WorldWideScience

Sample records for supervised clinical practice

  1. Best Practices in Clinical Supervision: another step in delineating effective supervision practice.

    Science.gov (United States)

    Borders, L Dianne

    2014-01-01

    Across the helping professions, we have arrived at a point where it is possible to create statements of best practices in supervision that are based on available empirical research; credentialing, ethical, and legal guidelines; and consensus opinion. Best practices are different from, but certainly complementary to, statements of supervision competencies. In this paper, I highlight the differences between competencies and best practices, and then describe the development and content of one comprehensive statement, the Best Practices in Clinical Supervision created for the field of counseling and counselor education. I then illustrate the applicability of the Best Practices across disciplines and countries through a comparison and contrast with several other existing documents. I conclude with a brief look at the development of supervisor expertise, which requires not only declarative knowledge (competencies) and procedural knowledge (statements of best practices), but also reflective knowledge. The latter is composed of insights built over years of supervision education, experience, and self-reflection regarding necessary adaptions and improvisations that inform an individualized approach to supervision practice.

  2. A National Survey of School Counselor Supervision Practices: Administrative, Clinical, Peer, and Technology Mediated Supervision

    Science.gov (United States)

    Perera-Diltz, Dilani M.; Mason, Kimberly L.

    2012-01-01

    Supervision is vital for personal and professional development of counselors. Practicing school counselors (n = 1557) across the nation were surveyed to explore current supervision practices. Results indicated that 41.1% of school counselors provide supervision. Although 89% receive some type of supervision, only 10.3% of school counselors receive…

  3. Clinical supervision.

    Science.gov (United States)

    Goorapah, D

    1997-05-01

    The introduction of clinical supervision to a wider sphere of nursing is being considered from a professional and organizational point of view. Positive views are being expressed about adopting this concept, although there are indications to suggest that there are also strong reservations. This paper examines the potential for its success amidst the scepticism that exists. One important question raised is whether clinical supervision will replace or run alongside other support systems.

  4. Educational clinical supervision: meeting the needs of specialist community practitioner students and professional practice.

    Science.gov (United States)

    Canham, J

    1998-07-01

    In light of the possible demise of the community practice teacher, this paper proposes that a specific system of educationally led clinical supervision would benefit learning, teaching and assessing in the practice elements of specialist community practitioner education. Such a system would be additional to models of clinical supervision currently utilized in practice. An educative supervisory relationship would foster those skills and attributes essential for specialist community practice, enabling students to move toward mature responsible practice. It would provide experience of supportive frameworks that could be later utilized in professional practice. Clinical supervision specifically tailored for specialist community practitioner education would enable equity across branches and could be delivered in a variety of settings without a supervisor having to be 'on-site', thus benefiting comparatively isolated students in practice nursing and occupational health. To work successfully, educationally led clinical supervision necessitates a joint response by educational institutions and those practices where specialist community students undertake assessed placements. Without such a system in place to support specialist community practitioner courses, the standard of education and future practice cannot be assured.

  5. Clinical Supervision Model in Teaching Practice: Does It Make a Difference in Supervisors' Performance?

    Science.gov (United States)

    Gürsoy, Esim; Kesner, John Edward; Salihoglu, Umut Muharrem

    2016-01-01

    In search for better practices there has been a plethora of research in preservice teacher training. To contribute to the literature, the current study aims at investigating teacher trainees' and cooperating teachers' views about the performance and contribution of supervisors during teaching practice after using Clinical Supervision Model.…

  6. Best practices in nursing homes. Clinical supervision, management, and human resource practices.

    Science.gov (United States)

    Dellefield, Mary Ellen

    2008-07-01

    Human resource practices including supervision and management are associated with organizational performance. Evidence supportive of such an association in nursing homes is found in the results of numerous research studies conducted during the past 17 years. In this article, best practices related to this topic have been culled from descriptive, explanatory, and intervention studies in a range of interdisciplinary research journals published between 1990 and 2007. Identified best practices include implementation of training programs on supervision and management for licensed nurses, certified nursing assistant job enrichment programs, implementation of consistent nursing assignments, and the use of electronic documentation. Organizational barriers and facilitators of these best practices are described. Copyright 2009, SLACK Incorporated.

  7. Clinical supervision: the state of the art.

    Science.gov (United States)

    Falender, Carol A; Shafranske, Edward P

    2014-11-01

    Since the recognition of clinical supervision as a distinct professional competence and a core competence, attention has turned to ensuring supervisor competence and effective supervision practice. In this article, we highlight recent developments and the state of the art in supervision, with particular emphasis on the competency-based approach. We present effective clinical supervision strategies, providing an integrated snapshot of the current status. We close with consideration of current training practices in supervision and challenges.

  8. Clinical Supervision and Psychological Functions: A New Direction for Theory and Practice.

    Science.gov (United States)

    Pajak, Edward

    2002-01-01

    Relates Carl Jung's concept of psychological functions to four families of clinical supervision: the original clinical models, the humanistic/artistic models, the technical/didactic models, and the developmental/reflective models. Differences among clinical supervision models within these families are clarified as representing "communication…

  9. Clinical Supervision in Denmark

    DEFF Research Database (Denmark)

    Jacobsen, Claus Haugaard

    2011-01-01

    on giving and receiving clinical supervision as reported by therapists in Denmark. Method: Currently, the Danish sample consists of 350 clinical psychologist doing psychotherapy who completed DPCCQ. Data are currently being prepared for statistical analysis. Results: This paper will focus primarily...

  10. Is it possible to strengthen psychiatric nursing staff's clinical supervision?

    DEFF Research Database (Denmark)

    Gonge, Henrik; Buus, Niels

    2015-01-01

    AIM: To test the effects of a meta-supervision intervention in terms of participation, effectiveness and benefits of clinical supervision of psychiatric nursing staff. BACKGROUND: Clinical supervision is regarded as a central component in developing mental health nursing practices, but the evidence...... on individuals or wards already actively engaged in clinical supervision, which suggested that individuals and wards without well-established supervision practices may require more comprehensive interventions targeting individual and organizational barriers to clinical supervision....

  11. Two Approaches to Clinical Supervision.

    Science.gov (United States)

    Anderson, Eugene M.

    Criteria are established for a definition of "clinical supervision" and the effectiveness of such supervisory programs in a student teaching context are considered. Two differing genres of clinical supervision are constructed: "supervision by pattern analysis" is contrasted with "supervision by performance objectives." An outline of procedural…

  12. Resistance to group clinical supervision

    DEFF Research Database (Denmark)

    Buus, Niels; Delgado, Cynthia; Traynor, Michael

    2017-01-01

    This present study is a report of an interview study exploring personal views on participating in group clinical supervision among mental health nursing staff members who do not participate in supervision. There is a paucity of empirical research on resistance to supervision, which has traditiona......This present study is a report of an interview study exploring personal views on participating in group clinical supervision among mental health nursing staff members who do not participate in supervision. There is a paucity of empirical research on resistance to supervision, which has...... traditionally been theorized as a supervisee's maladaptive coping with anxiety in the supervision process. The aim of the present study was to examine resistance to group clinical supervision by interviewing nurses who did not participate in supervision. In 2015, we conducted semistructured interviews with 24...

  13. Clinical supervision training across contexts.

    Science.gov (United States)

    Tai, Joanna; Bearman, Margaret; Edouard, Vicki; Kent, Fiona; Nestel, Debra; Molloy, Elizabeth

    2016-08-01

    Clinicians require specific skills to teach or supervise students in the workplace; however, there are barriers to accessing faculty member development, such as time, cost and suitability. The Clinical Supervision Support Across Contexts (ClinSSAC) programme was designed to provide accessible interprofessional educator training to clinical supervisors across a wide range of clinical settings. In Australia there are increasing numbers of health care students, creating pressure on existing placements. Students are now increasingly learning in community settings, where clinicians have traditionally had less access to faculty member development. An interprofessional team collaborated in the development and implementation of ClinSSAC. A total of 978 clinicians participated in a face-to-face, interactive, introductory module to clinical supervision; 672 people accessed the equivalent online core module, with 23 per cent completing all activities. Additional profession-and discipline-specific modules were also developed. Formal project evaluation found that most participants rated the workshops as helpful or very helpful for their roles as clinical supervisors. Interdisciplinary learning from the workshops was reported to enable cross-discipline supervision. Large participant numbers and favourable ratings indicate a continuing need for basic training in education. Key factors to workshop success included expert facilitators, the interprofessional context and interactive model. The online modules were an important adjunct, and provided context-specific resources, but the low online completion rate suggests protected face-to-face time for faculty member development is still required. Programmes such as ClinSSAC have the capacity to promote interprofessional education and practice. There are barriers to accessing faculty member development, such as time, cost and suitability. © 2015 John Wiley & Sons Ltd.

  14. Clinical Supervision in Denmark

    DEFF Research Database (Denmark)

    Jacobsen, Claus Haugaard

    Data fra den danske undersøgelse af psykoterapeuters faglige udvikling indsamlet ved hjælp af DPCCQ. Oplægget fokuserer på supervision (modtaget, givet, uddannelse i) blandt danske psykoterapeutiske arbejdende psykologer....

  15. Supervisees' Perception of Clinical Supervision

    Science.gov (United States)

    Willis, Lisa

    2010-01-01

    Supervisors must become aware of the possible conflicts that could arise during clinical supervision. It is important that supervisors communicate their roles and expectations effectively with their supervisees. This paper supports the notion that supervision is a mutual agreement between the supervisee and the supervisor and the roles of…

  16. Status of Clinical Supervision among School Counselors in Southeast Georgia

    Science.gov (United States)

    Black, Anna Lila; Bailey, Carrie Lynn; Bergin, James J.

    2011-01-01

    Previous studies have investigated the role of clinical supervision in school counseling practice. This research explored the status and meaning of clinical supervision to school counselors employed in two southeastern Georgia counties. Results indicate that participants value clinical supervision even though their employers did not necessarily…

  17. Providing effective supervision in clinical neuropsychology.

    Science.gov (United States)

    Stucky, Kirk J; Bush, Shane; Donders, Jacobus

    2010-01-01

    A specialty like clinical neuropsychology is shaped by its selection of trainees, educational standards, expected competencies, and the structure of its training programs. The development of individual competency in this specialty is dependent to a considerable degree on the provision of competent supervision to its trainees. In clinical neuropsychology, as in other areas of professional health-service psychology, supervision is the most frequently used method for teaching a variety of skills, including assessment, report writing, differential diagnosis, and treatment. Although much has been written about the provision of quality supervision in clinical and counseling psychology, very little published guidance is available regarding the teaching and provision of supervision in clinical neuropsychology. The primary focus of this article is to provide a framework and guidance for the development of suggested competency standards for training of neuropsychological supervisors, particularly at the residency level. In this paper we outline important components of supervision for neuropsychology trainees and suggest ways in which clinicians can prepare for supervisory roles. Similar to Falender and Shafranske (2004), we propose a competency-based approach to supervision that advocates for a science-informed, formalized, and objective process that clearly delineates the competencies required for good supervisory practice. As much as possible, supervisory competencies are related to foundational and functional competencies in professional psychology, as well as recent legislative initiatives mandating training in supervision. It is our hope that this article will foster further discussion regarding this complex topic, and eventually enhance training in clinical neuropsychology.

  18. How do we know what makes for "best practice" in clinical supervision for psychological therapists? A content analysis of supervisory models and approaches.

    Science.gov (United States)

    Simpson-Southward, Chloe; Waller, Glenn; Hardy, Gillian E

    2017-04-19

    Clinical supervision for psychotherapies is widely used in clinical and research contexts. Supervision is often assumed to ensure therapy adherence and positive client outcomes, but there is little empirical research to support this contention. Regardless, there are numerous supervision models, but it is not known how consistent their recommendations are. This review aimed to identify which aspects of supervision are consistent across models, and which are not. A content analysis of 52 models revealed 71 supervisory elements. Models focus more on supervisee learning and/or development (88.46%), but less on emotional aspects of work (61.54%) or managerial or ethical responsibilities (57.69%). Most models focused on the supervisee (94.23%) and supervisor (80.77%), rather than the client (48.08%) or monitoring client outcomes (13.46%). Finally, none of the models were clearly or adequately empirically based. Although we might expect clinical supervision to contribute to positive client outcomes, the existing models have limited client focus and are inconsistent. Therefore, it is not currently recommended that one should assume that the use of such models will ensure consistent clinician practice or positive therapeutic outcomes. There is little evidence for the effectiveness of supervision. There is a lack of consistency in supervision models. Services need to assess whether supervision is effective for practitioners and patients. Copyright © 2017 John Wiley & Sons, Ltd.

  19. The Strategic Impact of Clinical Practice Guidelines in Nursing on the Managerial Function of Supervision

    Directory of Open Access Journals (Sweden)

    Jose Antonio Vinagre Romero

    2013-10-01

    Full Text Available Clinical practice guidelines in nursing (CPG-N are tools that allow the necessary knowledge that frequently remains specialist-internalised to be made explicit. These tools are a complement to risk adjustment systems (RAS, reinforcing their effectiveness and permitting a rationalisation of healthcare costs. This theoretical study defends the importance of building and using CPG-Ns as instruments to support the figure of the nursing supervisor in order to optimise the implementation of R&D and hospital quality strategies, enabling clinical excellence in nursing processes and cost-efficient reallocation of economic resources through their linear integration with SARs.

  20. Experiences of Supervision at Practice Placement Sites

    Directory of Open Access Journals (Sweden)

    Lesley Diack

    2014-01-01

    Full Text Available Background. Whilst placement supervision and clinical education programmes are of significant value in shaping the behaviours of undergraduate healthcare students, appropriate provisions which are efficacious to the learner are somewhat lacking, particularly for students studying on UK MPharm programmes. Objectives. To explore and explain the value of placement supervision to the personal development and employability of undergraduate pharmacy students. Methods. Students participated in a week long community pharmacy pilot programme, a result of a collaborative effort between the School of Pharmacy and Life Sciences and a small consortium of community pharmacies. Students and stakeholders were asked to evaluate their experiences via separate questionnaires which had been developed to elicit views and attitudes. Key Findings. Feedback from students and stakeholders towards the experience was overwhelmingly positive with multiple benefits being reported. Of particular prominence was the emphasis in student feedback on the value of placement supervision to their professional and personal development. Findings were indicative of a development in clinical practice proficiencies, core skills, and improvement in decision-making practice. Conclusions. The benefits of clinical supervision to the professional and personal development of MPharm students are well documented, although attracting professional pharmacy supervisors is proving a problematic task for educational providers in the UK.

  1. Core ethical issues of clinical nursing supervision.

    Science.gov (United States)

    Berggren, Ingela; Barbosa da Silva, António; Severinsson, Elisabeth

    2005-03-01

    Clinical nursing supervision enables supervisees to reflect on ethically difficult caring situations, thereby strengthening their professional identity, integrating nursing theory and practice, and leading to the development of ethical competence. The aim of this study was to develop an understanding of the core ethical issues of clinical nursing supervision, using previous research as well as philosophical analysis of the theories of three moral philosophers: Harald Ofstad, Richard Hare and Carol Gilligan. The ultimate aim of this study was to develop a general model for ethical decision-making and to establish its relevance for clinical nursing supervision. The findings highlight four important values for the development of a basis for ethical decision-making. These values are caring, dignity, responsibility and virtue.

  2. Clinical supervision in a community setting.

    Science.gov (United States)

    Evans, Carol; Marcroft, Emma

    Clinical supervision is a formal process of professional support, reflection and learning that contributes to individual development. First Community Health and Care is committed to providing clinical supervision to nurses and allied healthcare professionals to support the provision and maintenance of high-quality care. In 2012, we developed new guidelines for nurses and AHPs on supervision, incorporating a clinical supervision framework. This offers a range of options to staff so supervision accommodates variations in work settings and individual learning needs and styles.

  3. AAPM Medical Physics Practice Guideline 3.a: Levels of supervision for medical physicists in clinical training.

    Science.gov (United States)

    Seibert, J Anthony; Clements, Jessica B; Halvorsen, Per H; Herman, Michael G; Martin, Melissa C; Palta, Jatinder; Pfeiffer, Douglas E; Pizzutiello, Robert J; Schueler, Beth A; Shepard, S Jeff; Fairobrent, Lynne A

    2015-05-08

    The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States.The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner.Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized.The following terms are used in the AAPM practice guidelines:Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline.Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.

  4. Group Supervision Attitudes: Supervisory Practices Fostering Resistance to Adoption of Evidence-Based Practices.

    Science.gov (United States)

    Brooks, Charles T; Patterson, David A; McKiernan, Patrick M

    2012-01-01

    The focus of this study was to qualitatively evaluate worker's attitudes about clinical supervision. It is believed that poor attitudes toward clinical supervision can create barriers during supervision sessions. Fifty-one participants within a social services organization completed an open-ended questionnaire regarding their clinical supervision experiences. Results suggest four key areas which appear to be strong factors in workers' experiences and attitudes regarding group supervision: a. facilitator's skill level; b. creativity; c. utilization of technology; and d. applicability. For organizations interested in overcoming potential barriers to adopting best practices, effectively addressing workers' negative attitudes toward group supervision would be a worthy endeavor.

  5. Exploring Clinical Supervision as Instrument for Effective Teacher Supervision

    Science.gov (United States)

    Ibara, E. C.

    2013-01-01

    This paper examines clinical supervision approaches that have the potential to promote and implement effective teacher supervision in Nigeria. The various approaches have been analysed based on the conceptual framework of instructional supervisory behavior. The findings suggest that a clear distinction can be made between the prescriptive and…

  6. Some reflections on clinical supervision: an existential-phenomenological paradigm.

    Science.gov (United States)

    Jones, A

    1998-03-01

    This paper reviews psychotherapy, counselling, and nursing literature related to ideas of clinical supervision and attempts to illuminate areas important to effective health related practice and specifically palliative care. Included are explorations of existentialism, phenomenology, existential phenomenology and psychoanalytical concepts. The phenomenological idea of lived experience is outlined and the Heideggerian notion of authenticity is explored in context. The paper also examines dynamic forces such as hope, trust and personal values that might influence clinical supervision design and so inform a framework for practice. An existential-phenomenological method of supervision is offered as one basis for professional practice. The central recommendation of this paper is, however, to identify relevant value and belief systems to direct clinical supervision. Nursing models might appropriately instruct approaches to supervision. The writer considers the phenomenological idea of the lived experiences as a means by which to at once capture the essence of palliative care nursing and guide the supervision towards the existential idea of authenticity.

  7. Teacher Supervision Practices and Principals' Characteristics

    Science.gov (United States)

    April, Daniel; Bouchamma, Yamina

    2015-01-01

    A questionnaire was used to determine the individual and collective teacher supervision practices of school principals and vice-principals in Québec (n = 39) who participated in a research-action study on pedagogical supervision. These practices were then analyzed in terms of the principals' sociodemographic and socioprofessional characteristics…

  8. Clinical Supervision Strategies for School Counselors Working with Twice-Exceptional Students

    Science.gov (United States)

    Goldsmith, SaDohl K.

    2012-01-01

    Clinical supervision is a way for counselors in training to develop needed skills (Bernard & Goodyear, 1998). Best practices indicate that counselors trained in the application of supervision theory should provide clinical supervision. However, many school counselors receive administrative supervision by non-counseling professionals who may…

  9. Perception of nursing students face clinical supervision: literature review

    OpenAIRE

    Certo, Ana; Galvão, Ana Maria; Louçano, Ana

    2015-01-01

    Currently, without theoretical clinical training is not possible for the nursing student adequately meet their clinical practices.In this regard, clinical supervision plays a key role monitoring and development of the same. However,so that the student can be supervised, requires evidence of nurse supervisor competence in this context. In contemporary literature, this issue has been much debated, as the target of numerous different scientific studies. Aim of the study was, under...

  10. Developing a manual for strengthening mental health nurses' clinical supervision

    DEFF Research Database (Denmark)

    Buus, Niels; Cassedy, Paul; Gonge, Henrik

    2013-01-01

    In this article, we report findings from a study aimed at developing the content and implementation of a manual for a research-based intervention on clinical supervision of mental health nursing staff. The intervention was designed to strengthen already existing supervision practices through...... educational preparation for supervision and systematic reflection on supervision. The intervention consists of three sessions and was implemented on two groups of mental health hospital staff. We present an outline of the manual and explain how the trial sessions made us adjust the preliminary manual...

  11. Supervision in neuropsychological assessment: a survey of training, practices, and perspectives of supervisors.

    Science.gov (United States)

    Shultz, Laura A Schwent; Pedersen, Heather A; Roper, Brad L; Rey-Casserly, Celiane

    2014-01-01

    Within the psychology supervision literature, most theoretical models and practices pertain to general clinical or counseling psychology. Supervision specific to clinical neuropsychology has garnered little attention. This survey study explores supervision training, practices, and perspectives of neuropsychology supervisors. Practicing neuropsychologists were invited to participate in an online survey via listservs and email lists. Of 451 respondents, 382 provided supervision to students, interns, and/or fellows in settings such as VA medical centers (37%), university medical centers (35%), and private practice (15%). Most supervisors (84%) reported supervision was discussed in graduate school "minimally" or "not at all." Although 67% completed informal didactics or received continuing education in supervision, only 27% reported receiving training specific to neuropsychology supervision. Notably, only 39% were satisfied with their training in providing supervision and 77% indicated they would likely participate in training in providing supervision, if available at professional conferences. Results indicate that clinical neuropsychology as a specialty has paid scant attention to developing supervision models and explicit training in supervision skills. We recommend that the specialty develop models of supervision for neuropsychological practice, supervision standards and competencies, training methods in provision of supervision, and benchmark measures for supervision competencies.

  12. Clinical supervision by consultants in teaching hospitals.

    Science.gov (United States)

    Hore, Craig T; Lancashire, William; Fassett, Robert G

    2009-08-17

    Clinical supervision is a vital part of postgraduate medical education. Without it, trainees may not learn effectively from their experiences; this may lead to acceptance by registrars and junior doctors of lower standards of care. Currently, supervision is provided by consultants to registrars and junior doctors, and by registrars to junior doctors. Evidence suggests that the clinical supervision provided to postgraduate doctors is inadequate. Registrars and juniors doctors have the right to expect supervision in the workplace. Impediments to the provision of clinical supervision include competing demands of hospital service provision on trainees and supervisors, lack of clarity of job descriptions, private versus public commitments of supervisors and lack of interest. Supervisors should be trained in the process of supervision and provided with the time and resources to conduct it. Those being supervised should be provided with clear expectations of the process. We need to create and develop systems, environments and cultures that support high standards of conduct and effective clinical supervision. These systems must ensure the right to supervision, feedback, support, decent working conditions and respect for both trainees and their supervisors.

