The Internet Journal of Allied Health Sciences & Practice A journal dedicated to allied health professionals
	Literature Review - Vol. 1 No. 1 - ISSN 1540-580X

Vol. 1, No.1 Articles Reviewed

A call for problem-based learning in physician assistant education
Perspective on Physician Assistant Education. 13(1):29-33, 2002. Winter-Spring

The economic benefit for family/general medicine practices employing physician assistants.
American Journal of Managed Care,  8(7):613-20, 2002 Jul

Assisting rural and metropolitan allied health professionals exchange clinical skills
Aust J Rural Health 2001 Dec;9(6):297-303

Cross-sector working: speech and language therapists in education.
J Manag Med 2002;16(1):67-77

Preparing psychologists to prescribe.
J Clin Psychol 2002 Jun;58(6):649-58

Specialty board certification and clinical outcomes: the missing link.
Acad Med 2002 Jun;77(6):534-42

Relatives' perceptions of side rail use on the older person in hospital.
Br J Nurs 2001 Mar 22-Apr 11;10(6):391-2, 394, 396-9

Literacy of children with physical disabilities: a literature review.
Can J Occup Ther 2002 Jun;69(3):176-82

Ultrasound-assisted percutaneous liver biopsy performed by a physician assistant.
American Journal of Gastroenterology.  97(6):1472-5, 2002 Jun

Lloyd LF.  Dunn L.  Scott QO.  Ledbetter C.  Deuel K.
A call for problem-based learning in physician assistant education
Seen in: Perspective on Physician Assistant Education. 13(1):29-33, 2002. Winter-Spring

True problem-based learning allows students to explore the a presented topic to its "logical conclusion" by using the resources (library, texts, journals, online resouces etc) around them.  Problem-based learning is an instructional strategy that promotes active learning on the part of a mature, adult learner. PBL is student centered with emphasis on working in small discussion groups with minimal input from the instructor or teacher. Teachers act as facilitators or guides, not active instructors. The introductions of "problems" or scenarios form the organizing focus and stimulus for learning with new information being acquired by the student through self-directed learning. The basic claim is that PBL is more focused on outcomes and comeptencies, with greater "learning" and retention for later application.

This paper describes PBL as it applies to Physician Assistant education but can be applied to any medical professional school of study. This article discusses the concepts of Problem-based learning (PBL) as defined by Howard S. Barrows, MD. The concept of PBL is based on the utilization of realistic patient problems as the educational and learning context for teaching medical professional students clinical science, reasoning, disgnostic skills, and basic problem solving.  The literature is, according to the authors, not definitive on the value of PBL in positively affecting learning and achievement.  The authors focus on their application of Barrowsian PBL in a physician assistant (PA) educational program. Their conclusions indicate that they believe students engaged in the PBL mode of learning easily, and demonstrated high academic performance, high clinical performance, and high levels of satisfaction in learning.

---

Grzybicki DM.  Sullivan PJ.  Oppy JM.  Bethke A.  Raab SS.
The economic benefit for family/general medicine practices employing physician assistants.
Seen in: American Journal of Managed Care,  8(7):613-20, 2002 Jul

The objective of this article and study was to measure the economic benefit of family and general medicine physician assistant (PA) practice from the perspective of the clinical manager or administrator.  The study involved qualitative description of a model PA practice in a family/general medicine practice office setting, and a comparison of the financial productivity of a PA practice with that of a non-PA (physician-only) practice.  In the study, the PA was economically beneficial for the practice, with a positive compensation-to-production ratio. Compared with a practice employing a full-time physician, the annual financial differential of a practice employing a full-time PA resulted in additonal positive cash flow of $52,592. Sensitivity analyses in this study illustrated the economic benefits of a PA practice in the family practice or general medicine practice office settings.

---

Parkin AE, McMahon S, Upfield N, Copley J, Hollands K.
Work experience program at a metropolitan paediatric hospital: assisting rural and metropolitan allied health professionals exchange clinical skills
Seen in: Aust J Rural Health 2001 Dec;9(6):297-303

The needs of rural allied health professionals (AHPs) have been widely documented. In particular, problems of professional isolation, lack of professional development opportunities and limited support systems have been highlighted as problems associated with working in rural and remote areas. This research aimed to provide rural and remote AHPs with an opportunity to gain experience in paediatric clinical areas of their choice, to provide rural/remote and metropolitan AHPs with an opportunity to share clinical knowledge and expertise, and to develop networks between rural/remote and metropolitan AHPs. A clinical experience program was developed to meet these aims. Twenty-nine AHPs from rural and remote areas of Queensland participated in the program. Participants completed questionnaires at the end of clinical experience program and 4-8 weeks after the visit. A focus group was also conducted. Analyses found the program met the majority of participants goals and expectations. Enhanced clinical skills in specialist paediatric areas, increased networking and access to resources were reported by rural/remote AHPs as benefits of the program. The role of a clinical consultant was found to be critical to the success of the program.

---

McCartney E.
Cross-sector working: speech and language therapists in education.
Seen in: J Manag Med 2002;16(1):67-77

Current policies and practices concerning speech and language therapy provision in schools are reviewed and issues which remain to be addressed are considered A general move to cross-sector approaches has resulted in a move to indirect therapy through assistants, and the effectiveness of this requires to be established. Funding streams for therapy differ across the UK, and despite extensive research and policy development remain somewhat unclear and vulnerable. The implications for policies on 'joined up thinking" are considered.

