scholarly journals Procedural Competency Among Hospitalists: A Literature Review and Future Considerations

2021 ◽  
Author(s):  
Joséphine A Cool ◽  
Grace C Huang
Keyword(s):  
Temporal Trends ◽  
Hospital Medicine ◽  
Professional Standards ◽  
Inpatient Setting ◽  
Medical Procedure ◽  
Procedural Skill ◽  
Referral Patterns ◽  
General Internists ◽  
Procedural Training

BACKGROUND: As general internists practicing in the inpatient setting, hospitalists at many institutions are expected to perform invasive bedside procedures, as defined by professional standards. In reality, hospitalists are doing fewer procedures and increasingly are referring to specialists, which threatens their ability to maintain procedural skills. The discrepancy between expectations and reality, especially when hospitalists may be fully credentialed to perform procedures, poses significant risks to patients because of morbidity and mortality associated with complications, some of which derive from practitioner inexperience. METHODS: We performed a structured search of the peer-reviewed literature to identify articles focused on hospitalists performing procedures. RESULTS: Our synthesis of the literature characterizes contributors to hospitalists’ procedural competency and discusses: (1) temporal trends for procedures performed by hospitalists and their associated referral patterns, (2) data comparing use and clinical outcomes of procedures performed by hospitalists compared with specialists, (3) the lack of nationwide standardization of hospitalist procedural training and credentialing, and (4) the role of medical procedure services, although limited in supportive evidence, in concentrating procedural skill and mitigating risk in the hands of a few well-trained hospitalists. CONCLUSION: We conclude with recommendations for hospital medicine groups to ensure the safety of hospitalized patients undergoing bedside procedures.

scholarly journals The evolving role of the pediatric nurse practitioner in hospital medicine

2014 ◽  
Vol 9 (4) ◽  
pp. 261-265 ◽  
Author(s):  
Stacey Wall ◽  
Douglas Scudamore ◽  
James Chin ◽  
Michael Rannie ◽  
Suhong Tong ◽  
...  
Keyword(s):  
Nurse Practitioner ◽  
Hospital Medicine ◽  
Pediatric Nurse ◽  
Pediatric Nurse Practitioner

Assess Role of School Nurse Regarding Professional Standards at Primary Schools in Benha City

2018 ◽  
Vol 3 (1) ◽  
pp. 107-117
Author(s):  
Shimaa Esmeal ◽  
Mahboba Abd El- Aziz ◽  
Hedea Mohy
Keyword(s):  
Primary Schools ◽  
School Nurse ◽  
Professional Standards

Standardization and modernization of Kazakhstan Higher education

2021 ◽  
pp. 95-101
Author(s):  
Yu.N. Pak ◽  
◽  
Zh.S. Nuguzhinov ◽  
D.Yu. Pak
Keyword(s):  
Higher Education ◽  
Quality Assurance ◽  
Learning Outcomes ◽  
Educational Programs ◽  
Educational Process ◽  
Professional Standards ◽  
Educational Standards ◽  
The Republic ◽  
State Educational

Worked out is the analyzes of development of the Kazakhstan system of standardization of higher education on the example of several generations of state educational standards. Their features are examined in structural terms, as well as in terms of the requirements for the compulsory minimum of the educational content, the level of preparedness of graduates and learning outcomes. The dynamics of transformations in the context of expansion of universities academic freedoms, the ratio of compulsory and university components of educational programs is shown. The role of educational and methodological associations of universities of the Republic of Kazakhstan in the development of the regulatory and legal support of the educational process is emphasized. The relevance of introducing the competence-based approach in higher education on the basis of combining educational and professional standards is noted. It is shown that inconsistent and hasty reforms, uncompetitive level of teachers’ remuneration, expanding bureaucratization, underdeveloped quality assurance culture do not contribute to the successful modernization of higher education.