  13. Instructional Supervision: The Policy-Practice Rift.

    Science.gov (United States)

    Tunison, Scott D.

    2001-01-01

    Discusses the results of a recent Canadian study in which the perceptions of superintendents, principals, and teachers were analyzed and compared in order to determine the actual level of agreement between the practices for instructional supervision outlined in the school division's policy manual and the actual practice in the schools governed by…

  14. Overcoming difficult conversations in clinical supervision

    Directory of Open Access Journals (Sweden)

    Williams B

    2016-06-01

    Full Text Available Brett Williams,1 Christine King,1 Tanya Edlington,21Department of Community Emergency Health and Paramedic Practice, Monash University, Franskton, VIC, 2The Conversation Clinic Pty Ltd, Melbourne, VIC, Australia Background: Clinical supervisors are responsible for managing many facets of clinical learning and face a range of challenges when the need for "difficult" conversations arises, including the need to manage conflict and relationships. Methods: Spotlight on Conversations Workshop was developed to improve the capacity of clinical supervisors to engage in difficult conversations. They were designed to challenge the mindset of clinical supervisors about difficult conversations with students, the consequences of avoiding difficult conversations, and to offer activities for practicing difficult conversations. Preworkshop, postworkshop, and 4-month follow-up evaluations assessed improvements in knowledge, intent to improve, and confidence along with workshop satisfaction. Results: Nine workshops were delivered in a range of locations across Victoria, Australia, involving a total of 117 clinical supervisors. Preworkshop evaluations illustrated that more than half of the participants had avoided up to two difficult conversations in the last month in their workplace. Postworkshop evaluation at 4 months showed very high levels of satisfaction with the workshop's relevancy, content, and training, as well as participants' intention to apply knowledge and skills. Also shown were significant changes in participants' confidence to have difficult conversations not only with students but also with other peers and colleagues. In follow-up in-depth interviews with 20 of the 117 participants, 75% said they had made definite changes in their practice because of what they learned in the workshop and another 10% said they would make changes to their practice, but had not had the opportunity yet to do so. Conclusion: We conclude that the Spotlight on

  15. Clinical supervision using video-conferencing technology: a reflective account.

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    Marrow, Carol E; Hollyoake, Kim; Hamer, Dorothy; Kenrick, Catherine

    2002-09-01

    This paper discusses three nursing practitioners' experiences of clinical supervision using video-conferencing (VC) technology. The study, based on supportive action research, involved 40 practising community and hospital nurses from a variety of specialties and took place over an 18-month period. The research was collaborative, educational and applied and focused on the effects of remote clinical supervision on the development of professional practice. Data were obtained through pre- and post-study questionnaires, repertory grids, focus group interviews and written narratives. The three research participants found that clinical supervision, as a mediator of learning, was vital in enabling them to develop their reflective and problem-solving skills. Through critical conversations with either a supervisor or within peer group supervision, the participants increased both their confidence and self-awareness and gained more insight into the practices and needs of other practitioners. They also examined critically patient care issues resulting in attention to existing or the development of new care protocols. They did, however, experience some impediments to the process of clinical supervision, mainly lack of peer and management support and ongoing education. The participants had mixed perceptions with regards to using VC technology for clinical supervision. They experienced technical and accessibility problems and communication problems, suggesting the need for clear protocols for both technical support and applied training.

  16. Exploring Organizational Barriers to Strengthening Clinical Supervision of Psychiatric Nursing Staff

    DEFF Research Database (Denmark)

    Gonge, Henrik; Buus, Niels

    2016-01-01

    This article reports findings from a longitudinal controlled intervention study of 115 psychiatric nursing staff. The twofold objective of the study was: (a) To test whether the intervention could increase clinical supervision participation and effectiveness of existing supervision practices...... that a) diminishing experience of social support from colleagues was associated with reduced participation in clinical supervision, while b) additional quantitative demands were associated with staff reporting difficulties finding time for supervision. This probably explained a negative development...

  17. Enhancing Adult Learning in Clinical Supervision

    Science.gov (United States)

    Goldman, Stuart

    2011-01-01

    Objective/Background: For decades, across almost every training site, clinical supervision has been considered "central to the development of skills" in psychiatry. The crucial supervisor/supervisee relationship has been described extensively in the literature, most often framed as a clinical apprenticeship of the novice to the master craftsman.…

  18. Clinical supervision for clinical psychology students in Uganda: an initial qualitative exploration.

    Science.gov (United States)

    Hall, Jennifer; Kasujja, Rosco; Oakes, Peter

    2015-01-01

    Burn out in clinical psychologists working in low income countries has been reported. Clinical supervisory structures do not yet exist in Uganda. A way to decrease levels of burn out and increase quality of care for people with mental illness is through clinical supervision. The aim of this study was to explore the initial experiences of supervision for clinical psychology students in Uganda to ascertain whether or not clinical supervision is culturally appropriate, and what aspects of supervision had been helpful and unhelpful. A qualitative design with thematic analysis was utilized. A focus group was held with 12 second year clinical psychology students to ask their experiences of receiving supervision. Data analysis created five themes. Firstly, the negative emotions that resulted from the training processed were discussed, and how supervision helped and did not help the students to manage these. Secondly, the students voiced that supervision helped them to learn through observational experiences, co-therapist roles and parallel processes within the supervisory relationship. Thirdly, supervision had taught the clinical psychology students their role as a clinical psychology student, how to act within the Ugandan mental health system and skills to conduct therapy. Fourthly, suggestions for the future of supervision were given, with the students requesting for it to start earlier in the training, for supervisors who can meet with the students on a regular basis to be selected and for the training the students receive at university to match the skills required on their placements, with a request for more practical techniques rather than theory. The final theme related to left over miscellaneous data, such as the students agreeing with each other. The students stated that supervision was helpful overall, implying that clinical supervision is culturally appropriate for clinical psychology students in Uganda. Suggestions for future supervision were given. In order to

  19. Supporting Placement Supervision in Clinical Exercise Physiology

    Science.gov (United States)

    Sealey, Rebecca M.; Raymond, Jacqueline; Groeller, Herb; Rooney, Kieron; Crabb, Meagan; Watt, Kerrianne

    2015-01-01

    The continued engagement of the professional workforce as supervisors is critical for the sustainability and growth of work-integrated learning activities in university degrees. This study investigated factors that influence the willingness and ability of clinicians to continue to supervise clinical exercise physiology work-integrated learning…

  20. Implementation of Clinical Supervision: educational preparation and subsequent diary accounts of the practicalities involved, from an Australian mental health [corrected] nursing innovation.

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    White, E; Winstanley, J

    2009-12-01

    Set against the backdrop of several inquiry reports about mental health service provision in Australia, the privately experienced cost of working and coping in contemporary mental health settings, remains poorly understood. Clinical Supervision, a structured staff support arrangement, has shown promise as a positive contribution to the clinical governance agenda and is now found reflected in central policy themes elsewhere in the world. However, the concept of Clinical Supervision remains underdeveloped in Australia. The background to a novel randomized controlled trial, currently in progress in Queensland, Australia, is reported elsewhere. This paper reports on the educational preparation for, and subsequent first-hand testimony of the issues faced by, front-line mental health nursing staff engaged in the implementation of Clinical Supervision, under the auspices of the randomized controlled trial. It is argued here that, in advance of quantitative findings becoming available, several challenges emerge from their supplementary and contemporaneous diary accounts of their experience that may confront Clinical Supervision policy makers, educators, managers and clinicians, anywhere in the world, with immediate effect.

  1. Supervising away from home: clinical, cultural and professional challenges.

    Science.gov (United States)

    Abramovitch, Henry; Wiener, Jan

    2017-02-01

    This paper explores some challenges of supervising clinical work of trainees, known as 'routers', who live in countries with diverse cultural, social and political traditions, and the analysts who travel to supervise them. It is written as an evolving dialogue between the authors, who explore together the effects of their own culture of origin, and in particular the legacy and values of their own training institutes on the styles and models of analytic supervision. Their dialogue is framed around the meaning of home and experiences of homesickness for analysts working away from home in an interactive field of strangeness in countries where analytical psychology is a relatively new discipline. The authors outline the findings from their own qualitative survey, where other supervisors working abroad, and those they have supervised, describe their experiences and their encounters with difference. The dialogue ends with both authors discussing what they have learned about teaching and supervising abroad, the implications for more flexible use of Jungian concepts, and how such visits have changed their clinical practice in their home countries. © 2017, The Society of Analytical Psychology.

  2. A coaching supervision programme to facilitate the mental health in business coaches in South African practice

    OpenAIRE

    2011-01-01

    D.Cur. Supervision is not a new concept in psychiatric nursing. It has a long history in clinical practice to bridge the gap between theory and practice. However, supervision is fairly new and still emerging in the coaching profession. Bluckert (2005:1) says that if one has to trace the references to supervision in coaching books, one will barely find anything before the millennium. It is only now recently that a demand is growing in coaching professions for coaching supervision. The pract...

  3. Joint Supervision Practices in Doctoral Education--A Student Experience

    Science.gov (United States)

    Lahenius, Katja; Ikävalko, Heini

    2014-01-01

    This paper presents a study of students' experiences of joint supervision practices and supervisors' professional work in doctoral education in one department of a Finnish university. A qualitative methodology was used to explore students' experiences of joint supervision practices and an inductive protocol was used to analyse the data gathered…

  4. Clinical supervision of psychotherapy: essential ethics issues for supervisors and supervisees.

    Science.gov (United States)

    Barnett, Jeffrey E; Molzon, Corey H

    2014-11-01

    Clinical supervision is an essential aspect of every mental health professional's training. The importance of ensuring that supervision is provided competently, ethically, and legally is explained. The elements of the ethical practice of supervision are described and explained. Specific issues addressed include informed consent and the supervision contract, supervisor and supervisee competence, attention to issues of diversity and multicultural competence, boundaries and multiple relationships in the supervision relationship, documentation and record keeping by both supervisor and supervisee, evaluation and feedback, self-care and the ongoing promotion of wellness, emergency coverage, and the ending of the supervision relationship. Additionally, the role of clinical supervisor as mentor, professional role model, and gatekeeper for the profession are discussed. Specific recommendations are provided for ethically and effectively conducting the supervision relationship and for addressing commonly arising dilemmas that supervisors and supervisees may confront.

  5. How medical residents perceive the quality of supervision provided by attending doctors in the clinical setting.

    Science.gov (United States)

    Busari, Jamiu O; Weggelaar, Nielske M; Knottnerus, Andrieke C; Greidanus, Petra-Marie; Scherpbier, Albert J J A

    2005-07-01

    The supervision of medical residents is a key responsibility of attending doctors in the clinical setting. Most attending doctors, however, are unfamiliar with the principles of effective supervision. Although inconsistent, supervision has been shown to be both important and effective for the professional development of medical residents. To examine how medical residents perceive the supervisory roles of attending doctors, in terms of what they perceive as poor supervision and what they characterise as good supervisory practice. We carried out a questionnaire survey of 38 medical residents at the Department of Paediatrics at the teaching hospital of the University of Amsterdam, the Netherlands. Attending doctors directly involved with the supervision of medical residents participated in the study. The clinical settings where supervision occurred included the neonatal and paediatric intensive care units and the general paediatric wards. Medical residents rated the quality of supervision they received in all departments positively. A majority of the attending doctors were rated highly in 'overall supervision'. Creating pleasant learning environments and being stimulated to learn and function independently were aspects of supervision characterised positively. Coaching in clinical skills and procedures, effective communication skills and clinical decision making using principles of cost-appropriate care were aspects of supervision found to be deficient. This study shows that medical residents enjoy supervision from collaborative, understanding and patient attending doctors. Medical residents prefer to be treated as adult learners and enjoy feedback that is constructive, measured and adapted to their professional needs.

  6. Clinical supervision in the provision of intensive home visiting by health visitors.

    Science.gov (United States)

    Jarrett, Patricia; Barlow, Jane

    2014-02-01

    The objective of this paper is to explore the perceptions of health visitors working in frontline child protection concerning the role of clinical supervision. Fifteen health visitors ('home visitors') providing an intensive home visiting service to high-risk families in the south east of England were interviewed about their experience of receiving supervision. The model of clinical supervision used was based on the Family Partnership Programme and delivered by two trained psychotherapists. The data were analysed using thematic analysis. Home visitors believed that clinical supervision enabled them to maintain boundaries, regulate and reflect on their practice, and develop a better understanding of the issues clients were facing. The model of supervision used and the organisational context were believed to be important factors in the delivery of clinical supervision and to have contributed to its success.

  7. Guidelines for clinical supervision in health service psychology.

    Science.gov (United States)

    2015-01-01

    This document outlines guidelines for supervision of students in health service psychology education and training programs. The goal was to capture optimal performance expectations for psychologists who supervise. It is based on the premises that supervisors (a) strive to achieve competence in the provision of supervision and (b) employ a competency-based, meta-theoretical approach to the supervision process. The Guidelines on Supervision were developed as a resource to inform education and training regarding the implementation of competency-based supervision. The Guidelines on Supervision build on the robust literatures on competency-based education and clinical supervision. They are organized around seven domains: supervisor competence; diversity; relationships; professionalism; assessment/evaluation/feedback; problems of professional competence, and ethical, legal, and regulatory considerations. The Guidelines on Supervision represent the collective effort of a task force convened by the American Psychological Association (APA) Board of Educational Affairs (BEA). PsycINFO Database Record (c) 2015 APA, all rights reserved.

  8. Developing a Peer Mentorship Program to Increase Competence in Clinical Supervision in Clinical Psychology Doctoral Training Programs.

    Science.gov (United States)

    Foxwell, Aleksandra A; Kennard, Beth D; Rodgers, Cynthia; Wolfe, Kristin L; Cassedy, Hannah F; Thomas, Anna

    2017-05-03

    Supervision has recently been recognized as a core competency for clinical psychologists. This recognition of supervision as a distinct competency has evolved in the context of an overall focus on competency-based education and training in health service psychology, and has recently gained momentum. Few clinical psychology doctoral programs offer formal training experiences in providing supervision. A pilot peer mentorship program (PMP) where graduate students were trained in the knowledge and practice of supervision was developed. The focus of the PMP was to develop basic supervision skills in advanced clinical psychology graduate students, as well as to train junior doctoral students in fundamental clinical and practical skills. Advanced doctoral students were matched to junior doctoral students to gain experience in and increase knowledge base in best practices of supervision skills. The 9-month program consisted of monthly mentorship meetings and three training sessions. The results suggested that mentors reported a 30% or more shift from the category of not competent to needs improvement or competent, in the following supervision competencies: theories of supervision, improved skill in supervision modalities, acquired knowledge in supervision, and supervision experience. Furthermore, 50% of the mentors reported that they were not competent in supervision experience at baseline and only 10% reported that they were not competent at the end of the program. Satisfaction data suggested that satisfaction with the program was high, with 75% of participants indicating increased knowledge base in supervision, and 90% indicating that it was a positive addition to their training program. This program was feasible and acceptable and appears to have had a positive impact on the graduate students who participated. Students reported both high satisfaction with the program as well as an increase in knowledge base and experience in supervision skills.

  9. Advanced psychiatric nurse practitioners’ ideas and needs for supervision in private practice in South Africa

    Directory of Open Access Journals (Sweden)

    Annie M. Temane

    2014-07-01

    Full Text Available Background: Supervision forms an integral part of psychiatric nursing. The value of clinical supervision has been demonstrated widely in research. Despite efforts made toward advanced psychiatric nursing, supervision seems to be non-existent in this field. Objectives: The aim of this study was to explore and describe advanced psychiatric nurse practitioners’ ideas and needs with regard to supervision in private practice in order to contribute to the new efforts made in advanced psychiatric nursing in South Africa. Method: A qualitative, descriptive, exploratory, and contextual design using a phenomenological approach as research method was utilised in this study. A purposive sampling was used. Eight advanced psychiatric nurse practitioners in private practice described their ideas and needs for supervision during phenomenological interviews. Tesch’s method of open coding was utilised to analyse data. After data analysis the findings were recontextualised within literature. Results: The data analysis generated the following themes – that the supervisor should have or possess: (a professional competencies, (b personal competencies and (c specific facilitative communication skills. The findings indicated that there was a need for supervision of advanced psychiatric nurse practitioners in private practice in South Africa. Conclusion: This study indicates that there is need for supervision and competent supervisors in private practice. Supervision can be beneficial with regard to developing a culture of support for advanced psychiatric practitioners in private practice and also psychiatric nurse practitioners.

  10. Form Follows Function: A Model for Clinical Supervision of Genetic Counseling Students.

    Science.gov (United States)

    Wherley, Colleen; Veach, Patricia McCarthy; Martyr, Meredith A; LeRoy, Bonnie S

    2015-10-01

    Supervision plays a vital role in genetic counselor training, yet models describing genetic counseling supervision processes and outcomes are lacking. This paper describes a proposed supervision model intended to provide a framework to promote comprehensive and consistent clinical supervision training for genetic counseling students. Based on the principle "form follows function," the model reflects and reinforces McCarthy Veach et al.'s empirically derived model of genetic counseling practice - the "Reciprocal Engagement Model" (REM). The REM consists of mutually interactive educational, relational, and psychosocial components. The Reciprocal Engagement Model of Supervision (REM-S) has similar components and corresponding tenets, goals, and outcomes. The 5 REM-S tenets are: Learning and applying genetic information are key; Relationship is integral to genetic counseling supervision; Student autonomy must be supported; Students are capable; and Student emotions matter. The REM-S outcomes are: Student understands and applies information to independently provide effective services, develop professionally, and engage in self-reflective practice. The 16 REM-S goals are informed by the REM of genetic counseling practice and supported by prior literature. A review of models in medicine and psychology confirms the REM-S contains supervision elements common in healthcare fields, while remaining unique to genetic counseling. The REM-S shows promise for enhancing genetic counselor supervision training and practice and for promoting research on clinical supervision. The REM-S is presented in detail along with specific examples and training and research suggestions.

  11. Post-graduate supervision practices in South African universities in ...

    African Journals Online (AJOL)

    Post-graduate supervision practices in South African universities in the era of ... in subject knowledge or genre knowledge in relation to postgraduate thesis ... and research and explores the complex nature of supervisory relationships which is ...

  12. Group Supervision Attitudes: Supervisory Practices Fostering Resistance to Adoption of Evidence-Based Practices

    Science.gov (United States)

    Brooks, Charles T.; Patterson, David A.; McKiernan, Patrick M.

    2012-01-01

    The focus of this study was to qualitatively evaluate worker's attitudes about clinical supervision. It is believed that poor attitudes toward clinical supervision can create barriers during supervision sessions. Fifty-one participants within a social services organization completed an open-ended questionnaire regarding their clinical supervision…

  13. A comparative study of clinical supervision in the Republic of Ireland and the United States.

    Science.gov (United States)

    Ellis, Michael V; Creaner, Mary; Hutman, Heidi; Timulak, Ladislav

    2015-10-01

    We replicated Son, Ellis, and Yoo (2013) and extended Ellis et al.'s (2014) taxonomy of harmful and inadequate supervision by providing and testing cross-national comparative descriptive data about clinical supervision practices in the Republic of Ireland versus the United States. Participants were 149 Republic of Ireland and 151 U.S. mental health supervisees currently receiving clinical supervision. The results suggested that characteristics of supervision in the Republic of Ireland and United States evidenced both similarities and differences. The dissimilar credentialing systems appeared to account for the observed differences, suggesting that Ellis et al.'s (2014) criteria for inadequate supervision need to be modified to account for country-specific standards for supervision. Unexpectedly, no significant differences were observed between the Republic of Ireland and United States in the high occurrence of inadequate, harmful, or exceptional supervision. The results suggested that 79.2% (Republic of Ireland) and 69.5% (United States) of the supervisees were categorized as currently receiving inadequate supervision, and 40.3% (Republic of Ireland) and 25.2% (United States) of the supervisees as receiving harmful supervision. At some point in their careers, 92.4% (Republic of Ireland) and 86.4% (United States) of the supervisees received inadequate supervision--51.7% (Republic of Ireland) and 39.7% (United States) received harmful supervision. On the positive side, 51.0% (Republic of Ireland) and 55.0% (United States) of the supervisees reported receiving exceptional supervision from their current supervisors. Substantial discrepancies were observed between supervisees' perceptions versus more objective criteria of the inadequate or harmful supervision they received. Implications for cross-national supervision research and training are discussed.

  14. Clinical Scholar Model: providing excellence in clinical supervision of nursing students.

    Science.gov (United States)

    Preheim, Gayle; Casey, Kathy; Krugman, Mary

    2006-01-01

    The Clinical Scholar Model (CSM) is a practice-education partnership focused on improving the outcomes of clinical nursing education by bridging the academic and service settings. An expert clinical nurse serves as a clinical scholar (CS) to coordinate, supervise, and evaluate the clinical education of nursing students in collaboration with school of nursing faculty. This article describes the model's evolution, how the model is differentiated from traditional clinical instruction roles and responsibilities, and the benefits to the collaborating clinical agency and school of nursing.

  15. Digital communication to support clinical supervision: considering the human factors.

    Science.gov (United States)

    Mather, Carey; Marlow, Annette; Cummings, Elizabeth

    2013-01-01

    During the last three years the School of Nursing and Midwifery at the University of Tasmania has used a needs assessment survey to explore the needs of organizations and nursing professionals that facilitate and clinically supervise Bachelor of Nursing students in the workplace. Findings from the survey indicated that staff at healthcare organizations wanted a communication strategy that was easily accessible by clinicians who supervised students during work integrated learning placements. In particular they wanted to receive timely information related to the role and function of supervisors in practice. The development of the digital strategy to strengthen the development of a community of practice between the University, organizations, facilities and clinical supervisors was identified as the key method of improving communication. Blogging and micro blogging were selected as methods of choice for the implementation of the digital strategy because they were easy to set up, use and enable equity of access to geographically dispersed practitioners in urban and rural areas. Change champions were identified to disseminate information about the strategy within their workplaces. Although clinicians indicated electronic communication as their preferred method, there were a number of human factors at a systems and individual level identified to be challenges when communicating with clinical supervisors who were based off-campus. Information communication technology policies and embedded culture towards social presence were impediments to using this approach in some organizations. Additionally, it was found that it is necessary for this group of clinicians to be educated about using digital methods to undertake their role as clinical supervisors in their varied clinical practice environments.

