experienced senior nurses might be more challenging than training novice nurses.

Reflecting on my career journey, so far

Deborah Easby is a third year student nurse at Sheffield Hallam University, now nearing the end of her studies. With 20 years of experience in healthcare behind her and two children in tow, Deborah decided to become a nurse. In this issue's column, Deborah reflects on her career journey so far, including her achievements and some of the obstacles she has had to overcome

[Amputation in low-income countries: particularities in epidmiological features and management practices]

The epidemiological features and management practices associated with amputation in low-income countries, generally synonymous with the tropics, are different from those observed in Western countries. Unlike developed countries, amputation most frequently involves traumatic injury in young active people. However, Westernization of the lifestyle is leading to an increasing number of cases involving diabetes and atherosclerotic disease. In the developing world, leprosy and Buruli ulcer are still significant etiologic factors for amputation. In war-torn countries, use of antipersonnel landmines is another major cause of amputation with characteristic features. Management of amputees in the developing world is hindered by the lack of facilities for rehabilitation and prosthetic fitting. Many international organizations are supporting national programs to develop such facilities. In addition to being affordable, prosthetics and orthotics must be adapted to the living conditions of a mostly rural amputee population, i.e., heat, humidity, and farm work. The rehabilitation process must be part of a global handicap policy aimed at changing attitudes about disability and reintegrating amputees both socially and professionally.

Using high-fidelity simulation as a teaching strategy with Baby Boomers returning to the RN workforce

As a result of a changing economy, many Baby Boomer nurses are returning to the workforce. Common teaching strategies used in schools of nursing, such as high-fidelity simulation, are unfamiliar to this group of learners. Educators must learn not only the characteristics of Baby Boomer returning nurses but also how to adapt simulation to their learning styles.

Foreign-trained dentists' perceived knowledge and skills after graduation from a structured two-year program

In this survey study, graduates of the University of Western Ontario program for foreign-trained dentists from 1999 to 2009 were asked for their perceptions of their knowledge and skill in fourteen clinical topic areas before they were admitted to the program and after graduation. Their ratings were made on a ten-point visual analog scale divided into three aptitude domains: competent, proficient, and master/expert. Definitions of each domain were provided. The majority of the respondents felt that their knowledge level improved at least one aptitude level in only four of the fourteen (29 percent) topic areas but that their skill level had increased at least one aptitude level in nine (64 percent) topic areas. Of note, clinical topics with content reflective of North American dental practice such as oral medicine and treatment planning, ethics, regulated dentistry, record keeping, and informed consent were the topic areas in which most respondents reported an improvement in both their knowledge and skill. It is suggested that programs evaluating or providing gap training for internationally trained dentists consider mandatory inclusion of these topics.

Physicians reentering clinical practice: characteristics and clinical abilities

INTRODUCTION

Limited information exists to describe physicians who return to practice after absences from patient care. The Center for Personalized Education for Physicians (CPEP) is an independent, not-for-profit organization that provides clinical competency assessment and educational programs for physicians, including those reentering practice. This article studies the medical licensure status, performance, and correlates between physician characteristics and performance on initial assessment.

METHODS

Sixty-two physicians who left practice voluntarily and without discipline or sanction and who were returning to practice in the same discipline as their previous practice participated in the CPEP reentry program. Physicians completed an objective clinical skills assessment including clinical interviews by specialty-matched board-certified physicians, simulated patient encounters, a documentation exercise, and a cognitive function screen. Physicians were rated from 1 (no or limited educational needs) to 4 (global, pervasive deficits). Performance scores were compared based on select physician characteristics.

RESULTS

Twenty-five (40.3%) participants were female; participants' average age was 53.7 years (female 48.1 years; male 57.5 years). Physicians left practice for family issues (30.6%), health issues (27.4%), retirement or nonmedical career change (17.7%), and change to medical administration (14.5%). Females were more likely than males to have left practice for child rearing (P < 0.0001). Approximately one-quarter (24.2%) of participants achieved a performance rating of 1 (best-performing group); 35.5% achieved a rating of 2; 33% achieved a rating of 3; 6.5% achieved a rating of 4 (worst-performing group). Years out of practice and increasing physician age predicted poorer performance (P = 0.0403, P = 0.0440). A large proportion of physicians presenting without an active license achieved active licensure; how many of these physicians actually returned to practice is not known.

DISCUSSION

Physicians who leave practice are a heterogeneous group. Most participants' performance warranted some formal education; few demonstrated global educational needs. The data from this study justify mandates that physicians demonstrate competence through an objective testing process prior to returning to practice. Emerging patterns regarding the performance of the reentering physician may help guide future policy.

Nursing as a second career: have you found your true calling? Interview by Erin Wyatt

Nursing is a noble profession involving much hard work but pays off in abundance. Some nurses have known since childhood what they wanted to be when they grew up, whereas others didn't decide until they switched majors a few times in college. Then there are those who didn't find out that nursing was meant for them until later-years later.

The role of therapist training in the implementation of psychosocial treatments: a review and critique with recommendations

Evidence-based treatments (EBT) are underutilized in community settings, where consumers are often seen for treatment. Underutilization of EBTs may be related to a lack of empirically informed and supported training strategies. The goals of this review are to understand the state of the literature for training therapists in psychotherapy skills and to offer recommendations to improve research in this area. Results of this review of 55 studies evaluating six training methods indicate that multi-component trainings have been studied most often and have most consistently demonstrated positive training outcomes relative to other training methods. Studies evaluating utility of reading, self-directed trainings, and workshops have documented that these methods do not routinely produce positive outcomes. Workshop follow-ups help to sustain outcomes. Little is known about the impact of train-the-trainer methods. Methodological flaws and factors that may influence training outcome and future directions are also reviewed.

