Transforming the One Health workforce: lessons learned from initiatives in Africa, Asia and Latin America.

The capacity to effectively and efficiently address threats to public and animal health requires an adequately trained workforce. A prerequisite for this is an effective plan for building the capacity of both private and public health workers. Yet capacity building and workforce development within One Health collaboration remain challenging for a number of reasons, including competing priorities, sectorspecific funding and a lack of trust and communication across sectors. Practical considerations, such as differences in language and culture, and working across time zones and geography, also have a considerable influence. Consequently, previous attempts to build capacity have traditionally lacked the attributes necessary for effective development and sustainability, such as continuity and systematic coordination of the learning process. Through the presentation and analysis of two recently implemented workforce development programmes, the authors highlight effective characteristics of workforce initiatives to build capacity. Such programmes can play a strategic role in developing, coordinating and supporting systematic and sustainable training for One Health and Veterinary Services performance on a regional and global scale.

La capacité d'apporter une réponse efficace et efficiente aux dangers qui menacent la santé publique et la santé animale est indissociable de l'existence de ressources humaines dotées d'un niveau de formation adéquat. Pour garantir ce niveau il est nécessaire de planifier au préalable le renforcement des capacités des personnels des secteurs public et privé de la santé. Le développement des capacités et des compétences des ressources humaines dans le cadre d'une collaboration Une seule santé demeure toutefois une entreprise difficile pour plusieurs raisons, notamment la concurrence entre priorités, le caractère spécifiquement sectoriel de certains financements et le manque de confiance et de communication entre secteurs. Des considérations pratiques peuvent également avoir une influence considérable, par exemple les différences de langue et de culture et le fait de travailler dans des fuseaux horaires et des contextes géographiques différents. Par le passé, les tentatives de renforcement des capacités étaient dépourvues des attributs indispensables à un développement efficace et durable, en particulier la continuité et la coordination systématique du processus d'apprentissage. À travers la description et l'analyse de deux programmes récents de renforcement des compétences, les auteurs mettent en avant les paramètres nécessaires à un développement efficace des capacités des ressources humaines. Des programmes de ce type peuvent jouer un rôle stratégique majeur pour concevoir, coordonner et soutenir la formation systématique et durable des Services vétérinaires et des intervenants Une seule santé afin de développer leurs compétences à l'échelle régionale et mondiale.

Para poder combatir con eficacia y eficiencia las amenazas que pesan sobre la salud pública y la sanidad animal hay que contar con recursos humanos debidamente formados. Un requisito previo al efecto es disponer de un plan eficaz para capacitar al personal de salud tanto privado como público. Sin embargo, la capacitación y el perfeccionamiento del personal como parte de la colaboración en clave de Una sola salud siguen siendo objetivos problemáticos por diversos motivos, en particular la existencia de prioridades encontradas, el hecho de que los fondos vayan destinados específicamente a uno u otro sector y la falta de confianza y comunicación entre los sectores. También influyen sensiblemente consideraciones de índole práctica como las diferencias de idioma y cultura o la dificultad de trabajar en distintas franjas horarias y zonas geográficas. De ahí que tradicionalmente las tentativas realizadas para crear capacidad vinieran careciendo de los atributos necesarios para resultar eficaces y deparar frutos duraderos, atributos tales como la continuidad y la coordinación sistemática del proceso de aprendizaje. Presentando y analizando dos programas de perfeccionamiento del personal implantados en fechas recientes, los autores destacan las características que debe reunir una iniciativa de capacitación de los recursos humanos para ser eficaz. Los programas de este tipo pueden cumplir una función estratégica a la hora de implantar, coordinar y secundar actividades sistemáticas y sostenibles de formación en clave de Una sola salud con objeto de constituir Servicios Veterinarios eficaces a escala regional y mundial.

Analysis of errors in laparoscopic surgical procedures.

BACKGROUND: The determination of laparoscopic surgeon ability is essential to training error avoidance. The present study describes a practical method of surgical error analysis. METHODS: After review of practice videotapes of the excisional phase of laparoscopic cholecystectomy, consensus on the identification of eight errors was achieved. Interrater agreement at the end of this phase was 84-96%. Fourteen study videotapes of gallbladder excision were then observed independently by expert reviewers blinded to surgical team identity. Procedures were assessed using a scoring matrix of 1-min segments with each error reported each minute. RESULTS: Interrater agreement was 84-100% for all error categories. CONCLUSIONS: The present study demonstrates that excellent interrater agreement of procedural errors can be achieved by carefully defining and training recognition of targeted events. Extension of this simple and reliable analysis tool to other procedures should be feasible to define behaviors leading to adverse clinical outcomes.