  16. Using clinical supervision to improve the quality and safety of patient care: a response to Berwick and Francis.

    Science.gov (United States)

    Tomlinson, Jonathon

    2015-06-11

    After widely publicised investigations into excess patient deaths at Mid Staffordshire hospital the UK government commissioned reports from Robert Francis QC and Professor Don Berwick. Among their recommendations to improve the quality and safety of patient care were lifelong learning, professional support and 'just culture'. Clinical supervision is in an excellent position to support these activities but opportunities are in danger of being squeezed out by regulatory and managerial demands. Doctors who have completed their training are responsible for complex professional judgements for which narrative supervision is particularly helpful. With reference to the literature and my own practice I propose that all practicing clinicians should have regular clinical supervision. Clinical supervision has patient-safety and the quality of patient care as its primary purposes. After training is completed, doctors may practice for the rest of their career without any clinical supervision, the implication being that the difficulties dealt with in clinical supervision are no longer difficulties, or are better dealt with some other way. Clinical supervision is sufficiently flexible to be adapted to the needs of experienced clinicians as its forms can be varied, though its functions remain focused on patient safety, good quality clinical care and professional wellbeing. The evidence linking clinical supervision to the quality and safety of patient care reveals that supervision is most effective when its educational and supportive functions are separated from its managerial and evaluative functions. Among supervision's different forms, narrative-based-supervision is particularly useful as it has been developed for clinicians who have completed their training. It provides ways to explore the complexity of clinical judgements and encourages doctors to question one another's authority in a supportive culture. To be successful, supervision should also be professionally led and

  17. Implementing clinical supervision: Part 1: laying the ground work.

    Science.gov (United States)

    Lynch, Lisa; Happell, Brenda

    2008-02-01

    Australia, like other countries, is experiencing a crisis in the recruitment and retention of nurses. Clinical supervision has been suggested as a potential strategy to enhance retention. However, there is a paucity of literature regarding the successful implementation of clinical supervision. The aim of this study is to explore and evaluate ways of implementing clinical supervision as undertaken in a rural health-care organization in Victoria. Qualitative methodology was used including a documentation audit and individual interviews with the staff responsible for implementation. The findings demonstrate that the successful implementation had occurred in five interrelated stages. This paper, one in a series of three, focuses on the preimplementation phase leading up to initial implementation. The main themes identified during these stages were: organizational culture, exploring the possibilities, leadership and education and training which will be examined. These issues were essential in laying the foundation for the systematic introduction of clinical supervision.

  18. Computer Monitor Supervision: A Clinical Note.

    Science.gov (United States)

    Scherl, Charles R.; Haley, Jay

    2000-01-01

    Presents communication procedures for supervisors and therapy trainees that have been developed as a result of the use of computer technology. Using the computer as a supervision tool, therapy can be influenced by the supervisor while minimizing disruption. Successes and pitfalls in a master's level practicum course in family therapy are…

  19. Computer Monitor Supervision: A Clinical Note.

    Science.gov (United States)

    Scherl, Charles R.; Haley, Jay

    2000-01-01

    Presents communication procedures for supervisors and therapy trainees that have been developed as a result of the use of computer technology. Using the computer as a supervision tool, therapy can be influenced by the supervisor while minimizing disruption. Successes and pitfalls in a master's level practicum course in family therapy are…

  20. The influence of resident seniority on supervised practice in the emergency department

    Science.gov (United States)

    Chiu, I-Min; Syue, Yuan-Jhen; Kung, Chia-Te; Cheng, Fu-Jen; Lee, Chien-Hung; Lin, Yan-Ren; Li, Chao-Jui

    2017-01-01

    Abstract To investigate the influence of resident seniority on supervised clinical practice in the emergency department (ED). This was a retrospective, 1-year cohort study conducted in 5 EDs within Taiwan largest healthcare system. All adult nontrauma visits presenting to the EDs during the day shift between July 1, 2011 and June 30, 2012 were included in the analysis. Visits were divided into supervised (ie, treated by resident under attending physician's supervision) and attending-alone. Supervised visits were further categorized by resident seniority (junior, intermediate, and senior). The decision-making time (door-to-order and door-to-disposition time), patient dispositions (eg, ED observation and hospital admission), and diagnostic tool use (laboratory examination or computed tomography [CT]) were selected as clinical performance indicators. The differences in clinical performance were determined between supervised visits (ie, resident-seniority groups) and attending-alone visits. Junior residents were found to have longer median door-to-order and door-to-disposition time than were the other residents for urgent and nonurgent patients. Furthermore, compared with attending-alone visits, supervised visits with junior residents had a greater odds of ED observation (adjusted odds ratio [aOR], 1.1; 95% CI, 1.07–1.20), while supervised visits with all 3 resident-seniority groups had significantly greater odds of laboratory examinations (junior: aOR, 1.1; 95% CI, 1.03–1.16; intermediate: aOR, 1.1; 95% CI, 1.04–1.15; and senior: aOR, 1.1; 95% CI, 1.05–1.15). As resident seniority increases, less time is needed for decision making in supervised visits. However, compared to attending-alone visits, supervised visits still resulted in greater use of laboratory examinations and delayed patient disposition. PMID:28121953

  1. Adaptive research supervision : Exploring expert thesis supervisors' practical knowledge

    NARCIS (Netherlands)

    de Kleijn, Renske A M; Meijer, Paulien C.; Brekelmans, Mieke; Pilot, Albert

    2015-01-01

    Several researchers have suggested the importance of being responsive to students' needs in research supervision. Adapting support strategies to students' needs in light of the goals of a task is referred to as adaptivity. In the present study, the practice of adaptivity is explored by interviewing

  2. Adaptive research supervision : Exploring expert thesis supervisors' practical knowledge

    NARCIS (Netherlands)

    de Kleijn, Renske A M; Meijer, Paulien C.; Brekelmans, Mieke; Pilot, Albert

    2015-01-01

    Several researchers have suggested the importance of being responsive to students' needs in research supervision. Adapting support strategies to students' needs in light of the goals of a task is referred to as adaptivity. In the present study, the practice of adaptivity is explored by interviewing

  3. Adaptive Research Supervision: Exploring Expert Thesis Supervisors' Practical Knowledge

    Science.gov (United States)

    de Kleijn, Renske A. M.; Meijer, Paulien C.; Brekelmans, Mieke; Pilot, Albert

    2015-01-01

    Several researchers have suggested the importance of being responsive to students' needs in research supervision. Adapting support strategies to students' needs in light of the goals of a task is referred to as "adaptivity." In the present study, the practice of adaptivity is explored by interviewing expert thesis supervisors about…

  4. Providing Competency Training to Clinical Supervisors through an Interactional Supervision Approach

    Science.gov (United States)

    Tebes, Jacob Kraemer; Matlin, Samantha L.; Migdole, Scott J.; Farkas, Melanie S.; Money, Roy W.; Shulman, Lawrence; Hoge, Michael A.

    2011-01-01

    Training in supervisory competencies is essential to effective clinical practice and helps address the current national crisis in the behavioral health workforce. Interactional supervision, the approach used in the current study, is well established in clinical social work and focuses the task of the supervisee on the interpersonal exchanges…

  5. Multivoiced Supervision of Master's Students: A Case Study of Alternative Supervision Practices in Higher Education

    Science.gov (United States)

    Dysthe, Olga; Samara, Akylina; Westrheim, Kariane

    2006-01-01

    This article describes and analyzes an alternative supervision model at the Master of Education Programme at the University of Bergen aimed at improving research supervision. A three-pronged approach was introduced, combining supervision groups, student colloquia and individual supervision. The supervision groups consisted of two supervisors and…

  6. Supervision--growing and building a sustainable general practice supervisor system.

    Science.gov (United States)

    Thomson, Jennifer S; Anderson, Katrina J; Mara, Paul R; Stevenson, Alexander D

    2011-06-06

    This article explores various models and ideas for future sustainable general practice vocational training supervision in Australia. The general practitioner supervisor in the clinical practice setting is currently central to training the future general practice workforce. Finding ways to recruit, retain and motivate both new and experienced GP teachers is discussed, as is the creation of career paths for such teachers. Some of the newer methods of practice-based teaching are considered for further development, including vertically integrated teaching, e-learning, wave consulting and teaching on the run, teaching teams and remote teaching. Approaches to supporting and resourcing teaching and the required infrastructure are also considered. Further research into sustaining the practice-based general practice supervision model will be required.

  7. An evaluation of the current patterns and practices of educational supervision in postgraduate medical education in the UK.

    Science.gov (United States)

    Patel, Priyank

    2016-08-01

    Globally, clinical supervision has been widely adopted and studied. But in the UK, another variant of supervision has developed in the form of educational supervision. The quality of supervision remains highly variable and inadequate time, investment and guidance hinders its ability to actually benefit trainees. Therefore, undertaking a detailed study of the patterns and practices in educational supervision to inform developments in supervisory practice would be extremely beneficial. In this mixed methods study, educational supervisors and trainees working within a large London Trust were surveyed online about their experiences of educational supervision. In addition, observations of supervision sessions with a small group of supervisor and trainee pairs followed-up by semi-structured interviews were conducted. The quantitative data were analyzed using statistical software via descriptive statistics. The qualitative data underwent thematic framework analysis. Both the qualitative and quantitative data revealed that whilst most junior doctors and supervisors value the ideal of educational supervision as a process for engaging in mentoring dialogues, it can become a tick box exercise, devaluing its usefulness and purpose. Trainees highlighted the need for more frequent formal meeting along with better preparation by supervisors. Supervisors would appreciate more support from trusts to help them enhance supervision for trainees. The effectiveness of educational supervision can be improved with trainees and supervisors engaging in meaningful preparation and proactive communication before meetings. During these formal meetings, improving the quality of feedback and ensuring that regular mentoring dialogues occurred would be highly valuable.

  8. Group supervision in a private setting: Practice and method for theory and practice in psychotherapy

    Directory of Open Access Journals (Sweden)

    Graziana Mangiacavallo

    2015-05-01

    Full Text Available The report aims to tell the experience of a supervision group in a private setting. The group consists of professional psychotherapists driven by the more experienced practitioner, who shares a clinical reasoning on psychotherapy with younger colleagues. The report aims to present the supervision group as a methode and to showcase its features. The supervision group becomes a container of professional experiences that speak of the new way of doing psychotherapy. 

  9. Extracting PICO Sentences from Clinical Trial Reports using Supervised Distant Supervision.

    Science.gov (United States)

    Wallace, Byron C; Kuiper, Joël; Sharma, Aakash; Zhu, Mingxi Brian; Marshall, Iain J

    2016-01-01

    Systematic reviews underpin Evidence Based Medicine (EBM) by addressing precise clinical questions via comprehensive synthesis of all relevant published evidence. Authors of systematic reviews typically define a Population/Problem, Intervention, Comparator, and Outcome (a PICO criteria) of interest, and then retrieve, appraise and synthesize results from all reports of clinical trials that meet these criteria. Identifying PICO elements in the full-texts of trial reports is thus a critical yet time-consuming step in the systematic review process. We seek to expedite evidence synthesis by developing machine learning models to automatically extract sentences from articles relevant to PICO elements. Collecting a large corpus of training data for this task would be prohibitively expensive. Therefore, we derive distant supervision (DS) with which to train models using previously conducted reviews. DS entails heuristically deriving 'soft' labels from an available structured resource. However, we have access only to unstructured, free-text summaries of PICO elements for corresponding articles; we must derive from these the desired sentence-level annotations. To this end, we propose a novel method - supervised distant supervision (SDS) - that uses a small amount of direct supervision to better exploit a large corpus of distantly labeled instances by learning to pseudo-annotate articles using the available DS. We show that this approach tends to outperform existing methods with respect to automated PICO extraction.

  10. Triadic Supervision in CACREP Accredited Counselor Education Programs: Current Practices and Rationale

    Science.gov (United States)

    Lyman, Steve R.

    2010-01-01

    In 2001 the Counsel for the Accreditation of Counseling and Related Educational Programs (CACREP) approved the use of triadic supervision as an adjunct or alternative to individual supervision in the clinical training of counselors-in-training. In so doing they sanctioned triadic supervision as equal to individual supervision without the benefit…

  11. Triadic Supervision in CACREP Accredited Counselor Education Programs: Current Practices and Rationale

    Science.gov (United States)

    Lyman, Steve R.

    2010-01-01

    In 2001 the Counsel for the Accreditation of Counseling and Related Educational Programs (CACREP) approved the use of triadic supervision as an adjunct or alternative to individual supervision in the clinical training of counselors-in-training. In so doing they sanctioned triadic supervision as equal to individual supervision without the benefit…

  12. Participation in clinical supervision (PACS): an evaluation of student nurse clinical supervision facilitated by mental health service users.

    Science.gov (United States)

    Maplethorpe, Fran; Dixon, Julie; Rush, Brenda

    2014-03-01

    This paper discusses an innovative learning approach in which people having experience of mental health services facilitated humanistic clinical supervision with groups of student nurses in the classroom. A four-day course of preparation for the role of supervisor is described and the results of subsequent clinical supervision sessions are analysed. Seven service users who had previous experience of teaching students in the classroom and fifty students on a Diploma/BSc in mental health nursing course participated in the project, which was evaluated through focus groups. The results indicated that the service user supervisors appreciated the skills they had gained on the course and felt that they were more appropriate than lecturers to facilitate clinical supervision sessions. Some students expressed initial uncertainty about the appropriateness of service users as supervisors but as changes to the pedagogical process of supervision were made and the supervisors gained more experience and confidence, students expressed greater satisfaction. The authors conclude that clinical supervision facilitated by service users who have preparation and continual support can add considerable value to the learning experience of student nurses.

  13. Psychiatric nursing staff members' reflections on participating in group-based clinical supervision: a semistructured interview study.

    Science.gov (United States)

    Buus, Niels; Angel, Sanne; Traynor, Michael; Gonge, Henrik

    2011-04-01

    This paper is a report of an interview study exploring psychiatric hospital nursing staff members' reflections on participating in supervision. Clinical supervision is a pedagogical process designed to direct, develop, and support clinical nurses. Participation rates in clinical supervision in psychiatric settings have been reported to be relatively low. Qualitative research indicates that staff members appreciate clinical supervision, but paradoxically, do not prioritize participation and find participation emotionally challenging. Little is known about these contradictory experiences and how they influence participation rates. Twenty-two psychiatric hospital nursing staff members were interviewed with a semistructured interview guide. Interview transcripts were interpreted by means of Ricoeur's hermeneutic method. The respondents understood clinical supervision to be beneficial, but with very limited impact on their clinical practice. Neither management nor the staff effectively prioritized clinical supervision, which added to a downward spiral where low levels of participation undermined the potential benefits of clinical supervision. The respondents embraced and used alternative forums for getting emotional support among peers, but maintained that formalized supervision was the only forum for reflection that could solve the most difficult situations.

  14. Utilizing Motivational Interviewing to Address Resistant Behaviors in Clinical Supervision

    Science.gov (United States)

    Wahesh, Edward

    2016-01-01

    Motivational interviewing is presented as an approach to address resistant behaviors in clinical supervision. A case example is used to illustrate the process in which the relational and technical elements of motivational interviewing can be applied to supervisee resistance. Implications for supervisors and researchers are discussed.

  15. Proposed Guidelines for Operating Counselor Education and Supervision Training Clinics

    Science.gov (United States)

    Lauka, Justin D.; McCarthy, Amanda K.

    2013-01-01

    The purpose of this article is to justify and present a set of guidelines for the effective and ethical administration of counselor education and supervision training clinics. Responding directly to a call for creating guidelines, the authors address core issues surrounding their development. Benefits for clear and accessible guidelines and risks…

  16. Using Clinical Supervision Techniques with Student Art Teachers.

    Science.gov (United States)

    Susi, Frank D.

    1992-01-01

    Contends that the student teaching experience and the cooperating teacher are the most significant aspects of the teacher education process. Describes the features and the implementation of clinical supervision in art education. Concludes that cooperating teachers also benefit as a result of their experiences with student teachers. (CFR)

  17. Evaluation of psychology practitioner competence in clinical supervision.

    Science.gov (United States)

    Gonsalvez, Craig J; Crowe, Trevor P

    2014-01-01

    There is a growing consensus favouring the development, advancement, and implementation of a competency-based approach for psychology training and supervision. There is wide recognition that skills, attitude-values, and relationship competencies are as critical to a psychologist's competence as are knowledge capabilities, and that these key competencies are best measured during placements, leaving the clinical supervisor in an unparalleled position of advantage to provide formative and summative evaluations on the supervisee's progression towards competence. Paradoxically, a compelling body of literature from across disciplines indicates that supervisor ratings of broad domains of competence are systematically compromised by biases, including leniency error and halo effect. The current paper highlights key issues affecting summative competency evaluations by supervisors: what competencies should be evaluated, who should conduct the evaluation, how (tools) and when evaluations should be conducted, and process variables that affect evaluation. The article concludes by providing research recommendations to underpin and promote future progress and by offering practice recommendations to facilitate a more credible and meaningful evaluation of competence and competencies.

  18. Clinical practice

    OpenAIRE

    2011-01-01

    Cerebral palsy (CP) is the most common physical disability in early childhood. The worldwide prevalence of CP is approximately 2–2.5 per 1,000 live births. It has been clinically defined as a group of motor, cognitive, and perceptive impairments secondary to a non-progressive defect or lesion of the developing brain. Children with CP can have swallowing problems with severe drooling as one of the consequences. Malnutrition and recurrent aspiration pneumonia can increase the risk of morbidity ...

  19. Effects of coaching supervision, mentoring supervision and abusive supervision on talent development among trainee doctors in public hospitals: moderating role of clinical learning environment.

    Science.gov (United States)

    Subramaniam, Anusuiya; Silong, Abu Daud; Uli, Jegak; Ismail, Ismi Arif

    2015-08-13

    Effective talent development requires robust supervision. However, the effects of supervisory styles (coaching, mentoring and abusive supervision) on talent development and the moderating effects of clinical learning environment in the relationship between supervisory styles and talent development among public hospital trainee doctors have not been thoroughly researched. In this study, we aim to achieve the following, (1) identify the extent to which supervisory styles (coaching, mentoring and abusive supervision) can facilitate talent development among trainee doctors in public hospital and (2) examine whether coaching, mentoring and abusive supervision are moderated by clinical learning environment in predicting talent development among trainee doctors in public hospital. A questionnaire-based critical survey was conducted among trainee doctors undergoing housemanship at six public hospitals in the Klang Valley, Malaysia. Prior permission was obtained from the Ministry of Health Malaysia to conduct the research in the identified public hospitals. The survey yielded 355 responses. The results were analysed using SPSS 20.0 and SEM with AMOS 20.0. The findings of this research indicate that coaching and mentoring supervision are positively associated with talent development, and that there is no significant relationship between abusive supervision and talent development. The findings also support the moderating role of clinical learning environment on the relationships between coaching supervision-talent development, mentoring supervision-talent development and abusive supervision-talent development among public hospital trainee doctors. Overall, the proposed model indicates a 26 % variance in talent development. This study provides an improved understanding on the role of the supervisory styles (coaching and mentoring supervision) on facilitating talent development among public hospital trainee doctors. Furthermore, this study extends the literature to better

  20. Quality of Supervision as an Independent Contributor to an Anesthesiologist’s Individual Clinical Value

    National Research Council Canada - National Science Library

    Dexter, Franklin; Hindman, Bradley J

    2015-01-01

    ...., hours of direct clinical care), the same is not true for the quality of that effort. In our study, we consider the quality of clinical supervision provided by anesthesiologists who are supervising anesthesia residents and nurse anesthetists...

  1. Quality of Supervision as an Independent Contributor to an Anesthesiologist's Individual Clinical Value

    National Research Council Canada - National Science Library

    Dexter, Franklin; Hindman, Bradley J

    2015-01-01

    ...., hours of direct clinical care), the same is not true for the quality of that effort. In our study, we consider the quality of clinical supervision provided by anesthesiologists who are supervising anesthesia residents and nurse anesthetists...

  2. Teacher Supervision Practices and Characteristics of In-School Supervisors in Uganda

    Science.gov (United States)

    Kalule, Lawrence; Bouchamma, Yamina

    2014-01-01

    We examined teacher supervision practices (supervision models, phases, and professional development guidelines) of in-school supervisors (principals, vice principals, and study program directors) in Uganda, the supervisors' efficacy perceptions regarding teacher supervision, and supervisor characteristics associated with the choice of supervisory…

  3. Reflections on the supervised relationship and interaction in nursing clinical training

    Directory of Open Access Journals (Sweden)

    Inês Alves da Rocha e Silva Rocha

    2013-05-01

    Full Text Available This reflection fits into the area of Clinical Supervision in Nursing focusing on relationships that the student develops during clinical training. It seems that in clinical training the student not only learns but also consolidates verbal, procedural and attitudinal contents. The relationship established with peers, teachers and tutors will contribute to their professional identity. It is underlined the importance of the contribution of clinical supervision for the development of a reflective thinking in students in Portugal, as highlighted here, which influences the changes in nursing practices, as well as ensuring the quality and safety of the care provided. The characteristics that the tutor must have to improve the development of the students are also explained as well as the possible solutions for the existing limitations of clinical training contexts.

  4. Designs and Discriminations for Clinical Group Supervision in Counselling Psychology: An Analysis

    Science.gov (United States)

    Grigg, Glen

    2006-01-01

    Evidence suggests that group clinical supervision of counsellors and trainees is an effective mode of service delivery. However, clinical supervision is often understood to be concerned with teaching a generic set of skills. Without specifically labeling them as such, clinical supervision groups are implicitly identified as psycho-educational…

  5. Impact of clinical supervision on field training of nursing students at Urmia University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    MOHAMMADREZA DEHGHANI

    2016-04-01

    Full Text Available Introduction: Obtaining clinical competency in clinical education is one of the problems in nursing and use of the new methods of clinical training is very important. Clinical supervision is one of the methods used as a mechanism to promote knowledge and skill for promoting professional performance in nursing students. This study is carried out to determine the impact of clinical supervision on field training of nursing students at Urmia University of Medical Sciences. Methods: In the present experimental study, 32 nursing students were enrolled in the study based on census and randomly assigned into two groups of experimental and control by block randomization. Clinical supervision was used in the experimental group and the control group received routine clinical trainings in the field. The students’ clinical skills were assessed using a researcher-made checklist, the validity of which was confirmed through content validity method by 13 faculty members and its reliability was approved by test-retest method on 20 nursing students in the form of a pilot study and through Cronbach’s alpha (87%. Data were analyzed using SPSS, version 14. Results: There was a significant difference between the experimental and control groups in clinical skills such as recognition and administration of medication, team participation, patients and their relatives’ education, considering the safety, infection prevention and nursing process (p<0.005. Conclusion: The study demonstrated that in clinical supervision process, students have a better communication and cooperation with their instructor and with each other and their confidence and understanding and the amount of learning in practical skills was enhanced more than routine clinical training. The implementation of this clinical training method for students of nursing and other fields of medical sciences is recommendable.

