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Deliberate practice

Jeannie Couper
AIM: The aim of the study was to explore the relationships between role strain, faculty stress, and perceived organizational support for nurse faculty who faced the decision to assign a failing clinical grade. BACKGROUND: Although faculty are responsible for assigning a grade reflecting students' competence and ability to practice safely, faculty find it troublesome and stressful to assign a failing clinical grade. METHOD: A national sample consisting of 390 nursing faculty completed an online four-part questionnaire with an open-ended question...
May 2018: Nursing Education Perspectives
Laurence A Savett
Unless we-in our professional and nonprofessional roles-learn the importance and practice of deliberate silence, engaged listening, and restrained response, we will miss the opportunity to provide our presence and comfort to those about whom we care. And unless we-as health care professionals-learn these lessons, we will miss the opportunity to do all of that and provide a more accurate, complete diagnosis and informed plan of treatment. Done well, these practices have application to all our relationships with patients, colleagues, family, and friends...
April 1, 2018: Creative Nursing
Lenzo Robijn, Jane Seymour, Luc Deliens, Ida Korfage, Jayne Brown, Peter Pype, Agnes Van Der Heide, Kenneth Chambaere, Judith Rietjens
BACKGROUND: Involving patients in decision-making is considered to be particularly appropriate towards the end of life. Professional guidelines emphasize that the decision to initiate continuous sedation should be made in accordance with the wishes of the dying person and be preceded by their consent. AIM: To describe the decision-making process preceding continuous sedation until death with particular attention to the involvement of the person who is dying. DESIGN: Qualitative case studies using interviews...
April 1, 2018: Palliative Medicine
An Tang, Roger Tam, Alexandre Cadrin-Chênevert, Will Guest, Jaron Chong, Joseph Barfett, Leonid Chepelev, Robyn Cairns, J Ross Mitchell, Mark D Cicero, Manuel Gaudreau Poudrette, Jacob L Jaremko, Caroline Reinhold, Benoit Gallix, Bruce Gray, Raym Geis
Artificial intelligence (AI) is rapidly moving from an experimental phase to an implementation phase in many fields, including medicine. The combination of improved availability of large datasets, increasing computing power, and advances in learning algorithms has created major performance breakthroughs in the development of AI applications. In the last 5 years, AI techniques known as deep learning have delivered rapidly improving performance in image recognition, caption generation, and speech recognition...
April 11, 2018: Canadian Association of Radiologists Journal, Journal L'Association Canadienne des Radiologistes
Federico Gheza, Paolo Raimondi, Leonardo Solaini, Federico Coccolini, Gian Luca Baiocchi, Nazario Portolani, Guido Alberto Massimo Tiberio
BACKGROUND: Outside the US, FLS certification is not required and its teaching methods are not well standardized. Even if the FLS was designed as "stand alone" training system, most of Academic Institution offer support to residents during training. We present the first systematic application of FLS in Italy. Our aim was to evaluate the role of mentoring/coaching on FLS training in terms of the passing rate and global performance in the search for resource optimization. METHODS: Sixty residents in general surgery, obstetrics & gynecology, and urology were selected to be enrolled in a randomized controlled trial, practicing FLS with the goal of passing a simulated final exam...
April 11, 2018: Surgical Endoscopy
Viktor Heinrichs, Sabine Dieluweit, Jörg Stellbrink, Wim Pyckhout-Hintzen, Nils Hersch, Dieter Richter, Rudolf Merkel
Living animal cells are strongly influenced by the mechanical properties of their environment. To model physiological conditions ultrasoft cell culture substrates, in some instances with elasticity (Young's modulus) of only 1 kPa, are mandatory. Due to their long shelf life PDMS-based elastomers are a popular choice. However, uncertainty about additives in commercial formulations and difficulties to reach very soft materials limit their use. Here, we produced silicone elastomers from few, chemically defined and commercially available substances...