Prenatal sonographic detection of congenital hepatic cyst in third trimester after normal second-trimester sonographic examination.

A solitary unilocular hepatic cyst (SUHC) is a rare prenatal or neonatal finding. There are few reports of the prenatal detection of SUHC, and the progression of SUHC in utero is unknown. We present a proven case of SUHC in a fetus detected on a 34-week ultrasound examination following a normal 19-week examination. The cyst was inseparable from the liver and caused some flattening of the liver edge. Prenatal detection of an SUHC inseparable from the liver and appearing in the late second or third trimester should suggest a congenital hepatic cyst.

Integrating a domestic violence education program into a medical school curriculum: challenges and strategies.

BACKGROUND: Domestic violence affects millions of women in the United States each year. Physicians are in a unique position to screen for violence in their patients' homes and refer individuals before they are injured or killed. All U.S. medical schools are expected to incorporate partner violence into their curricula. DESCRIPTION: The MCP Hahnemann School of Medicine has developed and integrated a domestic violence educational intervention program into the existing problem-based medical school curriculum. This educational intervention includes modification of an existing teaching case to include signs and symptoms specific to domestic violence, written learning objectives on domestic violence in the health care setting, relevant resource material, and a 3-hr training program conducted by an interdisciplinary teaching team. EVALUATION: Based on quantitative and qualitative data over a 3-year period, this domestic violence education program has been successfully integrated into an existing problem-based curriculum. Overall, the high student exam scores indicate the effectiveness of the teaching program. In addition, the students' evaluation of the program reflects a high level of student satisfaction with the curriculum presented on domestic violence. CONCLUSION: This article describes both the content of a domestic violence teaching program and the process used to integrate such a program into a medical school curriculum. Although medical schools and their teaching programs are uniquely structured, with slight modifications they are able to accommodate domestic violence teaching programs.

Asymmetric processes in the large-scale preparation of chiral drug candidates.

More than 50% of the 500 top selling drugs in the world today are single enantiomers. To address the production of enantiomerically pure drug candidates, several tools (chiral pool, asymmetric catalysis, chiral reagents, chiral auxiliaries, resolution and biotransformation) are becoming increasingly available to the process chemist for development and large-scale manufacturing. This article will document salient examples from the post-1998 literature that, in the opinion of the authors, best exemplify the utilization of these tools by process chemistry groups throughout the pharmaceutical industry.

Domestic violence training program for residents.

Domestic violence is occurring in epidemic proportions in the United States. Recent surveys have shown there is a need for educational programs for health care professionals. This report presents the results of a domestic violence workshop developed to increase knowledge and improve attitudes and skills in working with victims of domestic violence. The results of the workshop, measured by preintervention and postintervention attitude, knowledge, and skills surveys, are promising. There was a significant improvement in knowledge, self-assessed skills, and attitudes after the workshop. Although the full magnitude of the changes was not sustained over time, there was still significant improvement after 6 months in knowledge and attitude. Rates of detection and documentation did not change. Future educational programs will need to address maintaining routine screening for domestic violence in the primary care setting and to highlight more clearly the role of health care professionals in the detection and treatment of domestic violence.

Essentials: going online.

The moment has arrived for you to go online! This article provides an overview of online access and Internet services. Resources are suggested and hints are offered to get the novice started on the information highway. Enjoy your journey!

Love, boundaries, and the patient-physician relationship.

Physicians often use their relationships with patients to promote specific therapeutic goals. Because of their personal histories, values, and biases, patients may react to physicians in ways that inhibit or enhance the relationship. The feelings that are aroused may induce physicians to become overly distant, engendering patient and physician dissatisfaction, or to become overly involved emotionally, which can have serious psychological and clinical consequences. We explore how a balance between clinical objectivity and bonding with the patient is optimal and achievable. The nature and origin of personal boundaries are described. Boundary transgressions on the part of the patient are discussed, and the means of preventing transgressions by both patients and physicians through medical education, the process of self-awareness, and an exploration of family-of-origin issues are proposed. Through attention to communication with patients, the physician can maintain an empathetic yet objective relationship with the patient.