  6. Higher Degree Research Supervision: From Practice toward Theory

    Science.gov (United States)

    Maxwell, T. W.; Smyth, Robyn

    2011-01-01

    This paper presents our theorizing about the complex nature of higher degree research supervision. The intent is to make a contribution to the current debates about higher education generally, and supervision of higher degree research students in particular. We add to the pedagogy of supervision by extending its scope to and beyond the supervisory…

  7. Students Perceptions on the quality of clinical supervision among the 12 affiliated hospital of Medical Faculty of UNISSULA

    Directory of Open Access Journals (Sweden)

    Dian Apriliana Rahmawatie

    2011-12-01

    Design and Methods: This study involved 181 students of clinical internship of the year 2003, 2004 and 2005 of medical faculty of Islamic Sultan Agung University having the clinical rotation at the stage of surgery, obsgyn, pediatrics, internal medicine, ENT, neurology, dermatology and venerology, psychiatry, across the affiliated hospitals. The subject were divided into groups based on the hospital they were placed. Clinical Teaching Effectiveness Instrument (CTEI adapted in bahasa Indonesia was used. The Descriptive and Kruskal-Wallis test were applied for the data analysis. Results: Means of the effectiveness of clinical supervision for 12 affiliated hospitals ranged from 3.25 to 4.02. Kruskal-Wallis test resulted in the value of Chi-S=13.32 and p=0.27. Conclusion: Over all the clinical supervision for the 12 affiliated hospitals is perceived good and shows no significant difference. However the practice of clinical supervision varies among the hospitals (Sains Medika, 3(2:135-149.

  8. Postgraduate Research Supervision: A Critical Review of Current Practice

    Science.gov (United States)

    McCallin, Antoinette; Nayar, Shoba

    2012-01-01

    Changes in the funding and delivery of research programmes at the university level have, in recent years, resulted in significant changes to research supervision. This paper critically reviews key influences effecting postgraduate supervision. Analysis draws on literature spanning 2000-2010 to determine the appropriateness of traditional models of…

  9. Supervision to Enhance Educational and Vocational Guidance Practice: A Review

    Science.gov (United States)

    Reid, Hazel L.

    2010-01-01

    Supervision to support the work of career practitioners is evident in many countries, but is not universal. This author presents a literature review, intending to emphasise the prime importance of developing supervision for guidance work. The author also considers the issues facing those training to develop the role of supervisors in southeast…

  10. Learning outcomes using video in supervision and peer feedback during clinical skills training

    DEFF Research Database (Denmark)

    Lauridsen, Henrik Hein; Toftgård, Rie Castella; Nørgaard, Cita

    supervision of clinical skills (formative assessment). Demonstrations of these principles will be presented as video podcasts during the session. The learning outcomes of video supervision and peer-feedback were assessed in an online questionnaire survey. Results Results of the supervision showed large self...

  11. Rethinking attitudes to student clinical supervision and patient care: a change management success story.

    Science.gov (United States)

    O'Keefe, Maree; Wade, Victoria; McAllister, Sue; Stupans, Ieva; Miller, Jennifer; Burgess, Teresa; LeCouteur, Amanda; Starr, Linda

    2014-08-30

    The aim of this project was to explore the process of change in a busy community dental clinic following a team development intervention designed to improve the management of student supervision during clinical placements. An action research model was used. Seven members of a community dental clinic team (three dentists, two dental therapists, one dental assistant and the clinic manager), together with the university clinical placement supervisor participated in the team development intervention. The intervention consisted of two profiling activities and associated workshops spread six months apart. These activities focused on individual work preferences and overall team performance with the aim of improving the functioning of the clinic as a learning environment for dental students. Evaluation data consisted of 20 participant interviews, fourteen hours of workplace observation and six sets of field notes. Following initial thematic analysis, project outcomes were re-analysed using activity theory and expansive learning as a theoretical framework. At project commencement students were not well integrated into the day-to-day clinic functioning. Staff expressed a general view that greater attention to student supervision would compromise patient care. Following the intervention greater clinical team cohesion and workflow changes delivered efficiencies in practice, enhanced relationships among team members, and more positive attitudes towards students. The physical layout of the clinic and clinical workloads were changed to achieve greater involvement of all team members in supporting student learning. Unexpectedly, these changes also improved clinic functioning and increased the number of student placements available. In navigating the sequential stages of the expansive learning cycle, the clinical team ultimately redefined the 'object' of their activity and crossed previously impervious boundaries between healthcare delivery and student supervision with benefits to

  12. Child supervision practices for drowning prevention in rural Bangladesh: a pilot study of supervision tools.

    Science.gov (United States)

    Callaghan, J A; Hyder, A A; Khan, R; Blum, L S; Arifeen, S; Baqui, A H

    2010-07-01

    Injuries are an increasing child health concern and have become a leading cause of child mortality in the 1-4 years age group in many developing countries, including Bangladesh. Household observations during 9 months of a community-based pilot of two supervision tools-a door barrier and a playpen-designed to assess their community acceptability in rural Bangladesh are reported in this article. Statistical analysis of 2694 observations revealed that children were directly supervised or protected by a preventive tool in 96% of visits. Households with a supervision tool had a significantly lower proportion of observations with the child unsupervised and unprotected than households without a tool. Families that received a playpen had 6.89 times the odds of using it at the time of the visit than families that received a door barrier. Interventions such as the playpen, when introduced to households through community-based programs, are accepted by parents. Field trials are urgently needed to establish the effectiveness of barrier-based interventions at reducing under-five drowning mortality rates in low-income countries like Bangladesh.

  13. Driving Care Quality: Aligning Trainee Assessment and Supervision Through Practical Application of Entrustable Professional Activities, Competencies, and Milestones.

    Science.gov (United States)

    Carraccio, Carol; Englander, Robert; Holmboe, Eric S; Kogan, Jennifer R

    2016-02-01

    To address the long-standing challenge of meaningful trainee assessment, the authors reviewed and expanded on the Accountable Assessment for Quality Care and Supervision (AAQCS) equation. The equation proposes that care quality is the product of the interaction between trainee performance (measured by workplace assessment) and supervision (required level of intervention to ensure care quality) in the context of the environment where the care occurs: Trainee performance × Appropriate supervision = Safe, effective patient-centered care. Assessing trainee performance and matching that performance to "appropriate" supervision, however, is fraught with challenges. The authors suggest a unifying framework that integrates entrustable professional activities (EPAs), competencies, and milestones to inform trainee assessment and supervision, thereby enabling the practical application of the AAQCS equation in the workplace. Because the unit of measure for an EPA is the outcome of whether the trainee can safely and effectively perform the professional activity without supervision, the proposed unifying framework directly aligns with the dependent variable in the AAQCS equation: care quality.The value of applying a unifying framework that integrates EPAs, competencies, and milestones to the AAQCS equation in the clinical learning environment lies in its ability to provide supervisors with a shared mental model of performance expectations for trainees, reducing unwanted variability and improving assessment accuracy; guidance for aligning performance milestones of trainees with the needed level of supervisor intervention to ensure care quality; and substrate for specific feedback to improve the trainee's professional development as a way to ensure future care quality.

  14. A Study of Clinical Supervision Techniques and Training in Substance Abuse Treatment

    Science.gov (United States)

    West, Paul L.; Hamm, Terri

    2012-01-01

    Data from 57 clinical supervisors in licensed substance abuse treatment programs indicate that 28% had completed formal graduate course work in clinical supervision and 33% were professionally licensed or certified. Findings raise concerns about the scope and quality of clinical supervision available to substance abuse counselors. (Contains 3…

  15. Baccalaureate nursing students' perceptions of learning and supervision in the clinical environment.

    Science.gov (United States)

    Dimitriadou, Maria; Papastavrou, Evridiki; Efstathiou, Georgios; Theodorou, Mamas

    2015-06-01

    This study is an exploration of nursing students' experiences within the clinical learning environment (CLE) and supervision provided in hospital settings. A total of 357 second-year nurse students from all universities in Cyprus participated in the study. Data were collected using the Clinical Learning Environment, Supervision and Nurse Teacher instrument. The dimension "supervisory relationship (mentor)", as well as the frequency of individualized supervision meetings, were found to be important variables in the students' clinical learning. However, no statistically-significant connection was established between successful mentor relationship and team supervision. The majority of students valued their mentor's supervision more highly than a nurse teacher's supervision toward the fulfillment of learning outcomes. The dimensions "premises of nursing care" and "premises of learning" were highly correlated, indicating that a key component of a quality clinical learning environment is the quality of care delivered. The results suggest the need to modify educational strategies that foster desirable learning for students in response to workplace demands.

  16. The process, logistics and challenges of implementing clinical supervision in a generalist tertiary referral hospital.

    Science.gov (United States)

    Brunero, Scott; Lamont, Scott

    2012-03-01

    Clinical supervision (CS) has been identified within nursing as a process for improving clinical practice and reducing the emotional burden of nursing practice. Little is known about its implementation across large tertiary referral hospitals. The purpose of this study is to evaluate the implementation of clinical supervision across several different nursing specialities at a teaching hospital in Sydney, Australia. Using a model of nursing implementation science, a process was developed at the study site that facilitated the development, implementation and evaluation of the project. After a 6-month study period, the CS groups were postevaluated using a survey tool developed for the project. A total of nine CS groups were in operation over the 6-month study period. A predominant focus within the sessions was one of the collegial support and developing standards of practice. The process was able to achieve wide hospital-based support for the role of CS from the senior nurse executives to junior nurses. Whilst there was overall positive support for the CS groups, logistical and resource challenges remain, in the effective roll out of CS to large numbers of nurses. © 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.

  17. Is Direct Supervision in Clinical Education for Athletic Training Students Always Necessary to Enhance Student Learning?

    Science.gov (United States)

    Scriber, Kent; Trowbridge, Cindy

    2009-01-01

    Objective: To present an alternative model of supervision within clinical education experiences. Background: Several years ago direct supervision was defined more clearly in the accreditation standards for athletic training education programs (ATEPs). Currently, athletic training students may not gain any clinical experience without their clinical…

  18. Perceptions of Supervision Practices by Agricultural Education Student Teachers

    Science.gov (United States)

    Thobega, Moreetsi; Miller, Greg

    2008-01-01

    The purpose of this study was to describe student teachers' perceptions and preferences of the type of supervision they experienced while interacting with their university supervisors and cooperating teachers. Results revealed that student teachers perceived both their cooperating teachers and university supervisors to engage in contextual and…

  19. Maintaining capacity for in-practice teaching and supervision of students and general practice trainees: a cross-sectional study of early career general practitioners.

    Science.gov (United States)

    Catzikiris, Nigel; Tapley, Amanda; Morgan, Simon; Holliday, Elizabeth G; Ball, Jean; Henderson, Kim; Elliott, Taryn; Spike, Neil; Regan, Cathy; Magin, Parker

    2017-08-10

    Objectives Expanding learner cohorts of medical students and general practitioner (GP) vocational trainees and the impending retirement of the 'baby boomer' GP cohort threaten the teaching and supervisory capacity of the Australian GP workforce. Engaging newly qualified GPs is essential to sustaining this workforce training capacity. The aim of the present study was to establish the prevalence and associations of in-practice clinical teaching and supervision in early career GPs.Methods The present study was a cross-sectional questionnaire-based study of recent (within 5 years) alumni of three of Australia's 17 regional general practice training programs. The outcome factor was whether the alumnus taught or supervised medical students, GP registrars or other learners in their current practice. Logistic regression analysis was used to establish associations of teaching and supervision with independent variables comprising alumnus demographics, current practice characteristics and vocational training experiences.Results In all, 230 alumni returned questionnaires (response rate 37.4%). Of currently practising alumni, 52.4% (95% confidence interval (CI) 45.6-59.0%) reported current teaching or supervisory activities. Factors significantly (Pcareer GPs in practice-based apprenticeship-like teaching or training should inform strategies to maintain workforce training capacity.What is known about the topic? Projected changes in the demand for and supply of clinical teaching and supervision within Australian general practice will require greater uptake of teaching and supervision by recently qualified GPs to ensure sustainability of this teaching model. Although interest in and undertaking of teaching roles have been documented for GP or family medicine trainees, studies investigating the engagement in these clinical roles by GPs during their early post-training period are lacking.What does this paper add? This paper is the first to document the prevalence of teaching and

  20. Distance Supervision in Rehabilitation Counseling: Ethical and Clinical Considerations

    Science.gov (United States)

    Lund, Emily M.; Schultz, Jared C.

    2015-01-01

    Background: The use of technology-mediated distance supervision is a rapidly growing area in rehabilitation counseling and other fields. Distance supervision has both tremendous potential and notable challenges to address, including questions of ethics and evidence. Purpose: This article examines both the ethical and nonethical principles that…

  1. Model for investigating the benefits of clinical supervision in psychiatric nursing

    DEFF Research Database (Denmark)

    Gonge, Henrik; Buus, Niels

    2011-01-01

    The objective of this study was to test a model for analysing the possible benefits of clinical supervision. The model suggested a pathway from participation to effectiveness to benefits of clinical supervision, and included possible influences of individual and workplace factors. The study sample...... was 136 nursing staff members in permanent employment on nine general psychiatric wards and at four community mental health centres at a Danish psychiatric university hospital. Data were collected by means of a set of questionnaires. Participation in clinical supervision was associated...... with the effectiveness of clinical supervision, as measured by the Manchester Clinical Supervision Scale (MCSS). Furthermore, MCSS scores were associated with benefits, such as increased job satisfaction, vitality, rational coping and less stress, emotional exhaustion, and depersonalization. Multivariate analyses...

  2. Psychiatric nursing menbers' reflections on participating in group-based clinical supervision

    DEFF Research Database (Denmark)

    Buus, Niels; Angel, Sanne; Traynor, Michael

    2011-01-01

    This paper is a report of an interview study exploring psychiatric hospital nursing staff members' reflections on participating in supervision. Clinical supervision is a pedagogical process designed to direct, develop, and support clinical nurses. Participation rates in clinical supervision...... in psychiatric settings have been reported to be relatively low. Qualitative research indicates that staff members appreciate clinical supervision, but paradoxically, do not prioritize participation and find participation emotionally challenging. Little is known about these contradictory experiences and how...... they influence participation rates. Twenty-two psychiatric hospital nursing staff members were interviewed with a semistructured interview guide. Interview transcripts were interpreted by means of Ricoeur's hermeneutic method. The respondents understood clinical supervision to be beneficial, but with very...

  3. Essential processes for cognitive behavioral clinical supervision: Agenda setting, problem-solving, and formative feedback.

    Science.gov (United States)

    Cummings, Jorden A; Ballantyne, Elena C; Scallion, Laura M

    2015-06-01

    Clinical supervision should be a proactive and considered endeavor, not a reactive one. To that end, supervisors should choose supervision processes that are driven by theory, best available research, and clinical experience. These processes should be aimed at helping trainees develop as clinicians. We highlight 3 supervision processes we believe should be used at each supervision meeting: agenda setting, encouraging trainee problem-solving, and formative feedback. Although these are primarily cognitive-behavioral skills, they can be helpful in combination with other supervision models. We provide example dialogue from supervision exchanges, and discuss theoretical and research support for these processes. Using these processes not only encourages trainee development but also models for them how to use the same processes and approaches with clients.

  4. 75 FR 52860 - Professional Conduct of Attorneys Practicing Under the Cognizance and Supervision of the Judge...

    Science.gov (United States)

    2010-08-30

    ... Department of the Navy 32 CFR Part 776 RIN 0703-AA88 Professional Conduct of Attorneys Practicing Under the... relating to the professional conduct of attorneys practicing under the cognizance and supervision of the... policy reflected in JAG Instruction 5803.1 (Series), Professional Conduct of Attorneys Practicing Under...

  5. Clinical Supervision in Adventure Therapy: Enhancing the Field through an Active Experiential Model

    Science.gov (United States)

    Gass, Michael A.; Gillis, H. L.

    2010-01-01

    Supervision of therapeutic practice is one of the central professional elements of mental health practitioners. Supervision provides growth for therapists in their respective professional fields, more effective therapy for clients, and some measure of ethical protection for the welfare of clients and the public at large. However, therapists who…

  6. Practical Clinical Training in Skills Labs: Theory and Practice

    OpenAIRE

    Bugaj, T. J.; Nikendei, C.

    2016-01-01

    Today, skills laboratories or “skills labs”, i.e. specific practical skill training facilities, are a firmly established part of medical education offering the possibility of training clinical procedures in a safe and fault-forging environment prior to real life application at bedside or in the operating room. Skills lab training follows a structured teaching concept, takes place under supervision and in consideration of methodological-didactic concepts, ideally creating an atmosphere that al...

  7. Nurse lecturers' perceptions of what baccalaureate nursing students could gain from clinical group supervision.

    Science.gov (United States)

    Lindgren, Barbro; Athlin, Elsy

    2010-05-01

    The extensive amount of studies on clinical supervision during the nursing students' clinical programmes has shown that supervision most often is given on a one-to-one basis, and that many challenges are embedded in this kind of supervision. In some studies group supervision has been used, with mostly successful effects according to the nursing students. At a university in Sweden, a model of group supervision was included in the baccalaureate nursing programme, conducted by nurse lecturers. The purpose of this study was to describe the value of clinical group supervision to nursing students, as perceived by the nurse lecturers. Data consisted of field notes written by the nurse lecturers after 60 supervision sessions, and qualitative content analysis was performed. The findings showed how reflection in a group of equals was considered to give the nursing students opportunities to increase their understanding of themselves and others, prepare them for coming events, increase their personal and professional strengths, and inspire them for further development. On the basis of the findings and previous studies the value of using nurse lecturers as group supervisors was discussed. The impact of a contract to achieve a good learning environment in group supervision was also stressed.

  8. Clinical group supervision in yoga therapy: model effects, and lessons learned.

    Science.gov (United States)

    Forbes, Bo; Volpe Horii, Cassandra; Earls, Bethany; Mashek, Stephanie; Akhtar, Fiona

    2012-01-01

    Clinical supervision is an integral component of therapist training and professional development because of its capacity for fostering knowledge, self-awareness, and clinical acumen. Individual supervision is part of many yoga therapy training programs and is referenced in the IAYT Standards as "mentoring." Group supervision is not typically used in the training of yoga therapists. We propose that group supervision effectively supports the growth and development of yoga therapists-in-training. We present a model of group supervision for yoga therapist trainees developed by the New England School of Integrative Yoga Therapeutics™ (The NESIYT Model) that includes the background, structure, format, and development of our inaugural 18-month supervision group. Pre-and post-supervision surveys and analyzed case notes, which captured key didactic and process themes, are discussed. Clinical issues, such as boundaries, performance anxiety, sense of self efficacy, the therapeutic alliance, transference and counter transference, pacing of yoga therapy sessions, evaluation of client progress, and adjunct therapist interaction are reviewed. The timing and sequence of didactic and process themes and benefits for yoga therapist trainees' professional development, are discussed. The NESIYT group supervision model is offered as an effective blueprint for yoga therapy training programs.

  9. Psychiatric hospital nursing staff's experiences of participating in group-based clinical supervision:

    DEFF Research Database (Denmark)

    Buus, Niels; Angel, Sanne; Traynor, Michael

    2010-01-01

    Group-based clinical supervision is commonly offered as a stress-reducing intervention in psychiatric settings, but nurses often feel ambivalent about participating. This study aimed at exploring psychiatric nurses' experiences of participating in groupbased supervision and identifying psychosocial...... reasons for their ambivalence. Semi-structured interviews were conducted with 22 psychiatric nurses at a Danish university hospital. The results indicated that participation in clinical supervision was difficult for the nurses because of an uncomfortable exposure to the professional community. The sense...... of exposure was caused by the particular interactional organisation during the sessions, which brought to light pre-existing but covert conflicts among the nurses....

  10. The Role of Supervisors' and Supervisees' Mindfulness in Clinical Supervision

    Science.gov (United States)

    Daniel, Laura; Borders, L. DiAnne; Willse, John

    2015-01-01

    The authors explored whether supervisor and supervisee self-ratings of mindfulness (N = 72 supervision pairs) predicted perceptions of the supervisory relationship and session dynamics. Only supervisor self-ratings of mindfulness predicted their own ratings of the supervisory relationship and session dynamics.

  11. Ad hoc supervision of general practice registrars as a 'community of practice': analysis, interpretation and re-presentation.

    Science.gov (United States)

    Clement, T; Brown, J; Morrison, J; Nestel, D

    2016-05-01

    General practice registrars in Australia undertake most of their vocational training in accredited general practices. They typically see patients alone from the start of their community-based training and are expected to seek timely ad hoc support from their supervisor. Such ad hoc encounters are a mechanism for ensuring patient safety, but also provide an opportunity for learning and teaching. Wenger's (Communities of practice: learning, meaning, and identity. Cambridge University Press, New York, 1998) social theory of learning ('communities of practice') guided a secondary analysis of audio-recordings of ad hoc encounters. Data from one encounter is re-presented as an extended sequence to maintain congruence with the theoretical perspective and enhance vicariousness. An interpretive commentary communicates key features of Wenger's theory and highlights the researchers' interpretations. We argue that one encounter can reveal universal understandings of clinical supervision and that the process of naturalistic generalisation allows readers to transfer others' experiences to their own contexts. The paper raises significant analytic, interpretive, and representational issues. We highlight that report writing is an important, but infrequently discussed, part of research design. We discuss the challenges of supporting the learning and teaching that arises from adopting a socio-cultural lens and argue that such a perspective importantly captures the complex range of issues that work-based practitioners have to grapple with. This offers a challenge to how we research and seek to influence work-based learning and teaching in health care settings.

  12. Evaluation of a youth agency's supervision practices: A mixed-method approach.

    Science.gov (United States)

    Gosselin, Julie; Valiquette-Tessier, Sophie-Claire; Vandette, Marie-Pier; Romano, Elisa

    2015-10-01

    This research presents the findings from an evaluation and organizational development initiative that was requested by a Canadian youth agency working in a large urban setting. A team of four researchers affiliated with the Center for Research on Educational and Community Services (CRECS) at the University of Ottawa conducted the evaluation. The purpose of the evaluation was to identify the supervision needs and challenges of coordinators and front line staff, assess the efficiency of the current supervision practices, and evaluate the supervisors' and supervisees' satisfaction with these current practices. A literature review was performed to help provide a clear definition of 'supervision' and the different professional roles it encompasses. Additionally, research evidence pertaining both to what contributes to supervision efficacy and supervisor competency was reviewed to distill the most robust findings in the existing literature. The lines of evidence consisted of a document and file review, an online employee survey, group discussions (i.e. focus groups), and interviews with key informants. The results of the evaluation helped the research team formulate recommendations to the agency for the development of enhanced supervision practices across its various service areas.