---

Sechrest L, Coan JA.
Preparing psychologists to prescribe.
Seen in: J Clin Psychol 2002 Jun;58(6):649-58

In this report, an investigation of the training received by professionals currently authorized to prescribe medications is considered as a step toward understanding what might be involved in preparing psychologists appropriately if prescription privileges for psychology were to be obtained. Information about admission and curriculum requirements was collected from medical schools, dental schools, physician assistant programs, nurse practitioner programs, and schools of optometry. Results suggest a high level of pharmacologically relevant coursework is required for admission to, and the completion of, programs that currently prepare their professionals to prescribe. It is argued that preparing psychologists to prescribe would likely entail similar training requirements in addition to, or instead of, those already in place, leaving clinical psychology dramatically and permanently altered.

---

Sharp LK, Bashook PG, Lipsky MS, Horowitz SD, Miller SH.
Specialty board certification and clinical outcomes: the missing link.
Seen in: Acad Med 2002 Jun;77(6):534-42

Specialty board certification status is often used and is seen as a standard of excellence, but no systematic review has examined the link between certification and clinical outcomes. The authors evaluated published studies tracking clinical outcomes and certification status and reported on their findings. In the study, data sources consisted of studies cited in the literature between 1966 and July 1999 in OVID-Medline, psychological abstracts (PsycLit), and the Educational Research Information Clearinghouse (ERIC). Screening criteria included: only U.S. patients and physicians used as subjects; verified specialty board certification status by an American Board of Medical Specialties' (ABMS') member board using the ABMS database or derivative sources; described selection criteria for patients and physicians; selected nationally recognized standards of care for outcomes; and nested patient data by individual physician. The computerized searches that were conducted in 1999 identified 1,204 papers; one author and a research assistant selected 237 papers based on subject relevance, and reduced the list to 56 based on study quality. The authors independently applied inclusion and exclusion criteria to identify 13 of the 56 papers containing 33 separable relevant findings.

Of the 33 findings, 16 demonstrated a significant positive association between certification status and positive clinical outcomes, three revealed worse outcomes for certified physicians, and 14 showed no association. Three negative findings and one finding of no association were identified in two papers with insufficient case-mix adjustments in the analyses. Meta-analytic statistics were not feasible due to variability in outcome measures across studies.  Overall, few published studies (5%) used research methods appropriate for the research question, and among the screened studies more than half support an association between board certification status and positive clinical outcomes.

---

Gallinagh R, Nevin R, Campbell L, Mitchell F, Ludwick R.
Relatives' perceptions of side rail use on the older person in hospital.
Seen in: Br J Nurs 2001 Mar 22-Apr 11;10(6):391-2, 394, 396-9

With an increasing emphasis on improving standards in the care of older people, the use of physical restraints has received growing attention in the nursing literature. Physical restraint use has been  likened to abuse as it impedes the movement of a person, encourages dependence on staff and denies autonomy. Side rails (cot sides, bed rails) can be considered as a physical restrain device. The therapeutic use of restraint has not previously been adequately explained. Furthermore, there is a dearth of literature examining the personal experience of physical restraint use. The Family Interview Guide (Strumpf and Evans, 1988) was used to explore perceptions of nine relatives whose family had side rails used during their care in an older person ward. The findings of the study suggest that while families place value on the perceived safety function of side rails, they nonetheless have worries about their use. These pertain to the risk of patient entrapment and possible injury. Patients' relatives associated side rails with ritualized practice in gerontology and make suggestions for the re-design of side rails. The study also highlights the potential for increased family participation in the decision to use side rails.

---

Browning N.
Literacy of children with physical disabilities: a literature review.
Seen in: Can J Occup Ther 2002 Jun;69(3):176-82

The ability to read and write can influence an individual's educational, communication, and vocational opportunities. Occupational therapists can assist children with physical disabilities to achieve literacy skills. By setting priorities and goals for each child, in conjunction with their parent(s), opportunities can be provided and technologies utilized to access literacy material and enhance the child's abilities to read and write. This extensive literature review provides clinicians with information on the factors that influence the development of literacy for children with physical disabilities. The expectations and priorities of parent(s) are critical determinants of whether opportunities will be provided for the child to learn to read and write. This article concludes with recommendations and strategies for the use of technology to help develop literacy skills, and future research questions for considerations.

---

Gunneson TJ. Menon KV. Wiesner RH. Daniels JA. Hay JE. et al.
Ultrasound-assisted percutaneous liver biopsy performed by a physician assistant.
Seen in: American Journal of Gastroenterology.  97(6):1472-5, 2002 Jun.

Percutaneous liver biopsy is an essential diagnostic tool utilized in the management of patients with liver disease in the inpatient and outpatient settings. This procedure is generally performed by a skilled physician and has a small but well-defined complication rate. This review reported on the complication rate of the procedure itself and efficiency of ultrasound-assisted percutaneous liver biopsy performed by an trained and experienced physician assistant.  One thousand eighty-six outpatient liver biopsies were performed at a single center by a physician assistant between June, 1996 and June, 2000. Patients with hepatic mass lesions, unusual hepatic anatomy, and uncorrectable coagulopathy (international normalized ratio > 1.7, platelet count < 50 x 10(9)/L) were excluded. Bedside ultrasonography was used to determine the optimal site for the liver biopsy. Liver biopsies were performed with a 15-gauge aspiration biopsy needle. Patients were observed for 3 h after biopsy, followed by dismissal with subsequent contact in 24 h to assess outcome and complications.

In a majority of the cases, adequate tissue was obtained (1084 cases = 99.8%).  After the procedure, narcotic analgesia was necessary in 116 (10%) of the patients undergoing liver biopsies. The overall complication rate requiring hospitalization was 0.6%. Major complications requiring intervention occurred in four patients (0.4%). There were no deaths resulting from liver biopsies. The authors concluded that outpatient percutaneous liver biopsy can be safely and effectively performed by a trained physician assistant.

End of Listing - Back to Top