An innovative CME program in cardiology for primary care practitioners.

The authors describe an innovative continuing medical education (CME) program they developed to improve the ability of community practitioners to manage common cardiology problems. The program includes an objective structured clinical examination (OSCE) with nine standardized patient (SP) stations. The SPs are trained to use checklists to assess the examinees' clinical skills, and to enter the checklist data directly into computers located within each of the examining rooms. Checklists cover the participants' knowledge of cardiology, and their interviewing, physical-examination, and counseling skills. The computer immediately generates detailed individual reports, which include a skills report, reflecting performance of core skills across all nine stations with group means for comparison, and an omissions report, listing items missed in each case for each participant and, again, comparing the results with group means. Participants review and discuss their performances and then discuss identified learning issues with a cardiologist. The cardiologist also reviews state-of-the-art diagnosis and treatment for the cases presented in the OSCE. Participants have reported having a high regard for the program and have indicated that the program has left them better prepared to deal with clinical cardiology issues.

The effect of parents' alcohol problems on children's behaviour as reported by parents and by teachers.

Associations between parents' alcohol problems when children were aged 9 and children's behaviour at ages 9 and 13 as reported by parents and teachers were investigated. The sample consisted of participants in a multidisciplinary longitudinal study, data were collected by face-to-face interview. When compared to children with no or mild parental alcohol problems, children classified as having severe parental alcohol problems were more likely to display high levels of problem behaviour at age 9 as reported by teachers and at age 13 as reported by parents. Poorer family relationships, lower verbal and reading proficiency and being male were also associated with high levels of behaviour problems.

Adherence to medication regimens: updating a complex medical issue.

Clinicians face nonadherence as the norm in everyday medical practice. The literature suggests a number of techniques that are likely to increase adherence when incorporated into regular clinical practices and routines. Central to these guidelines appears to be the doctor-patient relationship. For instance, the physician who uses understandable language, encourages open doctor-patient exchange, fosters participation by patients in their own medical care, and creates a friendly and efficient environment should increase the likelihood of adherence. Clinicians can also check adherence to medication regimens by requesting patients to bring in their pill bottles (or other prescription containers) for a discussion on how the medication appears to be working for them. This should elicit information from the patient about problems related to medication adherence. Since patient variables and social support affect adherence behaviors, eliciting information from patients about their understanding and beliefs regarding their particular illness and treatment, as well as enlisting the support of family and friends, may encourage adherence. Identifying what individual patients perceive as obstacles in following treatment regimens decreases their likelihood of nonadherence; these are difficulties that can be negotiated during the medical interview. Individualizing the treatment and minimizing its complexity may provide the solution that encourages adherent behavior. Frequent reeducation, reinforcement, and encouragement, as well as training in self-management and self-monitoring, will at the very least maximize the patient's comprehension of the illness and his or her motivation for adherence--an especially important requisite for living with a chronic condition. Some patients may even wish to openly solicit family and friends for help in the management and monitoring of their illness and treatment, and to structure their environment to support adherence. Education programs for the patient featuring handouts and pamphlets that provide information about the illness in written and illustrated form have been used successfully. Education programs such as patient-oriented package inserts to accompany the medications and brief written summaries of complex treatment plans may also be useful. The purpose of such patient education adjuncts to illness and treatment lie in the hope that they will enhance the likelihood of following treatment recommendations. Through their use, the reason for the treatment and its potential effectiveness will, it is hoped, be better understood (Ley 1988). Overall, significant advances have been made in adherence research. Measurement systems have become more finely tuned, and the definitions and criteria for adherent behaviors are more clear and precise.(ABSTRACT TRUNCATED AT 400 WORDS)

Development and survival of thoracic motoneurons and hindlimb musculature following transplantation of the thoracic neural tube to the lumbar region in the chick embryo: anatomical aspects.