  13. Double Blind: Supervising Women as Creative Practice-Led Researchers

    Science.gov (United States)

    Pedersen, Courtney; Haynes, Rachael

    2015-01-01

    Many women creative practice-led researchers appear inhibited by a number of factors directly connected to their gender. This article discusses these factors, including the culture of visual arts professional practice, the circumstances surrounding women postgraduate students and unproductive self-theories about intelligence and creativity. A…

  14. Computerizing clinical practice guidelines

    DEFF Research Database (Denmark)

    Lyng, Karen Marie

    It is well described that hospitals have problems with sustaining high quality of care and expedient introduction of new medical knowledge. Clinical practice guidelines (CPGs) have been promoted as a remedy to deal with these problems. It is, however, also well described that application and comp......It is well described that hospitals have problems with sustaining high quality of care and expedient introduction of new medical knowledge. Clinical practice guidelines (CPGs) have been promoted as a remedy to deal with these problems. It is, however, also well described that application...... and compliance with CPGs in most areas of clinical practice are deficient. Computerization of CPGs has been brought forward as a method to disseminate and to support application of CPGs. Until now, CPG-computerization has focused on development of formal expressions of CPGs. The developed systems have, however......, not gained any extensive application in clinical practice. The basic assumption in this thesis is that the scanty penetration is due to an inappropriate design process when designing computerized CPGs for clinical work practice. This thesis examines the application of guidance within areas where CPG...

  15. Clinical supervision reflected in a Danish DPCCQ sample

    DEFF Research Database (Denmark)

    Nielsen, Jan; Jacobsen, Claus Haugaard

    on describing the amount and type of supervision received and given by the sample. Findings from these descriptive statistics will be compared within the sample across demographic parameters such as age and sex, and professional characteristics such as career level, theoretical preferences, type of clients...... (pathology), satisfaction or distress at work, etc. Discussion: Implications of the findings for the development of therapists and the training of supervisors will be discussed....

  16. Clinical supervision of allied health professionals in country South Australia: A mixed methods pilot study.

    Science.gov (United States)

    Kumar, Saravana; Osborne, Kate; Lehmann, Tanya

    2015-10-01

    Recent times have witnessed dramatic changes in health care with overt recognition for quality and safety to underpin health care service delivery. In addition to systems-wide focus, the importance of supporting and mentoring people delivering the care has also been recognised. This can be achieved through quality clinical supervision. In 2010, Country Health South Australia Local Health Network developed a holistic allied health clinical governance structure, which was implemented in 2011. This research reports on emergent findings from the evaluation of the clinical governance structure, which included mandating clinical supervision for all allied health staff. A mixed method approach was chosen with evaluation of the impact of clinical supervision undertaken by a psychometrically sound instrument (Manchester Clinical Supervision Scale 26-item version), collected through an anonymous online survey and qualitative data collected through semistructured interviews and focus groups. Overall, 189 allied health professionals responded to the survey. Survey responses indicated allied health professionals recognised the importance of and valued receiving clinical supervision (normative domain), had levels of trust and rapport with, and were supported by supervisors (restorative domain) and positively affected their delivery of care and improvement in skills (formative domain). Qualitative data identified enablers such as profession specific gains, improved opportunities and consistency for clinical supervision and barriers such as persistent organisational issues, lack of clarity (delineation of roles) and communication issues. The findings from this research highlight that while clinical supervision has an important role to play, it is not a panacea for all the ills of the health care system. © 2015 National Rural Health Alliance Inc.

  17. Computerizing clinical practice guidelines

    DEFF Research Database (Denmark)

    Lyng, Karen Marie

    . The analysis focuses on the emergence of general clinical work practice demands on guidance • An analysis of guidance demands from clinical work practice and business strategy, focusing on implications for the design of computerised CPGs. In my research, I have applied observation studies, interviews...... is comprised by fieldwork in three oncology departments and a case study of advanced life support. Although close to all patients within oncology are treated according to a CPG, I found limited application of physical CPGs and web-based CPG portals. However, I found comprehensive application of activity...... feasible • Designed in a way that provides room for local adaptations of guidance • Designed with focus on specific business strategic aims Further, based on my findings, I will suggest that design of computerized CPGs should be based on: 1) scrutinization of the clinical work practice, 2) articulation...

  18. Evaluation and Supervision of Co-Teaching: A Study of Administrator Practices in New Jersey

    Science.gov (United States)

    Kamens, Michele Wilson; Susko, JoAnn P.; Elliott, Janice S.

    2013-01-01

    With the continuing increase of inclusive education in our public school classrooms today, there is a great deal of interest in co-teaching teams. Research indicates that administrative support is a critical factor in co-teaching effectiveness. In this study, we explored administrator knowledge and practices related to the supervision and…

  19. Supervision Practices and Teachers' Satisfaction in Public Secondary Schools: Malaysia and China

    Science.gov (United States)

    Hamzah, Mohd Izham Mohd; Wei, Yan; Ahmad, Jamil; Hamid, Aida Hanim A.; Mansor, Azlin Norhaini

    2013-01-01

    The purpose of this study is to explore supervision practices among school management teams and teachers' satisfaction in secondary schools in Kuala Lumpur, Malaysia and He Fei, China. The samples consist of 248 managers and 367 teachers in Kuala Lumpur, and 175 managers and 346 teachers in He Fei. The study indicates that the level of supervision…

  20. Undergraduate Internship Supervision in Psychology Departments: Use of Experiential Learning Best Practices

    Science.gov (United States)

    Bailey, Sarah F.; Barber, Larissa K.; Nelson, Videl L.

    2017-01-01

    This study examined trends in how psychology internships are supervised compared to current experiential learning best practices in the literature. We sent a brief online survey to relevant contact persons for colleges/universities with psychology departments throughout the United States (n = 149 responded). Overall, the majority of institutions…

  1. Regulating the placebo effect in clinical practice.

    Science.gov (United States)

    Chan, Tracey E

    2015-01-01

    Recent research and ethical analysis have forced a clinical and ethical reappraisal of the utility of placebos in medical practice. The main concern of ethics and law is that using placebos in health care involves deception, which is antithetical to patient autonomy and trust in the physician-patient relationship. This article reviews the various, more nuanced scientific conceptions of the placebo effect, and evaluates the ethical and legal objections to deploying placebos in clinical practice. It argues that the placebo effect may be legitimately accommodated on the basis that it does not engage the requirement for material or quasi-fiduciary disclosures of information, and may also be justified by therapeutic privilege. In addition, this reconceptualisation of the placebo effect offers a new justification for therapeutic privilege in these contexts. Notwithstanding this, using the placebo effect in clinical practice raises regulatory issues that will require special regulatory supervision.

  2. BEST PRACTICE IN INDIVIDUAL SUPERVISION OF PSYCHOLOGISTS WORKING IN THE FRENCH CAPEDP PREVENTIVE PERINATAL HOME-VISITING PROGRAM: RESULTS OF A DELPHI CONSENSUS PROCESS.

    Science.gov (United States)

    Greacen, Tim; Welniarz, Bertrand; Purper-Ouakil, Diane; Wendland, Jaqueline; Dugravier, Romain; Saïas, Thomas; Tereno, Susana; Tubach, Florence; Haddad, Alain; Guedeney, Antoine

    2017-03-01

    Individual supervision of home-visiting professionals has proved to be a key element for perinatal home-visiting programs. Although studies have been published concerning quality criteria for supervision in North American contexts, little is known about this subject in other national settings. In the context of the CAPEDP program (Compétences parentales et Attachement dans la Petite Enfance: Diminution des risques liés aux troubles de santé mentale et Promotion de la résilience; Parental Skills and Attachment in Early Childhood: Reducing Mental Health Risks and Promoting Resilience), the first randomized controlled perinatal mental health promotion research program to take place in France, this article describes the results of a study using the Delphi consensus method to identify the program supervisors' points of view concerning best practice for the individual supervision of home visitors involved in such programs. The final 18 recommendations could be grouped into four general themes: the organization and setting of supervision sessions; supervisor competencies; relationship between supervisor and supervisee; and supervisor intervention strategies within the supervision process. The quality criteria identified in this perinatal home-visiting program in the French cultural context underline the importance of clinical supervision and not just reflective supervision when working with families with multiple, highly complex needs.

  3. Administrative clinical supervision as evaluated by the first-line managers in one health care organization district.

    Science.gov (United States)

    Sirola-Karvinen, Pirjo; Hyrkäs, Kristiina

    2008-07-01

    The aim of this article is to increase knowledge and understanding of administrative clinical supervision. Administrative clinical supervision is a learning process for leaders that is based on experiences. Only a few studies have focused on administrative clinical supervision. The materials for this study were evaluations collected in 2002-2005 using a clinical supervision evaluation scale (MCSS). The respondents (n = 126) in the study were nursing leaders representing different specialties. The data were analysed statistically. The findings showed that the supervision succeeded very well. The contents of the sessions differed depending on the nurse leader's position. Significant differences were found in the evaluations between specialties and within years of work experience. Clinical supervision was utilized best in the psychiatric and mental health sector. The supervisees' who had long work experience scored the importance and value of clinical supervision as high. Clinical supervision is beneficial for nursing leaders. The experiences were positive and the nursing leaders appreciated the importance and value of clinical supervision. It is important to plan and coordinate a longitudinal evaluation so that clinical supervision for nursing leaders is systematically implemented and continuously developed.

  4. A framework to facilitate self-directed learning, assessment and supervision in midwifery practice: a qualitative study of supervisors' perceptions.

    Science.gov (United States)

    Embo, M; Driessen, E; Valcke, M; van der Vleuten, C P M

    2014-08-01

    Self-directed learning is an educational concept that has received increasing attention. The recent workplace literature, however, reports problems with the facilitation of self-directed learning in clinical practice. We developed the Midwifery Assessment and Feedback Instrument (MAFI) as a framework to facilitate self-directed learning. In the present study, we sought clinical supervisors' perceptions of the usefulness of MAFI. Interviews with fifteen clinical supervisors were audio taped, transcribed verbatim and analysed thematically using Atlas-Ti software for qualitative data analysis. Four themes emerged from the analysis. (1) The competency-based educational structure promotes the setting of realistic learning outcomes and a focus on competency development, (2) instructing students to write reflections facilitates student-centred supervision, (3) creating a feedback culture is necessary to achieve continuity in supervision and (4) integrating feedback and assessment might facilitate competency development under the condition that evidence is discussed during assessment meetings. Supervisors stressed the need for direct observation, and instruction how to facilitate a self-directed learning process. The MAFI appears to be a useful framework to promote self-directed learning in clinical practice. The effect can be advanced by creating a feedback and assessment culture where learners and supervisors share the responsibility for developing self-directed learning. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Audit in clinical practice.

    Science.gov (United States)

    Modayil, Prince Cheriyan; Panchikkeel, Ragesh Kuyyattil; Alex, Nisha

    2009-06-01

    Audit dates back to as early as 1750 BC when king Hammurabi of Babylon instigated audit for clinicians with regard to outcome. Clinical audit is a way of fi nding out whether we are doing what we should be doing. It also verifi es whether we are applying the best practice. An audit cycle involves setting-up of standards, measuring current practice, comparing results with standards (criteria), changing practice and re-auditing to make sure practice has improved A 'clinical audit' is a quality improvement process that seeks to improve patient care and clinical outcomes through a systematic review of care against explicit criteria, and the implementation of change. Changes are implemented at an individual, team or service level and a subsequent re-audit is done to confi rm improvement in health care delivery. The importance of audit in healthcare sector needs to be appreciated by the relevant authorities. The most frequently cited barrier to successful audit is the failure of organizations to provide suffi cient fund and protected time for healthcare teams.

  6. Translating and validating the Finnish version of the Manchester Clinical Supervision Scale.

    Science.gov (United States)

    Hyrkäs, Kristiina; Appelqvist-Schmidlechner, Kaija; Paunonen-Ilmonen, Marita

    2003-12-01

    Evaluation research provides new perspectives for clinical supervision (CS), and international collaboration offers advantages to develop valid instruments for this purpose. Besides translation, an instrument developed and tested in another culture requires systematic validation. The study focuses on the translation process of the Manchester Clinical Supervision Scale for testing in Finland carried out collaboratively between the Universities of Tampere and Manchester. The instrument is a 45-item questionnaire with a Likert-type (1-5) scale comprising seven sub-scales: trust and rapport, supervisor advice and support, improved care and skills, importance and value of CS, finding time, personal issues and reflection and total score. At first, a licensed translator translated the instrument into Finnish. A native British language teacher at the University language centre performed the blind back-translation into English. The translations were compared by both collaborative parties and by three experienced Finnish supervisors. A pilot sample (n = 182) was collected to test the translated instrument. In this sample Cronbach's alpha value for the total score was 0.9227 and in the sub-scales 0.6393-0.8838. The mean values in the sub-scales were 14.2-29.3, SDs 3.02-3.88 and modes 14.0-30.0. The British test sample had almost similar values. Translating an instrument into another language not only requires expertise in language, but also in practice. The cultural validation is the most important phase in the process that can be accomplished with pilot testing and statistical methods. However, further expert evaluation is required for the validity of the instrument.

  7. Clinical supervision of nursing students: challenges and alternatives

    African Journals Online (AJOL)

    practice is to prepare nursing students develop and apply the necessary theoretical and empirical knowledge and skills in .... Practice, teaching methodology and inter-disciplinary ... The most common and probably the best model for Rwanda.

  8. [Guidelines for clinical practice].

    Science.gov (United States)

    Vleugels, A M

    1997-01-01

    Clinical practice guidelines are systematically developed statements that are intended to support medical decision making in well-defined clinical situations. Essentially, their object is to reduce the variability in medical practice, to improve quality, and to make appropriated control of the financial resources possible. Internationally, ever more organisations, associations, and institutions are concerned with the development of guidelines in many different areas of care. Making implicit knowledge explicit is one of the associated advantages of guidelines: they have a potential utility in training, in process evaluation, and in the reevaluation of outcome studies. In liability issues, their existence has a double effect: they can be used to justify medical behaviour, and they constitute a generally accepted reference point. A derivative problem is the legal liability of the compilers of the guidelines. The principle of the guideline approach can be challenged academically: science cannot give a definition of optimal care with absolute certainty. What is called objectivity often rests on methodologically disputable analyses; also the opinion of opinion leaders is not always a guarantee for scientific soundness. Moreover, patients are not all identical: biological variability, situational factors, patient expectations, and other elements play a role in this differentiation. Clinicians are often hesitant with respect to clinical guidelines: they are afraid of cookbook medicine and curtailment of their professional autonomy. Patients fear reduction of individualization of care and the use of guidelines as a rationing instrument. The effects of the introduction of clinical practice guidelines on medical practice, on the results and on the cost of care vary but are generally considered to be favourable. The choice of appropriate strategies in development, dissemination, and implementation turns out to be of critical importance. The article ends with concrete

  9. [Neuroethics in clinical practice].

    Science.gov (United States)

    Krug, H

    2009-08-01

    In recent years the ability of neuroscience to identify and intervene in mental functions has progressed immensely, which raises several anthropologic and ethical questions. Meanwhile neuroethics arose as a new interdisciplinary field for critical analysis of neuroscientific actions and ethical reflection on the increasing knowledge of the human brain, with regard to society and politics. This article provides a survey of neuroethical implications for clinical practice.

  10. The Effectiveness and Cost of Clinical Supervision for Motivational Interviewing: A Randomized Controlled Trial.

    Science.gov (United States)

    Martino, Steve; Paris, Manuel; Añez, Luis; Nich, Charla; Canning-Ball, Monica; Hunkele, Karen; Olmstead, Todd A; Carroll, Kathleen M

    2016-09-01

    The effectiveness of a competency-based supervision approach called Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency (MIA: STEP) was compared to supervision-as-usual (SAU) for increasing clinicians' motivational interviewing (MI) adherence and competence and client retention and primary substance abstinence in a multisite hybrid type 2 effectiveness-implementation randomized controlled trial. Participants were 66 clinicians and 450 clients within one of eleven outpatient substance abuse programs. An independent evaluation of audio recorded supervision sessions indicated that MIA: STEP and SAU were highly and comparably discriminable across sites. While clinicians in both supervision conditions improved their MI performance, clinician supervised with MIA: STEP, compared to those in SAU, showed significantly greater increases in the competency in which they used fundamental and advanced MI strategies when using MI across seven intakes through a 16-week follow-up. There were no retention or substance use differences among the clients seen by clinicians in MIA: STEP or SAU. MIA: STEP was substantially more expensive to deliver than SAU. Innovative alternatives to resource-intensive competency-based supervision approaches such as MIA: STEP are needed to promote the implementation of evidence-based practices.

  11. Self-care assessment as an indicator for clinical supervision in nursing

    Directory of Open Access Journals (Sweden)

    Sílvia Marlene Monteiro Teixeira

    2016-01-01

    Full Text Available Objective : to evaluate the needs of clinical supervision for nurses to assess the degree of dependence on self- care and planning of nursing interventions. Methods : analytical study, cross-cutting nature, collecting data from a sample of 110 patients. Results : it was shown the differences in the identification of the degree of dependence between registers and experts, as well as the selection of operations for each self-care and failures to the original assessment of the filling level (no evaluation self-care/no identification of the degree of dependence. Conclusion : there were gaps in the nursing process; they have proposed strategies such as clinical supervision sessions, training, case studies, protocols and guidance documents, to be included in a clinical supervision in nursing model.

  12. Self-care assessment as an indicator for clinical supervision in nursing

    Directory of Open Access Journals (Sweden)

    Sílvia Marlene Monteiro Teixeira

    2016-06-01

    Full Text Available Objective: to evaluate the needs of clinical supervision for nurses to assess the degree of dependence on self-care and planning of nursing interventions. Methods: analytical study, cross-cutting nature, collecting data from a sample of 110 patients. Results: it was shown the differences in the identification of the degree of dependence between registers and experts, as well as the selection of operations for each self-care and failures to the original assessment of the filling level (no evaluation self-care/no identification of the degree of dependence. Conclusion: there were gaps in the nursing process; they have proposed strategies such as clinical supervision sessions, training, case studies, protocols and guidance documents, to be included in a clinical supervision in nursing model.

  13. Genetic Counseling Supervisors' Self-Efficacy for Select Clinical Supervision Competencies.

    Science.gov (United States)

    Finley, Sabra Ledare; Veach, Pat McCarthy; MacFarlane, Ian M; LeRoy, Bonnie S; Callanan, Nancy

    2016-04-01

    Supervision is a primary instructional vehicle for genetic counseling student clinical training. Approximately two-thirds of genetic counselors report teaching and education roles, which include supervisory roles. Recently, Eubanks Higgins and colleagues published the first comprehensive list of empirically-derived genetic counseling supervisor competencies. Studies have yet to evaluate whether supervisors possess these competencies and whether their competencies differ as a function of experience. This study investigated three research questions: (1) What are genetic counselor supervisors' perceptions of their capabilities (self-efficacy) for a select group of supervisor competencies?, (2) Are there differences in self-efficacy as a function of their supervision experience or their genetic counseling experience, and 3) What training methods do they use and prefer to develop supervision skills? One-hundred thirty-one genetic counselor supervisors completed an anonymous online survey assessing demographics, self-efficacy (self-perceived capability) for 12 goal setting and 16 feedback competencies (Scale: 0-100), competencies that are personally challenging, and supervision training experiences and preferences (open-ended). A MANOVA revealed significant positive effects of supervision experience but not genetic counseling experience on participants' self-efficacy. Although mean self-efficacy ratings were high (>83.7), participant comments revealed several challenging competencies (e.g., incorporating student's report of feedback from previous supervisors into goal setting, and providing feedback about student behavior rather than personal traits). Commonly preferred supervision training methods included consultation with colleagues, peer discussion, and workshops/seminars.

  14. Bridging Theory and Practice: A Critical Discourse Analysis of a Social Justice Initiative within a Narrative Supervision Process

    Science.gov (United States)

    Kahn, Sarah Zeta

    2013-01-01

    The purpose of this study was to increase the current understanding of what occurs within a narrative supervision process and to explore how this approach to supervision can contribute to the development of educational practices that promote social justice efforts in the field of marriage and family therapy. In particular, this study sought to…

  15. Myocarditis in Clinical Practice.

    Science.gov (United States)

    Sinagra, Gianfranco; Anzini, Marco; Pereira, Naveen L; Bussani, Rossana; Finocchiaro, Gherardo; Bartunek, Jozef; Merlo, Marco

    2016-09-01

    Myocarditis is a polymorphic disease characterized by great variability in clinical presentation and evolution. Patients presenting with severe left ventricular dysfunction and life-threatening arrhythmias represent a demanding challenge for the clinician. Modern techniques of cardiovascular imaging and the exhaustive molecular evaluation of the myocardium with endomyocardial biopsy have provided valuable insight into the pathophysiology of this disease, and several clinical registries have unraveled the disease's long-term evolution and prognosis. However, uncertainties persist in crucial practical issues in the management of patients. This article critically reviews current information for evidence-based management, offering a rational and practical approach to patients with myocarditis. For this review, we searched the PubMed and MEDLINE databases for articles published from January 1, 1980, through December 31, 2015, using the following terms: myocarditis, inflammatory cardiomyopathy, and endomyocardial biopsy. Articles were selected for inclusion if they represented primary data or were review articles published in high-impact journals. In particular, a risk-oriented approach is proposed. The different patterns of presentation of myocarditis are classified as low-, intermediate-, and high-risk syndromes according to the most recent evidence on prognosis, clinical findings, and both invasive and noninvasive testing, and appropriate management strategies are proposed for each risk class.

  16. Supervision on Transference and Counter-Transference Issues for Undergraduate Students’ Counseling Practice at Counseling Department

    Directory of Open Access Journals (Sweden)

    Amirah Diniaty

    2014-07-01

    Full Text Available Undergraduate students should take 4 credits for counseling practice subject in Counseling Department of State Islamic University of Riau. The subject is taken by seventh semester students who conduct counseling practice at senior high school for 3 months. Based on prelimenary study, majority of students acknowledged that they felt nervous to follow this programme. Thus, the problem of transference and counter transference issue for undergraduate students counseling practice must be answered by their supervisions. The result showed that a total of 93% of respondents had positive transference, while 7% of them had negative one. It means that majority of respondents felt positive transference, while internship students faced identification counter transference. It was proved that internship students did not need to have negative thinking of being rejected by the schools. The finding also showed that 97.3% of interenship students faced identification counter transference, while 2,7%  of them experienced for unidentification of transfenece. It means that there were a few of them should be supervised to have good counter transference. Supervision format that done by supervisor (university teacher and tutor (high school teacher was by conducting monthly meeting and by following up counseling result and writing report. It is recommended that a professional discussion is conducted to discuss problems faced by internship students.