Regulating the regulators: the rise of the United Kingdom Professional Standards Authority

2018 ◽  
pp. 93-116
Author(s):  
Judith Allsop ◽  
Kathryn Jones
Keyword(s):  
United Kingdom ◽  
Self Regulation ◽  
Professional Standards ◽  
Corporate Management ◽  
Top Down ◽  
Professional Regulation ◽  
The United Kingdom ◽  
Management Techniques

In the United Kingdom reforms to professional regulation have been introduced to enhance public protection. This chapter accounts for changes from 2002 to 2016 with the introduction of a meta-regulator to oversee nine statutory professional Councils. It examines the expansion of the role of the meta-regulator and reforms within the professional councils themselves. It draws on data collected to show increases in costs and activity and explains the shift from self-regulation to top-down governance using corporate management techniques of audit and review. It demonstrates that the reforms have been evolutionary and that further reform is ongoing.

scholarly journals Consequences of Increased Variation in Peatland Hydrology for Carbon Storage: Legacy Effects of Drought and Flood in a Boreal Fen Ecosystem

2021 ◽  
Vol 8 ◽  
Author(s):  
Evan S. Kane ◽  
Catherine M. Dieleman ◽  
Danielle Rupp ◽  
Kevin H. Wyatt ◽  
Allison R. Rober ◽  
...  
Keyword(s):  
Water Table ◽  
Algal Biomass ◽  
Gross Primary Production ◽  
Temporal Trends ◽  
Sink Strength ◽  
Legacy Effects ◽  
Algal Production ◽  
Rich Fen ◽  
C Cycling

Globally important carbon (C) stores in boreal peatlands are vulnerable to altered hydrology through changes in precipitation and runoff patterns, groundwater inputs, and a changing cryosphere. These changes can affect the extent of boreal wetlands and their ability to sequester and transform C and other nutrients. Variation in precipitation patterns has also been increasing, with greater occurrences of both flooding and drought periods. Recent work has pointed to the increasing role of algal production in regulating C cycling during flooded periods in fen peatlands, but exactly how this affects the C sink-strength of these ecosystems is poorly understood. We evaluated temporal trends in algal biomass, ecosystem C uptake and respiration (using static and floating chamber techniques), and spectroscopic indicators of DOM quality (absorbance and fluorescence) in a boreal rich-fen peatland in which water table position had been experimentally manipulated for 13 years. Superimposed on the water table treatments were natural variations in hydrology, including periods of flooding, which allowed us to examine the legacy effects of flooding on C cycling dynamics. We had a particular focus on understanding the role of algae in regulating C cycling, as the relative contribution of algal production was observed to significantly increase with flooding. Ecosystem measures of gross primary production (GPP) increased with algal biomass, with higher algal biomass and GPP measured in the lowered water table treatment two years after persistent flooding. Prior to flooding the lowered treatment was the weakest C sink (as CO2), but this treatment became the strongest sink after flooding. The lower degree of humification (lower humification index, HIX) and yet lower bioavailability (higher spectral slope ratio, Sr) of DOM observed in the raised treatment prior to flooding persisted after two years of flooding. An index of free or bound proteins (tyrosine index, TI) increased with algal biomass across all plots during flooding, and was lowest in the raised treatment. As such, antecedent drainage conditions determined the sink-strength of this rich fen—which was also reflected in DOM characteristics. These findings indicate that monitoring flooding history and its effects on algal production could become important to estimates of C balance in northern wetlands.

scholarly journals Adrenal incidentaloma: prevalence and referral patterns from routine practice in a large UK university teaching hospital

2021 ◽  
Author(s):  
Fahmy W F Hanna ◽  
Sarah Hancock ◽  
Cherian George ◽  
Alexander Clark ◽  
Julius Sim ◽  
...  
Keyword(s):  
Teaching Hospital ◽  
Imaging Modality ◽  
Temporal Trends ◽  
Adrenal Incidentaloma ◽  
University Teaching ◽  
Routine Practice ◽  
Anatomical Site ◽  
Referral Patterns ◽  
Referral Rates ◽  
Abdomen Ct

Abstract Context Adrenal incidentalomas are increasingly being identified during unrelated imaging. Unlike AI clinical management, data on referral patterns in routine practice are lacking. Objective To identify factors associated with AI referral Design We linked data from imaging reports and outpatient bookings from a large UK teaching hospital. We examined; (i) AI prevalence and (ii) pattern of referral to endocrinology, stratified by age, imaging modality, scan anatomical site, requesting clinical specialty and temporal trends. Patients Utilising key radiology phrases to identify scans reporting potential AI, we identified 4,097 individuals from 479,945 scan reports (2015-19). Main Outcome Measures Prevalence of AI and referral rates Results Overall, AI lesions were identified in 1.2% of scans. They were more prevalent in abdomen CT and MRI scans (3.0% and 0.6%, respectively). Scans performed increased 7.7% year-on-year from 2015-19, with a more pronounced rise in the number with AI lesions (14.7% pa). Only 394/4097 patients (9.6%) had a documented endocrinology referral code within 90 days, with medical (11.8%) more likely to refer than surgical (7.2%) specialties (p<0.001). Despite prevalence increasing with age, older patients were less likely to be referred (p<0.001). Conclusions While overall AI prevalence appeared low, scan numbers are large and rising; the number with identified AI are increasing still further. The poor AI referral rates, even in centres such as ours where dedicated AI multi-disciplinary team meetings and digital management systems are used, highlights the need for new streamlined, clinically-effective systems and processes to appropriately manage the AI workload.

scholarly journals Are We Choosing Wisely in Canada?

2017 ◽  
Vol 12 (3) ◽  
Author(s):  
Mitch Levine
Keyword(s):  
Internal Medicine ◽  
Health Care ◽  
Choosing Wisely ◽  
Inpatient Setting ◽  
Evidence Based ◽  
X Rays ◽  
Stress Tests ◽  
General Internists ◽  
Physician Knowledge ◽  
Geographical Regions

The Choosing Wisely Canada program is intended to facilitate the more efficient use of health care resources. The program has messages for patients to align their expectations with an evidence based delivery of health care and to increase physician knowledge regarding evidence based directives for the appropriate use of investigations and treatments. In the current issue of CJGIM, an assessment was conducted regarding physician knowledge of the program, and the message was not positive. While many physicians acknowledged awareness of the Choosing Wisely Canada program, an appreciation of the specific messages on how to steer practice to evidence based activity was lacking amongst many. As these were the 33% who agreed to participate in the survey, one can only wonder whether a greater lack of knowledge about the program resides in the 67% that refused to participate. Despite having just laid a foundation of pessimism, I still wonder whether physicians are practicing evidence-based health care even if they do not know the detailed recommendations provided by the Choosing Wisely Canada program. The array of recommendations was developed by professional societies representing different clinical specialties in Canada. The Canadian Society of Internal Medicine (CSIM) established its Choosing Wisely Canada Top 5 recommendations by convening a Committee of 20 members that represented a diverse group of general internists from across Canada, reflecting a broad range of geographical regions, practice settings, institution types and experience.1 Below is the list of the five most recent recommendations targeted for physicians practicing in the field of internal medicine. Don’t routinely obtain neuro-imaging studies (computed tomography, magnetic resonance imaging, or carotid Doppler) in the evaluation of simple syncope in patients with a normal neurological examination.Don’t place, or leave in place, urinary catheters without an acceptable indication (such as critical illness, obstruction, palliative care).Don’t transfuse red blood cells for arbitrary hemoglobin or hematocrit thresholds in the absence of symptoms, active coronary disease, heart failure, or stroke.In the inpatient setting, don’t order repeated CBC and chemistry testing in the face of clinical and lab stability.Don’t routinely perform preoperative testing (such as chest X-rays, echocardiograms, or cardiac stress tests) for patients undergoing low risk surgeries.So, how are you doing in your practice? Mitchell LevineEditor, CJGIM