Thoracic spinal cord transplanted to the lumbar region at the time of neural tube closure in the chick embryo survives and initially differentiates normally similar to in situ thoracic cord. Normal numbers of motoneurons are produced that innervate the host hindlimb musculature. In control thoracic cord approximately 70% of the motoneurons are lost by normal cell death between embryonic day (E) 6 and E11-E12. By contrast, the transplanted thoracic cord loses only about 30% of the motoneurons during this period. Transplantation of one hindlimb to the thoracic region also reduces the normal loss of in situ thoracic motoneurons. We conclude that some factor(s) associated with the increased target size provided by the hindlimbs promotes the survival of thoracic motoneurons. In contrast, by E16-E18 motoneuron numbers in the thoracic transplants decrease to below control levels. Dorsal root ganglion cells in the transplant were also initially increased (on E8) but later decreased to below control values. Hindlimb muscles innervated by thoracic motoneurons in the transplant also differentiated normally up to E10 to E12. Myotube size and numbers, muscle size and myotube types (fast versus slow) all developed normally in several thoracically-innervated hindlimb muscles. However, beginning on E14 myotube numbers and muscle size were markedly decreased resulting in muscle atrophy. Injections of horseradish peroxidase (HRP) into the thoracic transplants labelled neurons in the host spinal cord and brainstem rostral to the transplant thereby indicating an anatomical continuity between host and transplant neural tube. Injections of HRP into specific thoracically innervated hindlimb muscles on E8 labelled distinct pools of motoneurons in the transplants.(ABSTRACT TRUNCATED AT 250 WORDS)

Development and survival of thoracic motoneurons and hindlimb musculature following transplantation of the thoracic neural tube to the lumbar region in the chick embryo: functional aspects.

Following heterotopic transplantation of the thoracic neural tube to the lumbar region on embryonic day (E) 2, the transplanted cord differentiates normally and establishes neuroanatomical connections with the host central nervous system and hindlimb muscles. Beginning on about E12, however, the neuromuscular system begins to undergo regressive changes resulting in motoneuron degeneration and muscle atrophy (O'Brien and Oppenheim, 1990). In the present paper, we have examined the development of neuromuscular function in thoracic transplant embryos from E6 to the time of hatching on E20-21. The onset of hindlimb movements and reflexes occurred at the same time (E6-E8) in both control and thoracic transplant embryos. Further, both the nature (pattern) and frequency of these movements appeared normal in the thoracic transplants up to E10-E12, after which there was a gradual and marked reduction in the frequency, and an alteration in the pattern, of both spontaneous and reflex-evoked hindlimb movements. After E16 normal movements were virtually absent in many of the thoracic transplant cases. By contrast, movements of the head, trunk and wings were normal in these embryos throughout the observation period. Hindlimbs innervated partly by the thoracic transplant and partly by remaining host lumbar cord did not exhibit the regressive changes in function after E10 that occurred in hindlimbs innervated exclusively by the thoracic transplant. EMG recordings from specific hindlimb muscles innervated solely by thoracic motoneurons demonstrated that the activation pattern of both flexors and extensors was similar to the repetitive pattern observed in normal thoracically innervated intercostal muscles (i.e., extensor-like). Muscles did not show distinguishable EMG burst patterns with inhibitory periods as do control lumbar innervated muscles. We conclude that the development of the pattern generating circuitry in the transplanted thoracic cord was similar to normal thoracic cord and thus appeared to be uninfluenced by having contacted the foreign hindlimb muscle targets early in development. Activity blockade with curare from E6 to E14 suppressed the loss of motoneurons that occurs in the thoracic transplant after E10. Thus, the abnormal thoracic-like activation pattern of thoracically innervated hindlimbs may be a critical signal in the initiation of the neuromuscular regression that occurs after E10 in these preparations. Finally, although the innervation and formation of neuromuscular endplates in thoracic transplants appeared normal up to E12, by E14 both the intramuscular nerves and the endplates exhibited signs of degeneration and regression. Thoracic motoneurons are initially able to innervate and functionally activate hindlimb muscles in a manner similar to that of thoracically innervated intercostal muscles.(ABSTRACT TRUNCATED AT 400 WORDS)

Standards of performance: a model for development in health care.

Effective performance appraisal is an ongoing and dynamic process. The experiences discussed here describe one approach to this complex and important issue. By examining the department's performance appraisal practices, the manager may be better able to define and measure specific expectations that reflect the reality of the work area.