  17. Supervision on Transference and Counter-Transference Issues for Undergraduate Students’ Counseling Practice at Counseling Department

    Directory of Open Access Journals (Sweden)

    Amirah Diniaty

    2014-07-01

    Full Text Available Undergraduate students should take 4 credits for counseling practice subject in Counseling Department of State Islamic University of Riau. The subject is taken by seventh semester students who conduct counseling practice at senior high school for 3 months. Based on prelimenary study, majority of students acknowledged that they felt nervous to follow this programme. Thus, the problem of transference and counter transference issue for undergraduate students counseling practice must be answered by their supervisions. The result showed that a total of 93% of respondents had positive transference, while 7% of them had negative one. It means that majority of respondents felt positive transference, while internship students faced identification counter transference. It was proved that internship students did not need to have negative thinking of being rejected by the schools. The finding also showed that 97.3% of interenship students faced identification counter transference, while 2,7%  of them experienced for unidentification of transfenece. It means that there were a few of them should be supervised to have good counter transference. Supervision format that done by supervisor (university teacher and tutor (high school teacher was by conducting monthly meeting and by following up counseling result and writing report. It is recommended that a professional discussion is conducted to discuss problems faced by internship students.

  18. Value and Clinical Impact of an Infectious Disease-Supervised Outpatient Parenteral Antibiotic Therapy Program

    Science.gov (United States)

    Petrak, Russell M.; Skorodin, Nathan C.; Fliegelman, Robert M.; Hines, David W.; Chundi, Vishnu V.; Harting, Brian P.

    2016-01-01

    Background. Outpatient parenteral antibiotic therapy (OPAT) is a safe and effective modality for treating serious infections. This study was undertaken to define the value of OPAT in a multicentered infectious disease (ID) private practice setting. Methods. Over a period of 32 months, 6120 patients were treated using 19 outpatient ID offices in 6 states. Analysis included patient demographics, indications of OPAT, diagnoses, therapeutic agent, duration of therapy, and site of therapy initiation. Outcomes were stratified by therapeutic success, clinical relapse, therapeutic complications, and hospitalizations after initiating therapy. Statistical analysis included an ordinal logistic regression analysis. Results. Forty-three percent of patients initiated therapy in an outpatient office, and 57% began therapy in a hospital. Most common diagnoses treated were bone and joint (32.2%), abscesses (18.8%), cellulitis (18.5%), and urinary tract infection (10.8%). Ninety-four percent of patients were successfully treated, and only 3% were hospitalized after beginning therapy. Most common cause of treatment failure was a relapse of primary infection (60%), progression of primary infection (21%), and therapeutic complication (19%). Conclusions. An ID-supervised OPAT program is safe, efficient, and clinically effective. By maximizing the delivery of outpatient care, OPAT provides a tangible value to hospitals, payers, and patients. This program is a distinctive competency available to ID physicians who offer this service to patients.

  19. The Relationship between Athletic Training Student Critical Thinking Skills and Clinical Instructor Supervision: A Pilot Study

    Science.gov (United States)

    Kabay, Michele R.

    2013-01-01

    The purpose of this study was to 1) assess the critical thinking skill level of the athletic training student at onset and end of the clinical education experience 2) to examine the influence of the students' critical thinking skills and the CIs' supervision responses to the changes in the students' critical thinking skills and 3) to compare the…

  20. Changes in Emotion Work at Interdisciplinary Conferences Following Clinical Supervision in a Palliative Outpatient Ward

    DEFF Research Database (Denmark)

    Nordentoft, Helle Merete

    2008-01-01

    In this article, I describe changes in emotion work at weekly interdisciplinary conferences in a palliative1 outpatient ward following clinical supervision (CS). I conceive emotions as constantly negotiated in interaction, and I researched the similarity between how this is done during CS and at ...... conclude that CS enhances professional development and may prevent burnout in palliative care....

  1. Integrating learning assessment and supervision in a competency framework for clinical workplace education.

    Science.gov (United States)

    Embo, M; Driessen, E; Valcke, M; van der Vleuten, C P M

    2015-02-01

    Although competency-based education is well established in health care education, research shows that the competencies do not always match the reality of clinical workplaces. Therefore, there is a need to design feasible and evidence-based competency frameworks that fit the workplace reality. This theoretical paper outlines a competency-based framework, designed to facilitate learning, assessment and supervision in clinical workplace education. Integration is the cornerstone of this holistic competency framework.

  2. How supportive supervision influences immunization session site practices: a quasi-experimental study in Odisha, India

    Directory of Open Access Journals (Sweden)

    Bhuputra Panda

    2015-01-01

    Full Text Available Background: Routine immunization (RI is a key child survival intervention. Ensuring acceptable standards of RI service delivery is critical for optimal outcomes. Accumulated evidences suggest that ‘supportive supervision’ improves the quality of health care services in general. During 2009–2010, the Government of Odisha and UNICEF jointly piloted this strategy in four districts to improve RI program outcomes. The present study aims to assess the effect of this strategy on improvement of skills and practices at immunization session sites. Design: A quasi-experimental ‘post-test only’ study design was adopted to compare the opinion and practices of frontline health workers and their supervisors in four intervention districts (IDs with two control districts (CDs. Altogether, we interviewed 111 supervisor–supervisee (health worker pairs using semi-structured interview schedules and case vignettes. We also directly observed health workers’ practices during immunization sessions at 111 sites. Data were analyzed with SPSS version 16.0. Results: The mean knowledge score of supervisors in CDs was significantly higher than in intervention groups. Variegated responses were obtained on case vignettes. The control group performed better in solving certain hypothetically asked problems, whereas the intervention group scored better in others. Health workers in IDs gave a lower rating to their respective supervisors’ knowledge, skill, and frequency of supervision. Logistics and vaccine availability were better in CDs. Conclusion: Notwithstanding other limitations, supportive supervision may not have independent effects on improving the quality of immunization services. Addressing systemic issues, such as the availability of essential logistics, supply chain management, timely indenting, and financial resources, could complement the supportive supervision strategy in improving immunization service delivery.

  3. Practicing the triad teaching-research- extension in supervised internship of licentiateship in biological sciences

    Directory of Open Access Journals (Sweden)

    Lilliane Miranda Freitas

    2012-06-01

    Full Text Available In this paper we report an educational experience based on the triad teaching-research-extension occurred in the supervised internship in licentiateship in Biological Sciences. In this experiment, the students made a transposition of the scientific knowledge produced in their course conclusion work to the knowledge of basic education curriculum. We analyze in this article the impressions of undergraduates after completion of pedagogical actions. We discuss, based on the reports, how the knowledge that is constructed and reconstructed in academic research can contribute directly to the improvement of the science education quality through science literacy and also in teacher training of undergraduates, through the reflection on their own practice. Therefore, we consider that, with the practice of the inseparability of teaching-research-extension, there will be more return for academic research and also for the school community, generating significant changes in educational practices in schools

  4. [Hydration in clinical practice].

    Science.gov (United States)

    Maristany, Cleofé Pérez-Portabella; Segurola Gurruchaga, Hegoi

    2011-01-01

    Water is an essential foundation for life, having both a regulatory and structural function. The former results from active and passive participation in all metabolic reactions, and its role in conserving and maintaining body temperature. Structurally speaking it is the major contributer to tissue mass, accounting for 60% of the basis of blood plasma, intracellular and intersticial fluid. Water is also part of the primary structures of life such as genetic material or proteins. Therefore, it is necessary that the nurse makes an early assessment of patients water needs to detect if there are signs of electrolyte imbalance. Dehydration can be a very serious problem, especially in children and the elderly. Dehydrations treatment with oral rehydration solution decreases the risk of developing hydration disorders, but even so, it is recommended to follow preventive measures to reduce the incidence and severity of dehydration. The key to having a proper hydration is prevention. Artificial nutrition encompasses the need for precise calculation of water needs in enteral nutrition as parenteral, so the nurse should be part of this process and use the tools for calculating the patient's requirements. All this helps to ensure an optimal nutritional status in patients at risk. Ethical dilemmas are becoming increasingly common in clinical practice. On the subject of artificial nutrition and hydration, there isn't yet any unanimous agreement regarding hydration as a basic care. It is necessary to take decisions in consensus with the health team, always thinking of the best interests of the patient.

  5. Tablets as a digital tool in supervision of student teachers’ practical training

    OpenAIRE

    2016-01-01

    In the project “Tablets in Practicum Supervision”, the tablet has been tested as a tool for observation and supervision in Norwegian teacher education. The study incorporates 14 practicum supervision groups and focuses on how the use of tablets can influence the quality of the supervision and the coherence between teaching, observation and supervision. Throughout the supervision process, the groups have used tablets to produce and share texts, pictures and video recordings. The use of tablets...

  6. Clinical learning environment, supervision and nurse teacher evaluation scale: psychometric evaluation of the Swedish version.

    Science.gov (United States)

    Johansson, Unn-Britt; Kaila, Päivi; Ahlner-Elmqvist, Marianne; Leksell, Janeth; Isoaho, Hannu; Saarikoski, Mikko

    2010-09-01

    This article is a report of the development and psychometric testing of the Swedish version of the Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale. To achieve quality assurance, collaboration between the healthcare and nursing systems is a pre-requisite. Therefore, it is important to develop a tool that can measure the quality of clinical education. The Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale is a previously validated instrument, currently used in several universities across Europe. The instrument has been suggested for use as part of quality assessment and evaluation of nursing education. The scale was translated into Swedish from the English version. Data were collected between March 2008 and May 2009 among nursing students from three university colleges, with 324 students completing the questionnaire. Exploratory factor analysis was performed on the 34-item scale to determine construct validity and Cronbach's alpha was used to measure the internal consistency. The five sub-dimensions identified in the original scale were replicated in the exploratory factor analysis. The five factors had explanation percentages of 60.2%, which is deemed sufficient. Cronbach's alpha coefficient for the total scale was 0.95, and varied between 0.96 and 0.75 within the five sub-dimensions. The Swedish version of Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale has satisfactory psychometric properties and could be a useful quality instrument in nursing education. However, further investigation is required to develop and evaluate the questionnaire.

  7. Broadening the "Ports of Entry" for Speech-Language Pathologists: A Relational and Reflective Model for Clinical Supervision

    Science.gov (United States)

    Geller, Elaine; Foley, Gilbert M.

    2009-01-01

    Purpose: To offer a framework for clinical supervision in speech-language pathology that embeds a mental health perspective within the study of communication sciences and disorders. Method: Key mental health constructs are examined as to how they are applied in traditional versus relational and reflective supervision models. Comparisons between…

  8. Clinical supervision in a UK military Department of Community Mental Health.

    Science.gov (United States)

    Wesson, Matthew I; Whybrow, D; Greenberg, N; Gould, M

    2013-12-01

    Recent service developments in the NHS on the provision of talking therapies such as the Improving Access to Psychological Therapies (IAPT) initiative have made the compliance with clinical supervision (CS) inherent among its service guidelines. This paper presents the findings of an audit, measuring compliance with CS among clinicians providing psychological therapies within a military Department of Community Mental Health. Adherence to the recommended monthly supervision and the presence of an indate CS contract were audited on two separate occasions over 2 years by analysing the departmental electronic CS database. Compliance rates were found to be lower than the Defence guidelines, which are already modest in their expectations compared with IAPT CS standards. Potential reasons are hypothesised including high levels of staff rotation, other military commitments, clinicians not keeping up-to-date records and the pressures of meeting performance indicators on other clinical issues. Proposals for improving the uptake of CS are suggested along with areas for further research.

  9. Implementing a system of structured clinical supervision with a group of DipHE(nursing) RMN students.

    Science.gov (United States)

    Markham, V; Turner, P

    1998-01-01

    Clinical supervision is to become an integral part of mental health nursing, and the United Kingdom Central Council for Nursing, Midwifery & Health Visiting has recommended that it be incorporated in pre-registration education. This paper describes teachers' experiences of delivering a programme of clinical supervision education within the mental health branch of a diploma in nursing course. It outlines the implementation and evaluation of the programme, including discussion of the process and difficulties encountered. The programme appears to have provided a positive first experience for the students and to have given them the enthusiasm to adopt clinical supervision as part of their future roles as qualified practitioners.

  10. Clinical neuropsychology practice and training in Canada.

    Science.gov (United States)

    Janzen, Laura A; Guger, Sharon

    2016-11-01

    This invited paper provides information about professional neuropsychology issues in Canada and is part of a special issue addressing international perspectives on education, training, and practice in clinical neuropsychology. Information was gathered from literature searches and personal communication with other neuropsychologists in Canada. Canada has a rich neuropsychological history. Neuropsychologists typically have doctoral-level education including relevant coursework and supervised practical experience. Licensure requirements vary across the 10 provinces and there are regional differences in salary. While training at the graduate and internship level mirrors that of our American colleagues, completion of a two-year postdoctoral fellowship in neuropsychology is not required to obtain employment in many settings and there are few postdoctoral training programs in this country. The majority of neuropsychologists are employed in institutional settings (e.g. hospitals, universities, rehabilitation facilities), with a growing number entering private practice or other settings. There are challenges in providing neuropsychological services to the diverse Canadian population and a need for assessment measures and normative data in multiple languages. Canadian neuropsychologists face important challenges in defining ourselves as distinct from other professions and other psychologists, in maintaining funding for high-quality training and research, in establishing neuropsychology-specific training and practice standards at the provincial or national level, and ensuring the clinical care that we provide is efficient and effective in meeting the needs of our patient populations and consumers, both within and outside of the publically funded health care system.

  11. Model of practical skill performance as an instrument for supervision and formative assessment

    DEFF Research Database (Denmark)

    Nielsen, Carsten; Sommer, Irene; Larsen, Karin

    2012-01-01

    as during practice, performance and formative assessment of practical skills learning. It provided a common language about practical skills and enhanced the participants’ understanding of professionalism in practical nursing skill. In conclusion, the model helped to highlight the complexity in mastering......There are still weaknesses in the practical skills of newly graduated nurses. There is also an escalating pressure on existing clinical placements due to increasing student numbers and structural changes in health services. Innovative educational practices and the use of tools that might support...... learning are sparsely researched in the field of clinical education for nursing students. This paper reports on an action research study that promoted and investigated use of The Model of Practical Skill Performance as a learning tool during nursing students’ clinical placement. Clinical supervisors...

  12. Over Time, How Do Post-Ph.D. Scientists Locate Teaching and Supervision within Their Academic Practice?

    Science.gov (United States)

    McAlpine, Lynn

    2014-01-01

    While building a strong research profile is usually seen as key for those seeking a traditional academic position, teaching is also understood as central to academic practice. Still, we know little of how post-Ph.D. researchers seeking academic posts locate teaching and supervision in their academic practice, nor how their views may shift as they…

  13. Clinical learning environment and supervision of international nursing students: A cross-sectional study.

    Science.gov (United States)

    Mikkonen, Kristina; Elo, Satu; Miettunen, Jouko; Saarikoski, Mikko; Kääriäinen, Maria

    2017-05-01

    Previously, it has been shown that the clinical learning environment causes challenges for international nursing students, but there is a lack of empirical evidence relating to the background factors explaining and influencing the outcomes. To describe international and national students' perceptions of their clinical learning environment and supervision, and explain the related background factors. An explorative cross-sectional design was used in a study conducted in eight universities of applied sciences in Finland during September 2015-May 2016. All nursing students studying English language degree programs were invited to answer a self-administered questionnaire based on both the clinical learning environment, supervision and nurse teacher scale and Cultural and Linguistic Diversity scale with additional background questions. Participants (n=329) included international (n=231) and Finnish (n=98) nursing students. Binary logistic regression was used to identify background factors relating to the clinical learning environment and supervision. International students at a beginner level in Finnish perceived the pedagogical atmosphere as worse than native speakers. In comparison to native speakers, these international students generally needed greater support from the nurse teacher at their university. Students at an intermediate level in Finnish reported two times fewer negative encounters in cultural diversity at their clinical placement than the beginners. To facilitate a successful learning experience, international nursing students require a sufficient level of competence in the native language when conducting clinical placements. Educational interventions in language education are required to test causal effects on students' success in the clinical learning environment. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Evaluation of Practical Clinical Examinations.

    Science.gov (United States)

    Berrong, Joseph M.; And Others

    1983-01-01

    The effectiveness of practical examinations in assessing the clinical competence of dental students is discussed. A grading system that derives a significant portion of the senior student's grade from this type of examination is described. The impact of practical clinical examinations on two consecutive graduating classes was analyzed. (Author/MLW)

  15. Translation and validation of the clinical learning environment, supervision and nurse teacher scale (CLES + T) in Croatian language.

    Science.gov (United States)

    Lovrić, Robert; Piškorjanac, Silvija; Pekić, Vlasta; Vujanić, Jasenka; Ratković, Karolina Kramarić; Luketić, Suzana; Plužarić, Jadranka; Matijašić-Bodalec, Dubravka; Barać, Ivana; Žvanut, Boštjan

    2016-07-01

    Clinical practice is essential to nursing education as it provides experience with patients and work environments that prepare students for future work as nurses. The aim of this study was to translate the "Clinical Learning Environment, Supervision and Nurse Teacher" questionnaire in Croatian language and test its validity and reliability in practice. The study was performed at the Faculty of medicine, Josip Juraj Strossmayer University of Osijek, Croatia in April 2014. The translated questionnaire was submitted to 136 nursing students: 20 males and 116 females. Our results reflected a slightly different factor structure, consisting of four factors. All translated items of the original constructs "Supervisory relationship", "Role of nurse teacher" and "Leadership style of the ward manager" loaded on factor 1. Items of "Pedagogical atmosphere on the ward" are distributed on two factors (3 and 4). The items of "Premises of nursing on the ward" loaded on factor 2. Three items were identified as problematic and iteratively removed from the analysis. The translated version of the aforementioned questionnaire has properties suitable for the evaluation of clinical practice for nursing students within a Croatian context and reflects the specifics of the nursing clinical education in this country.

  16. Pharmacogenetics in clinical practice

    NARCIS (Netherlands)

    Derijks, Luc J. J.; Derijks, H. Jeroen; Touw, Daan J.; Conemans, Jean M. H.; Egberts, Antoine C. G.

    2008-01-01

    The availability of data from pharmacogenetic studies is reflected in therapeutic practice, and pharmacogenetics is slowly entering the medical arena. Preconditions for the utilisation of pharmacogenetic knowledge are that: 1) genetic variation and prevalence are known 2) pharmacological consequence

  17. Training the Millennial learner through experiential evolutionary scaffolding: implications for clinical supervision in graduate education programs.

    Science.gov (United States)

    Venne, Vickie L; Coleman, Darrell

    2010-12-01

    They are the Millennials--Generation Y. Over the next few decades, they will be entering genetic counseling graduate training programs and the workforce. As a group, they are unlike previous youth generations in many ways, including the way they learn. Therefore, genetic counselors who teach and supervise need to understand the Millennials and explore new ways of teaching to ensure that the next cohort of genetic counselors has both skills and knowledge to represent our profession well. This paper will summarize the distinguishing traits of the Millennial generation as well as authentic learning and evolutionary scaffolding theories of learning that can enhance teaching and supervision. We will then use specific aspects of case preparation during clinical rotations to demonstrate how incorporating authentic learning theory into evolutionary scaffolding results in experiential evolutionary scaffolding, a method that potentially offers a more effective approach when teaching Millennials. We conclude with suggestions for future research.

  18. Photodynamic therapy in clinical practice

    OpenAIRE

    E. V. Filonenko; L. G. Serova

    2016-01-01

    The review is on opportunities and possibilities of application of photodynamic therapy in clinical practice. The advantages of this method are the targeting of effect on tumor foci and high efficiency along with low systemic toxicity. The results of the set of recent Russian and foreign clinical trials are represented in the review. The method is successfully used in clinical practice with both radical (for early vulvar, cervical cancer and pre-cancer, central early lung cancer, esophageal a...

  19. Clinical Practice in Portuguese Sexology.

    Science.gov (United States)

    Alarcão, Violeta; Ribeiro, Sofia; Almeida, Joana; Giami, Alain

    2016-12-02

    Few studies explore the clinicians' knowledge, attitudes, and practices regarding sexuality, despite their role in the sexual-health socialization process. This study focuses on Portuguese sexologists engaged in clinical practice. It aims to characterize sexologists' sex education and training and their clinical practices, including diagnostic and therapeutic approaches. This research followed the methodology of an European survey on sexology as a profession (Euro-Sexo). From the 91 respondents who completed questionnaires, 51 (56%) were active in clinical practice. Results indicate that the Portuguese clinical sexologist is significantly older, predominantly male, has had training in sexology, performs more scientific research, and is more engaged in teaching activities when compared to nonclinical working sexologists. This article describes the main sexual problems presented by patients to Portuguese clinical sexologists and highlights differences in the professional groups and approaches toward treating these problems by medical doctors and nonmedical professionals. Results reinforce the idea that there are intra-European differences in the educational background of sexologists and reveal important variations in Portuguese sexologists' education, training, and clinical practice. The representations and practices of the sexologists in Portugal, as in other European countries, are embedded in cultural scenarios and sexual cultures, with implications for the clinical practice.

  20. Quality of clinical supervision and counselor emotional exhaustion: the potential mediating roles of organizational and occupational commitment.

    Science.gov (United States)

    Knudsen, Hannah K; Roman, Paul M; Abraham, Amanda J

    2013-01-01

    Counselor emotional exhaustion has negative implications for treatment organizations as well as the health of counselors. Quality clinical supervision is protective against emotional exhaustion, but research on the mediating mechanisms between supervision and exhaustion is limited. Drawing upon data from 934 counselors affiliated with treatment programs in the National Institute on Drug Abuse's Clinical Trials Network (CTN), this study examined commitment to the treatment organization and commitment to the counseling occupation as potential mediators of the relationship between quality clinical supervision and emotional exhaustion. The final ordinary least squares (OLS) regression model, which accounted for the nesting of counselors within treatment organizations, indicated that these two types of commitment were plausible mediators of the association between clinical supervision and exhaustion. Higher quality clinical supervision was strongly correlated with commitment to the treatment organization as well as commitment to the occupation of SUD counseling. These findings suggest that quality clinical supervision has the potential to yield important benefits for counselor well-being by strengthening ties to both their employing organization as well the larger treatment field, but longitudinal research is needed to establish these causal relationships.

  1. Test-retest reliability of the Clinical Learning Environment, Supervision and Nurse Teacher (CLES + T) scale.

    Science.gov (United States)

    Gustafsson, Margareta; Blomberg, Karin; Holmefur, Marie

    2015-07-01

    The Clinical Learning Environment, Supervision and Nurse Teacher (CLES + T) scale evaluates the student nurses' perception of the learning environment and supervision within the clinical placement. It has never been tested in a replication study. The aim of the present study was to evaluate the test-retest reliability of the CLES + T scale. The CLES + T scale was administered twice to a group of 42 student nurses, with a one-week interval. Test-retest reliability was determined by calculations of Intraclass Correlation Coefficients (ICCs) and weighted Kappa coefficients. Standard Error of Measurements (SEM) and Smallest Detectable Difference (SDD) determined the precision of individual scores. Bland-Altman plots were created for analyses of systematic differences between the test occasions. The results of the study showed that the stability over time was good to excellent (ICC 0.88-0.96) in the sub-dimensions "Supervisory relationship", "Pedagogical atmosphere on the ward" and "Role of the nurse teacher". Measurements of "Premises of nursing on the ward" and "Leadership style of the manager" had lower but still acceptable stability (ICC 0.70-0.75). No systematic differences occurred between the test occasions. This study supports the usefulness of the CLES + T scale as a reliable measure of the student nurses' perception of the learning environment within the clinical placement at a hospital.

  2. Practical Clinical Training in Skills Labs: Theory and Practice

    Directory of Open Access Journals (Sweden)

    Bugaj, T. J.

    2016-08-01

    Full Text Available Today, skills laboratories or “skills labs”, i.e. specific practical skill training facilities, are a firmly established part of medical education offering the possibility of training clinical procedures in a safe and fault-forging environment prior to real life application at bedside or in the operating room. Skills lab training follows a structured teaching concept, takes place under supervision and in consideration of methodological-didactic concepts, ideally creating an atmosphere that allows the repeated, anxiety- and risk-free practice of targeted skills.In this selective literature review, the first section is devoted to (I the development and dissemination of the skills lab concept. There follows (II an outline of the underlying idea and (III an analysis of key efficacy factors. Thereafter, (IV the training method’s effectiveness and transference are illuminated, before (V the use of student tutors, in the sense of peer-assisted-learning, in skills labs is discussed separately. Finally, (VI the efficiency of the skills lab concept is analyzed, followed by an outlook on future developments and trends in the field of skills lab training.

  3. Supervised practice in occupational therapy in a psychosocial care center: Challenges for the assistance and the teaching and learning process

    Directory of Open Access Journals (Sweden)

    Milton Carlos Mariotti

    2014-09-01

    Full Text Available The psychiatric reform in Brazil has replaced the hospital-centered model by the reintegration of users to their respective communities. The Center of Psychosocial Care (CAPS has been the main equipment in that scope. Objectives: To report the development of Supervised Practice in Occupational Therapy in a CAPS II unit in Curitiba, Parana state, Brazil. Methods: This is an experience report. It features the training field and describes the stages of the teaching and learning process which involved institutional observation, reporting and intervention proposal, collecting data about the users’ profile and attendances. The work focused the non-intensive users because they are close to hospital discharge. Results: We found that users of the non-intensive system, rather than crave the discharge, would like to return to the semi-intensive or intensive systems, aiming to regain sickness and transportation benefits, which are lost as users make progress. This fact denotes great contradictions in the system. We also attended intensive and semi-intensive systems users. Conclusions: The students’ learning included aspects such as direct contact with the institutional reality; knowledge about the health system, its limitations and contradictions; approach to users, their families, realities, socioeconomic conditions, desires, aspirations, or lack thereof; difficulties in engaging in meaningful occupations in their territories, limitations, and social stigma; working with frustrations, reflecting about ways to change the reality; in addition to expanded clinical practice, participating in the discussions and formulation of public policies on mental healthcare and social control.

  4. Development of clinical practice guidelines.

    Science.gov (United States)

    Hollon, Steven D; Areán, Patricia A; Craske, Michelle G; Crawford, Kermit A; Kivlahan, Daniel R; Magnavita, Jeffrey J; Ollendick, Thomas H; Sexton, Thomas L; Spring, Bonnie; Bufka, Lynn F; Galper, Daniel I; Kurtzman, Howard

    2014-01-01

    Clinical practice guidelines (CPGs) are intended to improve mental, behavioral, and physical health by promoting clinical practices that are based on the best available evidence. The American Psychological Association (APA) is committed to generating patient-focused CPGs that are scientifically sound, clinically useful, and informative for psychologists, other health professionals, training programs, policy makers, and the public. The Institute of Medicine (IOM) 2011 standards for generating CPGs represent current best practices in the field. These standards involve multidisciplinary guideline development panels charged with generating recommendations based on comprehensive systematic reviews of the evidence. The IOM standards will guide the APA as it generates CPGs that can be used to inform the general public and the practice community regarding the benefits and harms of various treatment options. CPG recommendations are advisory rather than compulsory. When used appropriately, high-quality guidelines can facilitate shared decision making and identify gaps in knowledge.

  5. Building the capacity for evidence-based clinical nursing leadership: the role of executive co-coaching and group clinical supervision for quality patient services.

    Science.gov (United States)

    Alleyne, Jo; Jumaa, Mansour Olawale

    2007-03-01

    The general aims of this article were to facilitate primary care nurses (District Nurse Team Leaders) to link management and leadership theories with clinical practice and to improve the quality of the service provided to their patients. The specific aim was to identify, create and evaluate effective processes for collaborative working so that the nurses' capacity for clinical decision-making could be improved. This article, part of a doctoral study on Clinical Leadership in Nursing, has wider application in the workplace of the future where professional standards based on collaboration will be more critical in a world of work that will be increasingly complex and uncertain. This article heralds the type of research and development activities that the nursing and midwifery professions should give premier attention to, particularly given the recent developments within the National Health Service in the United Kingdom. The implications of: Agenda for Change, the Knowledge and Skills Framework, 'Our Health, Our Care, Our Say' and the recent proposals from the article 'Modernising Nursing Career', to name but a few, are the key influences impacting on and demanding new ways of clinical supervision for nurses and midwives to improve the quality of patient management and services. The overall approach was based on an action research using a collaborative enquiry within a case study. This was facilitated by a process of executive co-coaching for focused group clinical supervision sessions involving six district nurses as co-researchers and two professional doctoral candidates as the main researchers. The enquiry conducted over a period of two and a half years used evidence-based management and leadership interventions to assist the participants to develop 'actionable knowledge'. Group clinical supervision was not practised in this study as a form of 'therapy' but as a focus for the development of actionable knowledge, knowledge needed for effective clinical management and

  6. Clinical Practice. Postmenopausal Osteoporosis.

    Science.gov (United States)

    Black, Dennis M; Rosen, Clifford J

    2016-01-21

    Key Clinical Points Postmenopausal Osteoporosis Fractures and osteoporosis are common, particularly among older women, and hip fractures can be devastating. Treatment is generally recommended in postmenopausal women who have a bone mineral density T score of -2.5 or less, a history of spine or hip fracture, or a Fracture Risk Assessment Tool (FRAX) score indicating increased fracture risk. Bisphosphonates (generic) and denosumab reduce the risk of hip, nonvertebral, and vertebral fractures; bisphosphonates are commonly used as first-line treatment in women who do not have contraindications. Teriparatide reduces the risk of nonvertebral and vertebral fractures. Osteonecrosis of the jaw and atypical femur fractures have been reported with treatment but are rare. The benefit-to-risk ratio for osteoporosis treatment is strongly positive for most women with osteoporosis. Because benefits are retained after discontinuation of alendronate or zoledronic acid, drug holidays after 5 years of alendronate therapy or 3 years of zoledronic acid therapy may be considered for patients at lower risk for fracture.

  7. Model of practical skill performance as an instrument for supervision and formative assessment

    DEFF Research Database (Denmark)

    Nielsen, Carsten Munch; Sommer, Irene; Larsen, Karin;

    2012-01-01

    and two cohorts of nursing students placed in a hospital setting shared their experiences on the use of the model in six focus group interviews. Data was also generated through the supervisors’ reflective logs. The model was viewed as highly applicable in the planning of learning situations as well......There are still weaknesses in the practical skills of newly graduated nurses. There is also an escalating pressure on existing clinical placements due to increasing student numbers and structural changes in health services. Innovative educational practices and the use of tools that might support...... learning are sparsely researched in the field of clinical education for nursing students. This paper reports on an action research study that promoted and investigated use of The Model of Practical Skill Performance as a learning tool during nursing students’ clinical placement. Clinical supervisors...

  8. Whither Supervision?

    Directory of Open Access Journals (Sweden)

    Duncan Waite

    2006-11-01

    Full Text Available This paper inquires if the school supervision is in decadence. Dr. Waite responds that the answer will depend on which perspective you look at it. Dr. Waite suggests taking in consideration three elements that are related: the field itself, the expert in the field (the professor, the theorist, the student and the administrator, and the context. When these three elements are revised, it emphasizes that there is not a consensus about the field of supervision, but there are coincidences related to its importance and that it is related to the improvement of the practice of the students in the school for their benefit. Dr. Waite suggests that the practice on this field is not always in harmony with what the theorists affirm. When referring to the supervisor or the skilled person, the author indicates that his or her perspective depends on his or her epistemological believes or in the way he or she conceives the learning; that is why supervision can be understood in different ways. About the context, Waite suggests that there have to be taken in consideration the social or external forces that influent the people and the society, because through them the education is affected. Dr. Waite concludes that the way to understand the supervision depends on the performer’s perspective. He responds to the initial question saying that the supervision authorities, the knowledge on this field, the performers, and its practice, are maybe spread but not extinct because the supervision will always be part of the great enterprise that we called education.

  9. Intentional Practices in Supervision of Family Counseling: The Use of Supervisory Letters

    Science.gov (United States)

    Desmond, Kimberly J.; Kindsvatter, Aaron

    2010-01-01

    Supervisors perform various roles in helping to guide the supervisee through the challenging process of family counseling. The use of letters in supervision helps to focus the supervisory processes in family counseling. Following the discrimination model of supervision, three types of supervisory letters are suggested for intentional supervision…

  10. The Practice of Supervision for Professional Learning: The Example of Future Forensic Specialists

    Science.gov (United States)

    Köpsén, Susanne; Nyström, Sofia

    2015-01-01

    Supervision intended to support learning is of great interest in professional knowledge development. No single definition governs the implementation and enactment of supervision because of different conditions, intentions, and pedagogical approaches. Uncertainty exists at a time when knowledge and methods are undergoing constant development. This…

  11. The Profound of Students' Supervision Practice in Higher Education to Enhance Student Development

    Science.gov (United States)

    Ismail, Affero; Abiddin, Norhasni Zainal; Hassan, Razali; Ro'is, Ihsan

    2014-01-01

    Supervision has become a highlight in higher education in recent years. While striving for the quality of education, the stress in research supervision has become dominant. Excellent research can contribute to the prominent of institutions' image. This paper accumulates the models from expert scholars in students' development regarding supervision…

  12. Group supervision in general practice as part of continuing professional development

    DEFF Research Database (Denmark)

    Nielsen, Helena Galina; Söderström, Margareta

    2012-01-01

    The aim of the present study was to explore the current use of supervision groups and the value of such groups for today's Danish general practitioners (GPs).......The aim of the present study was to explore the current use of supervision groups and the value of such groups for today's Danish general practitioners (GPs)....

  13. The Practice of Supervision for Professional Learning: The Example of Future Forensic Specialists

    Science.gov (United States)

    Köpsén, Susanne; Nyström, Sofia

    2015-01-01

    Supervision intended to support learning is of great interest in professional knowledge development. No single definition governs the implementation and enactment of supervision because of different conditions, intentions, and pedagogical approaches. Uncertainty exists at a time when knowledge and methods are undergoing constant development. This…

  14. Supervision as Metaphor

    Science.gov (United States)

    Lee, Alison; Green, Bill

    2009-01-01

    This article takes up the question of the language within which discussion of research degree supervision is couched and framed, and the consequences of such framings for supervision as a field of pedagogical practice. It examines the proliferation and intensity of metaphor, allegory and allusion in the language of candidature and supervision,…

  15. Cyriax physiotherapy versus phonophoresis with supervised exercise in subjects with lateral epicondylalgia: a randomized clinical trial.

    Science.gov (United States)

    Nagrale, Amit V; Herd, Christopher R; Ganvir, Shyam; Ramteke, Gopichand

    2009-01-01

    Cyriax and Cyriax advocated the use of deep transverse friction massage in combination with Mill's manipulation in treating lateral epicondylalgia. Evidence comparing this approach with other physical therapies is lacking. The purpose of this randomized clinical trial was to compare the effectiveness of deep transverse friction massage with Mill's manipulation versus phonophoresis with supervised exercise in managing lateral epicondylalgia. Sixty patients age 30-60, presenting with the teno-periosteal variety of lateral epicondylalgia with symptom duration greater than one month, were randomized into two groups. The control group received phonophoresis with diclofenac gel over the area of the lateral epicondyle for 5 minutes combined with supervised exercise. The experimental group received 10 minutes of deep transverse friction massage followed by a single application of Mill's manipulation. Both groups received treatment 3 times per week for 4 weeks. Outcomes of interest included pain via visual analog scale (VAS), pain-free grip strength, and functional status measured with the Tennis Elbow Function Scale. Data were analyzed using a one-way ANOVA. Whereas both groups improved significantly from the initiation of treatment, a between-group comparison revealed significantly greater (pCyriax physiotherapy is a superior treatment approach compared to phonophoresis and exercise in managing lateral epicondylalgia.

  16. Preventive psychiatry in clinical practice

    Directory of Open Access Journals (Sweden)

    Mamta Sood

    2017-01-01

    Full Text Available In the last two and a half decades, there have been series of global burden of disease studies which have highlighted significant disability attributable to mental and behavioral disorders with a huge treatment gap. Integration of the preventive strategies in the clinical practice has the potential to reduce the disability due to mental illnesses. The patients come to the clinic with an intention to get treated and investigated for the symptoms they have. At this point, they may also be amenable to the advice related to prevention. Therefore, the clinical encounter can be seen as an opportunity to implement preventive strategies. Preventive efforts in clinical practice must be guided by knowledge about the epidemiological data related to specific mental illnesses and about the evidence-based preventive strategies available for specific mental illnesses. These should be directed toward all those persons (patients, caregivers accompanying and at home, teachers, employers, etc. who are present and also toward those who are not present during the clinical encounter and must be age, gender, and culture sensitive. Sociodemographic characteristics of a person seeking relief from a problem in the clinical encounter help in directing the preventive efforts. The preventive efforts are also driven by the fact that the patient has the first episode or established or treatment refractory mental illness and the short or long duration of illness. For prevention-minded clinical practice, it helps to have a template so that the assessments and interventions relevant for prevention can be carried out as per that scheme; it also helps in orienting the practicing mental health professionals. While making various assessments, making a list of the likely issues to be addressed by preventive efforts during clinical encounter ( first and subsequent is also helpful.

  17. Clinical Practice Guidelines and Industry

    Directory of Open Access Journals (Sweden)

    Ajai R. Singh

    2007-01-01

    Full Text Available In this section we shall see what Clinical Practice Guidelines (CPGs should be and what they are, the recent case of Xigris and a thriller-like manipulation by the concerned company to enter a performance 'bundle', CPG effectiveness/cost effectiveness and other considerations, how they serve Industry needs, and what methods can possibly assist them actualise their enormous potential.Introduction From the early nineties, a number of Clinical Practice Guidelines (CPGs have been created and published by many different associations and organizations at considerable expense. CPGs are supposed to serve an important purpose. They offer objective consensus of expert opinion on treatment and hence are trusted by hospitals and practicing physicians alike. They can reduce the possibility of inappropriate care being delivered, while helping introduce new knowledge into clinical practice (Grimshaw and Russell, 1993; Merritt et al. , 1997; Woolf et al. , 1999. They are a distillate of biomedical wisdom at a certain point of time applied to better and more efficient patient care. Hence, rigorously developed guidelines can translate complicated research findings into actionable recommendations of clinical care (Shiffman et al. , 2003; Haines and Jones, 1994. Clinical practice guidelines have generally been accepted as an objective consensus on evidence (Baird, 2003. Practice guidelines approved by expert panels are intended to standardize care in such a way as to improve health outcomes (Eichacker et al. , 2006. Major hospitals and knowledge updated physicians feel reassured they are doing the very best by following CPGs. State of the art, and such other fancy labels, can be justifiably applied to them.McMaster et al., (2007 have talked recently of getting guidelines to work in practice. In an effort to make CPGs more effective, developers of such guidelines have started grouping evidence-based interventions into what are called 'bundles'. The justification for

  18. Evaluating students' perception of their clinical placements - testing the clinical learning environment and supervision and nurse teacher scale (CLES + T scale) in Germany.

    Science.gov (United States)

    Bergjan, Manuela; Hertel, Frank

    2013-11-01

    Clinical nursing education in Germany has not received attention in nursing science and practice for a long time, as it often seems to be a more or less "formalized appendix" of nursing education. Several development projects of clinical education taking place are mainly focused on the qualification of clinical preceptors. However, the clinical context and its influence on learning processes have still not been sufficiently investigated. The aim of this study was the testing of a German version of the clinical learning environment and supervision and nurse teacher scale (CLES + T scale). The sample of the pilot study consists of first-, second- and third-year student nurses (n=240) of a university nursing school from January to March 2011. Psychometric testing of the instrument is carried out by selected methods of classical testing theories using SPPS 19. The results show transferability of all subcategories of the CLES + T scale in the non-academic nursing education system of a university hospital in Germany, without the teacher scale. The strongest factor is "supervisory relationship". The German version of the CLES + T scale may help to evaluate and compare traditional and new models in clinical nursing education.

  19. Anxiety, supervision and a space for thinking: some narcissistic perils for clinical psychologists in learning psychotherapy.

    Science.gov (United States)

    Mollon, P

    1989-06-01

    The process of learning psychotherapy involves narcissistic dangers--there may be injuries to self-esteem and self-image, especially when working with certain kinds of disturbed and hostile patients. Some patients will unconsciously recreate, in the transference, representations of early damaging experiences with parents, but now reversed with the therapist as the victim. It is vital for the trainee to be helped to understand these powerful interactional pressures. There are aspects of the professional culture and ideals of clinical psychologists (and possibly of some psychiatrists and social workers as well) which may make them particularly vulnerable in work with the hostile patient. It is argued that the function of supervision is not to teach a technique directly, but to create a 'space for thinking'--a kind of thinking which is more akin to maternal reverie, as described by Bion, than problem solving.

  20. 临床督导专题述评%Editorial on the column of clinical supervision

    Institute of Scientific and Technical Information of China (English)

    张道龙; 张小梅; 黄国平; 杨昆

    2016-01-01

    Clinical supervision is a valuable and essential part of any healthcare professional’s development. By receiving feedback and clinical training,psychiatrists and clinical psychologists can accelerate their professional growth and clinical competency.Supervision is especially important in developing familiarity with diagnostic criteria,such as the DSM - 5 or ICD - 10,distinguishing differential diagnoses,improving psychotherapy,and learning psychopharmacology. It also serves a critical function in teaching junior psychiatrists and clinical psychologists to analyae their patient’s symptoms and condition. For instance,a supervisor’s guidance and experience can assist a clinician to differentiate primary depression and anxiety from a personality disorder,with secondary presentation of depression and anxiety. Supervision can additionally direct young clinicians and help them to course - correct when running into obstacles. Through the use of videotaping,recordings,and clinical interview transcripts,a supervisor can walk them step - by - step through what can be improved in future patient interactions. Finally,a supervisor’s chief role is to support new clinicians through the complexities of the clinical setting and help them to overcome inevitable frustrations while developing achievements and a sense of accomplishment. Without the opportunity to receive feedback on their performance in the clinic,junior psychiatrists and psychologists are missing a crucial opportunity for personal and professional growth.%临床督导是精神科医生和心理咨询师职业发展的必备环节,通过不断操练和接收反馈可以加速专业化进程并有效地提升临床胜任力。在督导中,要着重训练以下几个方面:熟练掌握 DSM-5或 ICD-10诊断标准,厘清鉴别诊断的思路,提高心理治疗技能,并将精神药理学理论灵活应用于实践。例如,一位督导师的指导和经验可以帮助临床工作者区分继发抑郁

  1. Disciplinary supervision following ethics complaints: goals, tasks, and ethical dimensions.

    Science.gov (United States)

    Thomas, Janet T

    2014-11-01

    Clinical supervision is considered an integral component of the training of psychologists, and most of the professional literature is focused on this type of supervision. But psychologists also may supervise fully credentialed colleagues in other circumstances. One such context occurs when licensing boards mandate supervision as part of a disciplinary order. When supervision is provided in disciplinary cases, there are significant implications for the ethical dimensions of the supervisory relationship and concomitant ethical challenges for supervisors. Not only are the goals, objectives, and supervisory tasks of disciplinary supervision distinct from other types of supervision, but the supervisor's ethical responsibilities also encompass unique dimensions. Competence, informed consent, boundaries, confidentiality, and documentation are examined. Recommendations for reports to licensing boards include a statement of the clinical or ethical problems instigating discipline, description of how these problems have been addressed, and an assessment of the supervisee's current practices and ability to perform competently.

  2. Handbook of clinical nursing practice

    Energy Technology Data Exchange (ETDEWEB)

    Asheervath, J.; Blevins, D.R.

    1986-01-01

    Written in outline format, this reference will help nurses further their understanding of advanced nursing procedures. Information is provided on the physiological, psychological, environmental, and safety considerations of nursing activities associated with diagnostic and therapeutic procedures. Special consideration is given to the areas of pediatric nursing, nursing assessment, and selected radiologic and nuclear medicine procedures for each system. Contents: Clinical Introduction. Clinical Nursing Practice: Focus on Basics. Focus on Cardiovascular Function. Focus on Respiratory Function. Focus on Gastrointestinal Function. Focus on Renal and Genito-Urological Function. Focus on Neuro-Skeletal and Muscular Function. Appendices.

  3. Effective Clinical Supervision in Substance Use Disorder Treatment Programs and Counselor Job Performance.

    Science.gov (United States)

    Rothrauff-Laschober, Tanja C; Eby, Lillian Turner de Tormes; Sauer, Julia B

    2013-01-01

    When mental health counselors have limited and/or inadequate training in substance use disorders (SUDs), effective clinical supervision (ECS) may advance their professional development. The purpose of the current study was to investigate whether ECS is related to the job performance of SUD counselors. Data were obtained in person via paper-and-pencil surveys from 392 matched SUD counselor-clinical supervisor dyads working in 27 SUD treatment organizations across the United States. ECS was rated by counselors and measured with five multi-item scales (i.e., sponsoring counselors' careers, providing challenging assignments, role modeling, accepting/confirming counselors' competence, overall supervisor task proficiency). Clinical supervisors rated counselors' job performance, which was measured with two multi-item scales (i.e., task performance, performance within supervisory relationship). Using mixed-effects models, we found that most aspects of ECS are related to SUD counselor job performance. Thus, ECS may indeed enhance counselors' task performance and performance within the supervisory relationship, and, as a consequence, offset limited formal SUD training.

  4. Practitioners' Perspectives on the Use of Clinical Supervision in Their Therapeutic Engagement with Asylum Seekers and Refugee Clients

    Science.gov (United States)

    Apostolidou, Zoe; Schweitzer, Robert

    2017-01-01

    The present study is the first study undertaken in Australia that seeks to explore practitioners' perspectives on the use of clinical supervision in their therapeutic engagement with asylum seekers and refugees. We used thematic analysis to analyse extracts of interviews that were conducted with nine professionals who worked therapeutically with…

  5. Exchange students crossing language boundaries in clinical nursing practice.

    Science.gov (United States)

    Myhre, K

    2011-12-01

    This article examines challenges and learning outcomes for nursing students from a Central European university of applied sciences who completed 3 months of clinical practice in Norway. The clinical practice was supervised in English by Norwegian nurses and nursing teachers. English is not the primary language in any of the countries. Increases in global migration have contributed to the need for an international dimension in nursing education. Personal mobility is a crucial part of the European Union's goal of becoming a knowledge society. Clinically based experiences pose challenges that are additional to and often more complex than traditional course-based experiences. Students who come from a non-English-speaking country for clinical practice in Norway face challenges regarding language. Accepting incoming students is a way of achieving higher quality and more relevant education in nursing. The study shows that clinical practice in a foreign country gives added value compared with clinical practice at home. Greater self-confidence and understanding of core concepts in nursing is described by the participants. Language differences are not regarded as a problem but as a way of developing personal and professional competence. The ability to compare healthcare systems in the two counties is important in developing competencies in nursing. © 2011 The Author. International Nursing Review © 2011 International Council of Nurses.

  6. Developing a practice of supervision in university as a collective learning process

    DEFF Research Database (Denmark)

    Lund, Birthe; Jensen, Annie Aarup

    2009-01-01

    of the framework surrounding the supervision process, both as regards the students and the teachers; to de-privatize the problems encountered by the individual teacher during the supervision; to ensure that students would be able to graduate within the timeframe of the education (the institutional economic......The point of departure of the paper is a university pedagogical course established with the purpose of strengthening the university teachers’ competence regarding the supervision of students working on their master’s thesis. The purpose of the course is furthermore to ensure the improvement...... of creating a transformation in the sense that it may change from being a top-down project (instigated by the Faculty) and develop into being a bottom-up project. It may hold the potential for developing collective learning processes assuming that good structures and frameworks can be created, as well...

  7. Systemic-Developmental Supervision: Clinical Supervisory Approach for Family Counseling Student Interns

    Science.gov (United States)

    Carlson, Ryan G.; Lambie, Glenn W.

    2012-01-01

    Supervision models for marriage and family counseling student interns primarily focus on the use of traditional systemic techniques. In addition, a supervisee's level of development may not be considered when utilizing systemic tools. Furthermore, the supervisory relationship has been identified as a significant indicator of quality supervision,…

  8. A Content Analysis of 10 Years of Clinical Supervision Articles in Counseling

    Science.gov (United States)

    Bernard, Janine M.; Luke, Melissa

    2015-01-01

    This content analysis follows Borders's (2005) review of counseling supervision literature and includes 184 counselor supervision articles published over the past 10 years. Articles were coded as representing 1 of 3 research types or 1 of 3 conceptual types. Articles were then analyzed for main topics producing 11 topic categories.

  9. A Content Analysis of 10 Years of Clinical Supervision Articles in Counseling

    Science.gov (United States)

    Bernard, Janine M.; Luke, Melissa

    2015-01-01

    This content analysis follows Borders's (2005) review of counseling supervision literature and includes 184 counselor supervision articles published over the past 10 years. Articles were coded as representing 1 of 3 research types or 1 of 3 conceptual types. Articles were then analyzed for main topics producing 11 topic categories.

  10. Developing a practice of supervision in university as a collective learning process

    DEFF Research Database (Denmark)

    Lund, Birthe; Jensen, Annie Aarup

    2009-01-01

    of the framework surrounding the supervision process, both as regards the students and the teachers; to de-privatize the problems encountered by the individual teacher during the supervision; to ensure that students would be able to graduate within the timeframe of the education (the institutional economic...... of creating a transformation in the sense that it may change from being a top-down project (instigated by the Faculty) and develop into being a bottom-up project. It may hold the potential for developing collective learning processes assuming that good structures and frameworks can be created, as well...

  11. Photodynamic therapy in clinical practice

    Directory of Open Access Journals (Sweden)

    E. V. Filonenko

    2016-01-01

    Full Text Available The review is on opportunities and possibilities of application of photodynamic therapy in clinical practice. The advantages of this method are the targeting of effect on tumor foci and high efficiency along with low systemic toxicity. The results of the set of recent Russian and foreign clinical trials are represented in the review. The method is successfully used in clinical practice with both radical (for early vulvar, cervical cancer and pre-cancer, central early lung cancer, esophageal and gastric cancer, bladder cancer and other types of malignant tumors, and palliative care (including tumor pleuritis, gastrointestinal tumors and others. Photodynamic therapy delivers results which are not available for other methods of cancer therapy. Thus, photodynamic therapy allows to avoid gross scars (that is very important, for example, in gynecology for treatment of patients of reproductive age with cervical and vulvar cancer, delivers good cosmetic effect for skin tumors, allows minimal trauma for intact tissue surrounding tumor. Photodynamic therapy is also used in other fields of medicine, such as otorhinolaryngology, dermatology, ophthalmology, orthopaedics, for treatment of papilloma virus infection and purulent wounds as antibacterial therapy.

  12. Are clinical practice guidelines impartial?

    Science.gov (United States)

    Cohen, Joshua

    2004-01-01

    In A Theory of Justice, John Rawls demands from citizens who decide upon principles of justice and the rules derived from such principles that they abstract from all particularities that constitute their identity as unique individuals. This demand is unrealistic in policy settings where actual policy-makers convene to provide guidance, establish rules regarding public good, and enact legislation. In practice, I argue, policy-makers, legislators, and others involved in developing social rules that pertain to distributive justice formulate such rules as reasonably partial spectators. To illustrate, I show how clinical practice guidelines are established and mediated by a reasonably partial expert panel whose partial action is publicly justifiable, yet whose claims to impartiality are not.

  13. Identification of Best Practices for Resident Aesthetic Clinics in Plastic Surgery Training: The ACAPS National Survey

    Directory of Open Access Journals (Sweden)

    C. Scott Hultman, MD, MBA, FACS

    2015-03-01

    Conclusions: RACs are an important component of plastic surgery education. Most clinics are financially viable but carry high malpractice risk and consume significant resources. Best practices, to maximize patient safety and optimize resident education, include use of accredited procedural rooms and direct faculty supervision of all components of care.

  14. Proton therapy in clinical practice

    Science.gov (United States)

    Liu, Hui; Chang, Joe Y.

    2011-01-01

    Radiation dose escalation and acceleration improves local control but also increases toxicity. Proton radiation is an emerging therapy for localized cancers that is being sought with increasing frequency by patients. Compared with photon therapy, proton therapy spares more critical structures due to its unique physics. The physical properties of a proton beam make it ideal for clinical applications. By modulating the Bragg peak of protons in energy and time, a conformal radiation dose with or without intensity modulation can be delivered to the target while sparing the surrounding normal tissues. Thus, proton therapy is ideal when organ preservation is a priority. However, protons are more sensitive to organ motion and anatomy changes compared with photons. In this article, we review practical issues of proton therapy, describe its image-guided treatment planning and delivery, discuss clinical outcome for cancer patients, and suggest challenges and the future development of proton therapy. PMID:21527064

  15. Proton therapy in clinical practice

    Institute of Scientific and Technical Information of China (English)

    Hui Liu; Joe Y. Chang

    2011-01-01

    Radiation dose escalation and acceleration improves local control but also increases toxicity. Proton radiation is an emerging therapy for localized cancers that is being sought with increasing frequency by patients. Compared with photon therapy, proton therapy spares more critical structures due to its unique physics. The physical properties of a proton beam make it ideal for clinical applications. By modulating the Bragg peak of protons in energy and time, a conformal radiation dose with or without intensity modulation can be delivered to the target while sparing the surrounding normal tissues. Thus, proton therapy is ideal when organ preservation is a priority. However, protons are more sensitive to organ motion and anatomy changes compared with photons. In this article, we review practical issues of proton therapy, describe its image-guided treatment planning and delivery, discuss clinical outcome for cancer patients, and suggest challenges and the future development of proton therapy.

  16. Supervising international students in clinical placements: perceptions of experiences and factors influencing competency development.

    Science.gov (United States)

    Attrill, Stacie; Lincoln, Michelle; McAllister, Sue

    2016-07-16

    Health professional education programs attract students from around the world and clinical supervisors frequently report that international students find learning in clinical placement contexts particularly challenging. In existing literature clinical supervisors, who support international students on placement have identified concerns about their communication and interactions within clinical environments. However, clinical supervisors' perspectives about their experiences with international students on placement and the strategies they utilise to facilitate international student learning have not been described. As a result we have little insight into the nature of these concerns and what clinical supervisors do to support international students' competency development. Five focus group interviews were conducted with twenty Speech-Language Pathology clinical supervisors, recruited from 2 Australian universities. Interview data were analysed thematically. Themes identified were interpreted using cognitive load and sociocultural learning theories to enhance understanding of the findings. Four themes were identified: 'Complex teaching and learning relationships', 'Conceptions of students as learners'; Student communication skills for professional practice', and 'Positive mutual learning relationships'. Findings indicated that clinical supervisors felt positive about supporting international students in clinical placements and experienced mutual learning benefits. However, they also identified factors inherent to international students and the placement environment that added to workload, and made facilitating student learning complex. Clinical supervisors described strategies they used to support international students' cultural adjustment and learning, but communication skills were reported to be difficult to facilitate within the constraints of placements. Future research should address the urgent need to develop and test strategies for improving international

  17. Digital Communication and Records in Service Provision and Supervision: Regulation and Practice.

    Science.gov (United States)

    Cavalari, Rachel N S; Gillis, Jennifer M; Kruser, Nathan; Romanczyk, Raymond G

    2015-10-01

    While the use of computer-based communication, video recordings, and other "electronic" records is commonplace in clinical service settings and research, management of digital records can become a great burden from both practical and regulatory perspectives. Three types of challenges commonly present themselves: regulatory requirements; storage, transmission, and access; and analysis for clinical and research decision-making. Unfortunately, few practitioners and organizations are well enough informed to set necessary policies and procedures in an effective, comprehensive manner. The three challenges are addressed using a demonstrative example of policies and procedural guidelines from an applied perspective, maintaining the unique emphasis behavior analysts place upon quantitative analysis. Specifically, we provide a brief review of federal requirements relevant to the use of video and electronic records in the USA; non-jargon pragmatic solutions to managing and storing video and electronic records; and last, specific methodologies to facilitate extraction of quantitative information in a cost-effective manner.

  18. SUPERVISED CURRICULUM INTERNSHIP IN GEOGRAPHY AND PEDAGOGICAL MEDIATION: between knowledge and practices for a dialogical approach

    Directory of Open Access Journals (Sweden)

    Francisco Kennedy Silva dos Santos

    2014-01-01

    Full Text Available The present article is the result of an inquiry which has for its object the pedagogical mediation in Geography, with reference to the supervised curriculum internship in Geography, obligatory component for teacher training in degree courses. We start from an analysis of reflective professional trajectory teaching, in research supported type "state of the art" or "state of knowledge" for bibliographical supports our interventions (FERREIRA, 2002. We seek authors such as (CORTELLA, 2008; FAZENDA, 1991; FREIRE, 2003; LIBÂNEO, 2005; TARDIF, 2002; among others further deepening of the central categories for our analyzes. We intend to test this, open up new possibilities for understanding the role of teaching practice in teacher education in the light of the narrowing theory and practice. The reflection on the everyday, especially from the real questions of the teacher, is in the condition to proceed with training more articulate and coherent with reality. The lack of a more systematic partnership between schools and the University has led to the development of proposals and optimized with little impact on the educational community. Being a teacher today is a challenge that involves humanitarian issue and expertise needed to see and mingle with the world. RESUMO: O presente artigo resulta de uma investigação que tem por objeto a mediação pedagógica em Geografia, tendo como referência o estágio curricular supervisionado, componente obrigatório para formação de professores nos cursos de licenciatura. Partimos de uma análise reflexiva da trajetória profissional docente, respaldados em pesquisas do tipo “estado da arte” ou “estado do conhecimento” de caráter bibliográfico para dá suporte a nossas intervenções (FERREIRA, 2002. Buscamos em autores como (CORTELLA, 2008; FAZENDA, 1991; FREIRE, 2003; LIBÂNEO, 2005; TARDIF, 2002; entre outros um maior aprofundamento das categorias centrais para nossas análises. Pretendemos com este

  19. Remotely-Supervised Transcranial Direct Current Stimulation (tDCS for Clinical Trials: Guidelines for Technology and Protocols

    Directory of Open Access Journals (Sweden)

    Leigh E Charvet

    2015-03-01

    Full Text Available The effect of transcranial direct current stimulation (tDCS is cumulative. Treatment protocols typically require multiple consecutive sessions spanning weeks or months. However, traveling to clinic for a tDCS session can present an obstacle to subjects and their caregivers. With modified devices and headgear, tDCS treatment can be administered remotely under clinical supervision, potentially enhancing recruitment, throughput, and convenience. Here we propose standards and protocols for clinical trials utilizing remotely-supervised tDCS with the goal of providing safe, reproducible and well-tolerated stimulation therapy outside of the clinic. The recommendations include: 1 training of staff in tDCS treatment and supervision, 2 assessment of the user’s capability to participate in tDCS remotely, 3 ongoing training procedures and materials including assessments of the user and/or caregiver, 4 simple and fail-safe electrode preparation techniques and tDCS headgear, 5 strict dose control for each session, 6 ongoing monitoring to quantify compliance (device preparation, electrode saturation/placement, stimulation protocol, with corresponding corrective steps as required, 7 monitoring for treatment-emergent adverse effects, 8 guidelines for discontinuation of a session and/or study participation including emergency failsafe procedures tailored to the treatment population’s level of need. These guidelines are intended to provide a minimal level of methodological rigor for clinical trials seeking to apply tDCS outside a specialized treatment center. We outline indication-specific applications (Attention Deficit Hyperactivity Disorder, Depression, Multiple Sclerosis, Palliative Care following these recommendations that support a standardized framework for evaluating the tolerability and reproducibility of remote-supervised tDCS that, once established, will allow for translation of tDCS clinical trials to a greater size and range of patient populations.

  20. Kollegial supervision

    DEFF Research Database (Denmark)

    Andersen, Ole Dibbern; Petersson, Erling

    Publikationen belyser, hvordan kollegial supervision i en kan organiseres i en uddannelsesinstitution......Publikationen belyser, hvordan kollegial supervision i en kan organiseres i en uddannelsesinstitution...

  1. Discovering treatment pattern in Traditional Chinese Medicine clinical cases by exploiting supervised topic model and domain knowledge.

    Science.gov (United States)

    Yao, Liang; Zhang, Yin; Wei, Baogang; Wang, Wei; Zhang, Yuejiao; Ren, Xiaolin; Bian, Yali

    2015-12-01

    In Traditional Chinese Medicine (TCM), the prescription is the crystallization of clinical experience of doctors, which is the main way to cure diseases in China for thousands of years. Clinical cases, on the other hand, describe how doctors diagnose and prescribe. In this paper, we propose a framework which mines treatment patterns in TCM clinical cases by exploiting supervised topic model and TCM domain knowledge. The framework can reflect principle rules in TCM and improve function prediction of a new prescription. We evaluate our method on 3090 real world TCM clinical cases. The experiment validates the effectiveness of our method.

  2. Mentoring and supervising clinical pharmacist students at patients' bedside: which benefits?

    Science.gov (United States)

    Rouzaud-Laborde, Charlotte; Damery, Léa; Cestac, Philippe; Sallerin, Brigitte; Calvet, Pauline

    2016-02-01

     Hospital clinical pharmacists are involved in teaching students during professional internship. Organization between the unit care and the pharmacy place is complicated. This study evaluated the effectiveness of two pharmaceutical teams: an experienced pharmacist in the pharmacy place, reachable by phone (team 1) or an experienced pharmacist in the ward, near patients and students (team 2). Pharmaceutical interventions were collected during two successive time periods, each of 6 months in a 15-bed unit (neurology). During the first time period, prescriptions were analyzed by the student (resident) in the ward and experienced pharmacist in the pharmacy place. During the second time period, prescriptions were analyzed by both experienced pharmacist and the resident in the ward. We compared the number, the type, the approval of pharmaceutical interventions and the medication reconciliation activities. Proportions were compared by a chisquared test (or Fisher exact test) as well as the quantitative value was calculated by a Student test. 'Mentoring and supervising' students in the ward increased significantly the number of pharmaceutical interventions (PI; 104 interventions for 1408 analyzed prescriptions (7.4%) by the students in the ward and 317 interventions for 1391 (22.8%) by both the experienced pharmacist and the students in the ward (P = 0.002). Furthermore, specific interventions from medication reconciliation were significantly increased by the presence of experienced pharmacist in the ward (0.96% vs. 8.83% P = 0.018). Effectiveness of clinical pharmacists can be improved by the presence of experienced pharmacist at patients' bedside, near students. © 2015 John Wiley & Sons, Ltd.

  3. Does Moral Distress Differ Between California Certified Registered Nurse Anesthetists in Independent Versus Medically Supervised Practice: An Exploratory Study.

    Science.gov (United States)

    Dumouchel, Michael; Boytim, Michael; Gorman, Nicholas; Weismuller, Penny

    2015-06-01

    The purpose of this exploratory, descriptive study was to determine if moral distress levels differed between certified registered nurse anesthetists (CRNAs) working in medically supervised versus independent practice in California. A 63-question survey was administered to 1,190 California CRNAs. Moral distress was measured by the included Ethics Stress Scale. The response rate was 14.7%, yielding demographic and Ethics Stress scores for 175 respondents. Sixty-five participants answered an open-ended question about moral distress yielding qualitative data. Medically supervised CRNAs had a lower mean moral distress scores (176.8) versus independent practice CRNAs (187.8) (p = .002). Lower scores on the ESS indicate higher moral distress. Qualitative data demonstrated that CRNAs experienced moral distress in the following situations: when pressured to give anesthesia to unoptimized patients, when differences of opinion regarding anesthetic plans occurred, in dealing with end-of-life issues, when working with incompetent providers, and during interprofessional struggles between CRNAs and anesthesiologists. In order to reduce moral distress among CRNAs, implications for practice include increased administrative support, increased communication and reciprocated collegial respect between anesthesiologists and CRNAs, and CRNA representation on ethics committees.

  4. Effect evaluation of a supervised versus non-supervised implementation of an oral health care guideline in nursing homes: a cluster randomised controlled clinical trial.

    NARCIS (Netherlands)

    Visschere, L. De; Schols, J.; Putten, G.J. van der; Baat, C. de; Vanobbergen, J.

    2012-01-01

    OBJECTIVE: To compare a supervised versus a non-supervised implementation of an oral health care guideline in Flanders (Belgium). BACKGROUND: The key factor in realising good oral health is daily oral hygiene care. In 2007, the Dutch guideline 'Oral health care in care homes for elderly people' was

  5. What is the right time for supportive versus expressive interventions in supervision? An illustration based on a clinical mistake.

    Science.gov (United States)

    Leibovich, Liat; Zilcha-Mano, Sigal

    2016-09-01

    Although supportive-expressive (SE) psychotherapy is one of the most studied psychodynamic therapies today, little is known empirically about effective strategies in SE supervision, or in psychodynamic supervision in general (Diener & Mesrie, 2015; Watkins, 2011). One of the important questions in SE psychotherapy is how to decide when to use supportive and when to use expressive interventions. As a parallel process, this type of decision is relevant also to SE supervision. The present case study focuses on the decision-making process in an SE supervision session: when should supervisors use supportive as opposed to expressive strategies with their supervisees? Our aim is to develop decision rules that reliably support supervisors' decisions. We analyze a clinical error made by supervisors in this type of decision making, and show how mistakes of this type can either be avoided or, when they occur, how to turn them into opportunities for learning and for the formation of new understanding and growth. Similarly to the finding that therapists with better skills in managing their countertransference feelings were shown to have better outcomes with their patients (Gelso, Latts, Gomez, & Fassinger, 2002; Hayes, Gelso, & Hummel, 2011), we suggest that the management of the supervisors' feelings, and working through their mistakes with the therapists, can contribute to the supervisory relationship and to the development of the psychodynamic therapists' skills. (PsycINFO Database Record

  6. Supernumerary teeth in clinical practice

    Directory of Open Access Journals (Sweden)

    Anna K. Szkaradkiewicz

    2011-07-01

    Full Text Available Introduction: Hyperdontia is the condition of having supernumerary teeth, or teeth which appear in addition to the regular number of teeth. The prevalence rates of supernumerary teeth in the permanent dentition amounts 0.1-6.9%, and in deciduous dentition 0.4-0.8%. The presence of supernumerary teeth can be found in everyday dental practice.Case presentation: We describe 3 cases of patients with supernumerary teeth. First patient had supernumerary lateral incisor 12s, second - premolar fused, multicuspid, supernumerary deciduous tooth 64s of having several interconnected roots, and third - erupted odontoma between teeth 13 and 14. In all cases treatment involved the removal of the supernumerary tooth.Conclusions: The decision on proceeding with the supernumerary teeth should be based on the full clinical picture and interview. Early diagnosis and removal of supernumerary teeth allow to avoid or reduce possible complications.

  7. Evaluation of a PBL strategy in clinical supervision of nursing students: patient-centred training in student-dedicated treatment rooms.

    Science.gov (United States)

    Staun, Margaretha; Bergström, Berit; Wadensten, Barbro

    2010-10-01

    The present study aimed at investigating staff members' and nursing students' perception of and satisfaction with an intervention involving patient-centred training in student-dedicated treatment rooms during clinical supervision. It is well known that clinical education is important and that the clinical learning environment influences the development of nursing students' ability to solve clinical problems. In the present study, an intervention using a problem-based learning (PBL) strategy was introduced and evaluated in clinical education. The PBL strategy is called 'Patient-centred training in student-dedicated treatment rooms'. Descriptive; both quantitative and qualitative methods were used. A questionnaire and focus group interviews were used. Most participants found the PBL strategy to be highly satisfactory, both for staff and for students. The students seemed to feel that their time in clinical education had been used efficiently. Integration of theory and practice during clinical training has been emphasized as a necessary component, and the new strategy, which involves a method of promoting students' reflection, represents one way of facilitating such integration, in that it may bridge the gap between theory and practice. More extensive and more specific research is need in the future. Copyright © 2009 Elsevier Ltd. All rights reserved.

  8. Body composition in clinical practice.

    Science.gov (United States)

    Andreoli, Angela; Garaci, Francesco; Cafarelli, Francesco Pio; