Elective abortion as a primary health service in rural India: experience with manual vacuum aspiration

India allows abortion up to 20 weeks of pregnancy but places restrictions on abortion facilities and providers. Abortion services are especially deficient in rural areas. Although vacuum aspiration is safer, sharp curettage continues to be used by providers as they lack relevant training. This paper describes the provision of first trimester abortion services using manual vacuum aspiration (MVA) in a rural clinic in the state of Rajasthan over a four-year period. Non-use of anaesthesia increased safety and allowed women to return early to a normal routine. Of 534 women, none suffered major complications; 16 required repeat evacuation and the procedure failed in two. We recommend that models based on MVA and including medical methods be piloted in rural areas of a number of states of the country, to establish the feasibility of delivering first trimester abortion as a primary health service. Ways to increase access to second trimester procedures are also required. Current requirements for certification of private facilities are excessive and the process of obtaining certification is arduous. The law in India does not extend these norms to government facilities, which remain under-equipped and lack trained providers. We recommend that certification of facilities be liberalized and applied equally to government and private institutions. There is also a need to rapidly increase training capacity across the country.     

Putting the pieces together: teaching undergraduate research from a theoretical perspective

PROBLEM/PURPOSE: Baccalaureate graduates are expected to utilize research across a wide variety of practice settings. While the literature reports a variety of teaching approaches, few studies examine baccalaureate students' comprehension of research content. Teaching techniques that focus on a conceptual or theoretical approach may foster research comprehension. Therefore, the purpose of this paper is to evaluate teaching/learning outcomes of an undergraduate nursing research course designed from a conceptual or theoretical approach. PROCEDURE/FINDINGS: Two classes of senior baccalaureate nursing students (n = 47) at a private institution, whose curriculum was based on the Roy adaptation model, were surveyed in 1990 and 1991 at the end of their undergraduate research course. The survey tool consisted of seven three-point Likert scale questions, four open-ended questions, and one unstructured comment. Findings showed that 72% strongly agreed that they would continue to read nursing articles in their practice field, 57% disagreed that they were intimidated by research language, and 55% agreed that they trusted their ability to use and utilize nursing research in practice. The most helpful learning activity was the research critique (34%) followed by group work (28%). The support of the teacher and Instructor's use of own research examples was also seen as most helpful (36%), while abstract cards (8%) were least helpful. Nonetheless, 23% requested more group activities, 13% wanted more class examples, and 11% asked for more time to comprehend definitions. IMPLICATIONS: Students who approached research from the perspective of a nursing conceptual framework indicated that they put the pieces of the research puzzle together by working in groups, being supported by the Instructor, and learning from a variety of teaching methods.     

Applying phenomenography in nursing research

AIMS: This paper examines phenomenography, a research approach designed to answer certain questions about how people make sense of their experience. The research approach, developed within educational research, is a content-related approach investigating the different qualitative ways in which people make sense of the world around them. The outcomes of phenomenographic research are different content-related categories describing the differences in other people's ways of experiencing and conceiving their world. METHODS: The research approach is presented by describing the underlying ontological and epistemological assumptions, describing the research method in detail and providing some examples of phenomengraphic studies in health care and nursing research. The possibilities for applying the methodology to nursing research are discussed, illustrated by research examples. Finally, the future role of the approach within nursing research is discussed. CONCLUSION: The emphasis on differences in the phenomenographical research approach makes it distinct from other research approaches, and accordingly, it seems to be reasonable to incorporate knowledge of this kind in the professional education of health care personnel.     

Establishment of a convenient system for the long-term culture and study of non-neoplastic human salivary gland epithelial cells

Epithelial cells appear to play an important role in the initiation and maintenance of autoimmune lesions in the salivary glands of patients with Sjögren's syndrome. Therefore, the detailed study of immunological function of salivary gland epithelial cells (SGEC) may provide useful information for the understanding of Sjögren's syndrome pathogenesis. In this report we aimed to formulate a protocol for the establishment of human non‐neoplastic SGEC lines as a tool for the study of the physiology and pathophysiology of these cells. Pointing towards a practical approach, we sought to establish SGEC lines from quite a limited amount of biopsy tissue obtained during the diagnostic evaluation of patients. Herein, the favorable conditions for the long‐term maintenance of human non‐neoplastic SGEC lines are presented and involve the successive application of a serum‐containing and a serum‐free culture medium, supplemented with essential epithelial growth factors. This protocol has been found reliable and convenient, as attested by the reproducible establishment of non‐neoplastic SGEC lines. The analysis of SGEC phenotypic features, as well as a coculture system for the study of interactions between epithelial cells and lymphocytes, are also described. Such techniques may provide valuable means for the functional and molecular investigation of human SGEC and particularly for the study of Sjögren's syndrome and other disorders of glandular epithelia.     

Benefit-risk analysis: a proposal using quantitative methods

This is the first part of a two-article series which will introduce the theory and practice of a proposed set of quantitative methods for benefit-risk analysis. Adjustments to number-needed-to-treat (NNT) analysis and a new method, minimum clinical efficacy (MCE) analysis are presented and critically discussed. The goal of these methods is to condense into a summary metric the benefit-risk profile of a product so that manufacturers, regulators, clinicians and patients can better understand and participate in risk management. A second article will present examples of these methods.     

Utility of a dynamic termination criterion in the ZEST adaptive threshold method

Bayesian adaptive threshold procedures may be run for a fixed number of trials, or may be stopped when the calculated confidence interval for the threshold reaches a selected limit (a dynamic termination criterion). This study used Monte-Carlo simulations to determine whether the confidence interval is a useful predictor of errors in the estimated threshold. No difference was found between the distribution of errors in a fixed trial procedure versus a dynamically terminated procedure of the same average number of trials. In addition, the width of the confidence interval failed to usefully predict observer variability arising from a shallow psychometric function slope or increased false positive response probabilities. This study suggests that dynamic termination criteria are of little use in Bayesian adaptive threshold procedures.     

A web-based presentation of an undergraduate clinical skills curriculum

AIMS: The aim of this study was to use information and communications technology to present a curriculum of clinical skills in a user-friendly format. SETTING: A UK undergraduate medical school with a problem-based curriculum and a strong emphasis on proficiency in clinical skills. STUDY DESIGN: Case study describing the qualitative analysis of users' requirements and development of a web-based learning portfolio. EVALUATION: The study involved direct observation of users during a 'think-aloud' protocol, a validated software users' measurement inventory and a 17-item questionnaire designed to test whether 'SkillsBase' met its users' requirements. RESULTS: Students wanted a clear and flexible presentation of their skills curriculum that was easy to navigate, offered instructional material and standards for self- and peer assessment, offered useful Internet links, allowed them to compare their progress with school standards and peer norms, and could be used as a learning portfolio. During the think-aloud protocol, students made very few errors in data interpretation or navigation, and found SkillsBase easy to learn and aesthetically pleasing to use. They rated it higher on all measures of usability than standard commercial software. The questionnaire showed that it met most aspects of its design specification, although many students were doubtful that they would use its reflective function. It is available for inspection at http://www.skillsbase.man.ac.uk/. CONCLUSIONS: SkillsBase meets the design specification for a training and reflective aid to learning clinical skills and is very usable.     

Martin's Map: a conceptual framework for teaching and learning the medical interview using a patient-centred approach

OBJECTIVE: At the end of training, students seem to lack a basic understanding of how to take an organised, relevant medical and social history using a patient-centred approach. The aim of developing the map described in this paper was to provide a framework for such an approach. METHODS: Action research was used to continuously modify and refine an interview map that was used by medical clerks, family medicine residents, international medical graduates and practising doctors for teaching and learning purposes over a 10-year period. CONCLUSION: 'Martin's Map' provides a realistic framework for flexibly organising and integrating medical content with process that did not previously exist. The map provides medical educators with a standardised framework for talking about the medical interview, which helps learners understand how to use their medical knowledge with a patient-centred approach. Learners are able to visually see how they can take a focused medical and social history using a patient-centred approach, which subsequently seems to help them organise their thinking and approach during the medical encounter.     

Evaluating surgeons' informed decision making skills: pilot test using a videoconferenced standardised patient

BACKGROUND: Standardised patients (SPs) are effective in evaluating communication skills, but not every training site may have the resources to develop and maintain SP programmes. OBJECTIVES: To test whether videoconferencing technology (VT) could enable an interaction between an SP and an orthopaedic surgeon that would allow the SP to accurately evaluate the surgeon's informed decision making (IDM) skills. We also assessed whether this sort of interaction was acceptable to orthopaedic surgeons as a means of learning IDM skills. METHODS: We trained an SP to represent a 75-year-old woman considering hip replacement surgery. Orthopaedic surgeons in Chicago individually consulted with the SP in Philadelphia; each participant could see and hear the other on large television screens. The SP evaluated the surgeons' advice using a 23-item checklist of IDM elements, and gave each surgeon verbal and written feedback on his IDM skills. The surgeons then gave their evaluations of the exercise. RESULTS: Twenty-two surgeons completed the project. The SP was > or = 80% accurate in classifying 20 of the 23 IDM skills when compared to a clinician rater. Although 12 (55%) of the orthopaedic surgeons felt that some aspects of the technology were distracting, most were pleased with it, and 19 of 22 (86%) would recommend the videoconferenced SP interaction to their colleagues as a means of learning IDM skills. CONCLUSIONS: These results suggest that VT allows accurate evaluation of IDM skills in a format that is acceptable to orthopaedic surgeons. Videoconferencing technology may be useful in long-distance SP communication assessment for a variety of learners.