Role of Hospital Medicine in Management of Intracranial Brain Tumors

2019 ◽  
pp. 57-73
Author(s):  
Donald Y. Ye ◽  
Thana Theofanis ◽  
Tomas Garzon-Muvdi ◽  
James J. Evans
Keyword(s):  
Risk Factors ◽  
Brain Tumor ◽  
Postoperative Complications ◽  
Brain Tumors ◽  
Management Strategies ◽  
Hospital Medicine ◽  
Intracranial Tumors ◽  
Medical Oncologists ◽  
Insight Into

Intracranial tumors reflect a broad range of benign and malignant processes that are often managed by neurosurgeons and medical oncologists. Patients presenting with new brain tumors will undergo biopsies or resection for tissue diagnosis and resolution of neurological symptoms. These patients have significant perioperative risk factors that must be addressed to ensure the best possible outcomes. Hospitalists play a pivotal role in identifying these risk factors and offering management strategies prior to the development of an operative plan. This chapter provides insight into the range of preoperative considerations and postoperative complications that a hospitalist may face when managing brain tumor patients.

Crocodilian diversity in space and time: the role of climate in paleoecology and its implication for understanding K/T extinctions

Paleobiology ◽  
1998 ◽  
Vol 24 (4) ◽  
pp. 470-497 ◽  
Author(s):  
Paul J. Markwick
Keyword(s):  
Northern Hemisphere ◽  
Middle Eocene ◽  
Temporal Trends ◽  
Late Eocene ◽  
High Rate ◽  
Mass Extinctions ◽  
Crown Group ◽  
Climatic Effects ◽  
General Decline

The taxonomic diversity of crocodilians (Crocodylia) through the last 100 million years shows a general decline in the number of genera and species to the present day. But this masks a more complex pattern. This is investigated here using a comprehensive database of fossil crocodilians that provides the opportunity to examine spatial and temporal trends, the influence of sampling, and the role of climate in regulating biodiversity.Crown-group crocodilians, comprising the extant families Alligatoridae, Crocodylidae, and Gavialidae, show the following trend: an initial exponential diversification through the Late Cretaceous and Paleocene that is restricted to the Northern Hemisphere until after the K/T boundary; relatively constant diversity from the Paleocene into the middle Eocene that may be an artifact of sampling, which might mask an actual decline in numbers; low diversity during the late Eocene and Oligocene; a second exponential diversification during the Miocene and leveling off in the late Miocene and Pliocene; and a precipitous drop in the Pleistocene and Recent. The coincidence of drops in diversity with global cooling is suggestive of a causal link—during the initial glaciation of Antarctica in the Eocene and Oligocene and the Northern Hemisphere glaciation at the end of the Pliocene. However, matters are complicated in the Northern Hemisphere by the climatic effects of regional uplift.Although the global trend of diversification is unperturbed at the K/T boundary, this is largely due to the exceptionally high rate of origination in the early Paleocene. Nonetheless, the survival of such a demonstrably climate-sensitive group strongly suggests that a climatic explanation for the K/T mass extinctions, especially the demise of the dinosaurs, must be reconsidered.

scholarly journals The Role of Ultrafiltration in Patients with Decompensated Heart Failure

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Sandeep A. Kamath
Keyword(s):  
Heart Failure ◽  
Decompensated Heart Failure ◽  
Cardiorenal Syndrome ◽  
Loop Diuretics ◽  
Inpatient Setting ◽  
Effective Volume ◽  
Primary Driver ◽  
High Doses

Congestion, due in large part to hypervolemia, is the primary driver of heart failure (HF) admissions. Relief of congestion has been traditionally achieved through the use of loop diuretics, but there is increasing concern that these agents, particularly at high doses, may be deleterious in the inpatient setting. In addition, patients with HF and the cardiorenal syndrome (CRS) have diminished response to loop diuretics, making these agents less effective at relieving congestion. Ultrafiltration, a mechanical volume removal strategy, has demonstrated promise in achieving safe and effective volume removal in patients with cardiorenal syndrome and diuretic refractoriness. This paper outlines the rationale for ultrafiltration in CRS and the available evidence regarding its use in patients with HF. At present, the utility of ultrafiltration is restricted to selected populations, but a greater understanding of how this technology impacts HF and CRS may expand its use.

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