2018: PloS One
Sarah Diefenbach
Along with the dissemination of technical assistance in nearly every part of life, there has been growing interest in the potential of technology to support well-being and human flourishing. "Positive technology" thereby takes the responsible role of a "digital coach," supporting people in achieving personal goals and behavior change. The design of such technology requires knowledge of different disciplines such as psychology, design and human-computer interaction. However, possible synergies are not yet used to full effect, and it needs common frameworks to support a more deliberate design of the "therapeutic interaction" mediated through technology...
2018: Frontiers in Psychology
Tyler Chesney, Karen Devon
BACKGROUND: Patients with poor underlying prognosis experiencing surgical emergencies face challenging treatment decisions. The Best Case/Worst Case (BC/WC) framework has improved shared decision-making by surgeons, but it is unclear whether residents can be similarly trained. We evaluated senior general surgical residents' acceptance of the BC/WC tool and their attitudes, confidence and actions before and after training. METHODS: Two-hour training included a didactic session, live demonstration, small-group practice and debriefing...
April 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
Melissa Bathish, Colwick Wilson, Kathleen Potempa
BACKGROUND: Increasing demand for accountability in health care requires that we understand how nurses continually increase their expertise. Development of expertise has been linked to deliberate practice in many domains but little is known about how deliberate practice impacts the expertise of registered nurses. OBJECTIVES: Evaluate the relationships among experience, education, deliberate practice, and competence as an empirical referent of expertise, and to identify which of the independent variables makes the highest contribution to competence...
April 2018: Applied Nursing Research: ANR
Jianjun Chen, Ming Zhong
Regardless of laparoscopic or open colorectal surgeries, intestinal anastomosis is usually an important operative procedure. Even if stapler is widely used in different intestinal surgery nowadays, hand sewn suture is an indispensable procedure in clinical practice, meanwhile after stapled anastomosis, additional hand sewn suture is usually performed to ensure the safety of anastomosis. The inner figure-of-eight suture is a single layer suture technique which has been widely used in skin, tendon, rectus and uterus for quick and secure approximation...
March 25, 2018: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Tine Larsen
As part of a reorganisation of the delivery of health care in Denmark therapies for chronic medical conditions are moved out of hospitals and disease-specific patient education programmes instituted to train patients to assume responsibility for treating their disease at home, that is, perform tasks and functions traditionally done by healthcare professionals. Drawing on video-recordings (90:25h) from a programme for self-management of end-stage renal disease through automated home peritoneal dialysis, the study employs conversation analysis to examine nurses' instructional practices for providing patients with the necessary knowledge, skill and competences...
March 24, 2018: Sociology of Health & Illness
Ravi Chauhan, Bianca M Conti, Damian Keene
Terrorist attacks are increasing each year as are the number of deaths associated with them. Recent incidents have seen a shift in tactics with the use of multiple terrorists across multiple locations with firearms or knives, referred to as the marauding terrorist attack. These methods are becoming more prevalent alongside the use of vehicles deliberately aimed at pedestrians. Management of these incidents can be challenging. Not only it involves a large number of casualties but also the management of a dynamic scene in terms of both location and threat from attack...
March 23, 2018: Emergency Medicine Journal: EMJ
Dora Bartulovic, Bradley W Young, Lindsay McCardle, Joseph Baker
Sustained persistence in deliberate practice (DP) could be aided by engagement in adaptive motivational and metacognitive types of self-regulated learning (SRL) processes. We examined relationships between SRL and each of DP and physical preparation (PP; e.g., cross-training) in supervised, unsupervised, social and non-social practice contexts. 272 individual-sport athletes (from city to international level; M sport activity = 13.54 hrs/wk; 200 males, ages 18-35) completed the Self-Regulation of Learning Self-Report Scale and reported weekly DP and PP amounts...