Physicians reentering clinical practice: characteristics and clinical abilities

INTRODUCTION

Limited information exists to describe physicians who return to practice after absences from patient care. The Center for Personalized Education for Physicians (CPEP) is an independent, not-for-profit organization that provides clinical competency assessment and educational programs for physicians, including those reentering practice. This article studies the medical licensure status, performance, and correlates between physician characteristics and performance on initial assessment.

METHODS

Sixty-two physicians who left practice voluntarily and without discipline or sanction and who were returning to practice in the same discipline as their previous practice participated in the CPEP reentry program. Physicians completed an objective clinical skills assessment including clinical interviews by specialty-matched board-certified physicians, simulated patient encounters, a documentation exercise, and a cognitive function screen. Physicians were rated from 1 (no or limited educational needs) to 4 (global, pervasive deficits). Performance scores were compared based on select physician characteristics.

RESULTS

Twenty-five (40.3%) participants were female; participants' average age was 53.7 years (female 48.1 years; male 57.5 years). Physicians left practice for family issues (30.6%), health issues (27.4%), retirement or nonmedical career change (17.7%), and change to medical administration (14.5%). Females were more likely than males to have left practice for child rearing (P < 0.0001). Approximately one-quarter (24.2%) of participants achieved a performance rating of 1 (best-performing group); 35.5% achieved a rating of 2; 33% achieved a rating of 3; 6.5% achieved a rating of 4 (worst-performing group). Years out of practice and increasing physician age predicted poorer performance (P = 0.0403, P = 0.0440). A large proportion of physicians presenting without an active license achieved active licensure; how many of these physicians actually returned to practice is not known.

DISCUSSION

Physicians who leave practice are a heterogeneous group. Most participants' performance warranted some formal education; few demonstrated global educational needs. The data from this study justify mandates that physicians demonstrate competence through an objective testing process prior to returning to practice. Emerging patterns regarding the performance of the reentering physician may help guide future policy.

Motivations for training as an SCPHN in Northern Ireland

Several policy consultations addressing post-registration nursing careers have followed the creation of the specialist community public health nurse (SCPHN) part of the NMC register, for health visitors, school nurses and occupational health nurses. This study surveyed a cohort of students (n = 44) starting a SCPHN programme, to explore what factors influenced their decision to train for this part of the register, and whether these differed according to previous experience or chosen pathway. The most highly rated factors were an interest in health promotion, a desire to work in community settings, and more involvement in the social aspects of health. These factors were closely linked with aspirations of career progression. There was no significant difference between previous experience and factors influencing career change decisions. However, there were some variations between chosen pathways, with occupational health respondents prioritising factors differently to their health visiting and school nursing counterparts. It is recommended that research is conducted into occupational health nursing roles, SCPHN proficiencies reviewed, and more flexible educational programmes developed.

Assessment tool for nursing student computer competencies

Computer skills have been established as important for nursing students and for graduate nurses. No current research was found on the best method to evaluate the skills of incoming nursing students. The purpose of this descriptive, correlational study was to compare student ratings of their computer competency to their performance of those skills on a computer-graded assessment. A convenience sample of 87 nursing students was used. There was a low, but significant correlation between the scores on the survey and the assessment. The results suggest that students rate themselves higher on their skills than their actual performance of computer skills. Implications for educators are presented, and the value of using a computer-graded assessment is discussed.

Characteristics of mechanical ventilation employed in intensive care units: a multicenter survey of hospitals

A 1D point-prevalence study was performed to describe the characteristics of conventional mechanical ventilation in intensive care units (ICUs). In addition, a survey was conducted to determine the characteristics of ICUs. A prospective, multicenter study was performed in ICUs at 24 university hospitals. The study population consisted of 223 patients who were receiving mechanical ventilation or had been weaned off mechanical ventilation within the past 24 hr. Common indications for the initiation of mechanical ventilation included acute respiratory failure (66%), acute exacerbation of chronic respiratory failure (15%) (including tuberculosis-destroyed lung [5%]), coma (13%), and neuromuscular disorders (6%). Mechanical ventilation was delivered via an endotracheal tube in 68% of the patients, tracheostomy in 28% and facial mask with noninvasive ventilation (NIV) in 4%. NIV was used in 2 centers. In patients who had undergone tracheostomy, the procedure had been performed 16.9+/-8.1 days after intubation. Intensivists treated 29% of the patients. A need for additional educational programs regarding clinical practice in the ICU was expressed by 62% of the staff and 42% of the nurses. Tuberculosis-destroyed lung is a common indication for mechanical ventilation in acute exacerbation of chronic respiratory failure, and noninvasive ventilation was used in a limited number of ICUs.

A new curriculum for a new era of nursing education

The need for curriculum reform, a common theme in the nursing and health sciences literature for a number of years, is becoming urgent. This article describes an innovative undergraduate nursing curriculum. Central to the curriculum revision were the adoption of a conceptual approach, the institution of clinical experiences driven by conceptually based learning, and a focus on experiences across population groups and practice settings. An innovative, Web-based community was developed as a platform for the curriculum.

So, what's up doc? Interview by Christian Duffin

Nurses who decide to retrain as doctors can face tough challenges from their former colleagues.