March 23, 2018: Journal of Sports Sciences
Dimitrios Papanagnou, Hyunjoo Lee, Carlos Rodriguez, Xiao Chi C Zhang, Joshua Rudner
As students in the health professions transition from the classroom into the clinical environment, they will be expected to effectively communicate with their team members and their patients. Effective communication skills are essential to their ability to effectively contribute to their clinical team and the patient care they deliver. The authors propose an interactive workshop that can support students' deliberate practice of communication skills. The authors designed a simulation workshop that affords students the opportunity to practice their communication and peer-to-peer coaching skills...
January 21, 2018: Curēus
Ramesh M Nataraja, Nathalie Webb, Pedro-Jose Lopez
Surgical training has changed radically in the last few decades. The traditional Halstedian model of time-bound apprenticeship has been replaced with competency-based training. Advanced understanding of mastery learning principles has vastly altered educational methodology in surgical training, in terms of instructional design, delivery of educational content, assessment of learning, and programmatic evaluation. As part of this educational revolution, fundamentals of simulation-based education have been adopted into all levels and aspects of surgical training, requiring an understanding of concepts of fidelity and realism and the impact they have on learning...
March 1, 2018: Journal of Pediatric Urology
Ron J Smith
BACKGROUND: Siege, a process of political domination aimed at isolating an entire population, is a unique threat to health-care provision. The aim of this study was to qualitatively examine the effects of the Israeli siege on the practices and systems that underlie health in the Gaza Strip. METHODS: Data were from participant observation between 2009 and 2017, including 20 interviews with doctors and health administrators in non-governmental organisations (NGO), government, and UN sectors...
February 21, 2018: Lancet
Carolyn F Weiniger, Sharon Einav, Uriel Elchalal, Vladislav Ozerski, Daniel Shatalin, Alexander Ioscovich, Yehuda Ginosar
BACKGROUND: Care of pregnant women with concurrent medical conditions can be optimized by multidisciplinary antenatal management. In the current study we describe women with concurrent medical conditions who attended our antenatal anesthesia clinic over a 14-year period, 2002-2015 and, based on the findings, we suggest new policies, strategies and practices to improve antenatal care. METHODS: In 2002, an antenatal anesthesia clinic was established in Hadassah Medical Center...
March 19, 2018: Israel Journal of Health Policy Research
Sabine Salloch, Ina C Otte, Anke Reinacher-Schick, Jochen Vollmann
The impact of patient preferences in evidence-based medicine is a complex issue which touches on theoretical questions as well as medical practice in the clinical context. The interaction between evidence-based recommendations and value-related patient preferences in clinical practice is, however, highly complex and requires not only medical knowledge but social, psychological and communicative competencies on the side of the physician. The multi-layered process of oncology physicians' clinical decision-making was explored in 14 semi-structured interviews with respect to a first diagnosis of a pancreatic adenocarcinoma...
March 12, 2018: Zeitschrift Für Evidenz, Fortbildung und Qualität Im Gesundheitswesen
Jolanda van Dijke, Inge van Nistelrooij, Pien Bos, Joachim Duyndam
BACKGROUND: Empathy is a contested concept in the field of care ethics. According to its proponents, empathy is a unique way to connect with others, to understand what is at stake for them, and to help guide moral deliberation. According to its critics, empathy is biased, inaccurate or a form of projection that does not truly grasp and respect the otherness of the other, and that may be distorted by prejudices. OBJECTIVES: We aim to contribute to a better understanding of the significance of empathy in care ethics by reviewing both the functions and limitations of empathy in this field...
January 1, 2018: Nursing Ethics
Jose Francois, Jeffrey Sisler, Stephanie Mowat
BACKGROUND: The Manitoba Physician Achievement Review (MPAR) is a 360-degree feedback assessment that physicians undergo every 7 years to retain licensure. Deliberate reflection on feedback has been demonstrated to encourage practice change. The MPAR Reflection Exercise (RE), a peer-assisted debriefing tool, was developed whereby the physician selects a peer with whom to review and reflect on feedback, committing to change. This qualitative study explores how physicians who had undergone the MPAR used the RE, what areas of change are identified and committed to, and what they perceived as the role of reflection in the MPAR process...
March 14, 2018: BMC Medical Education
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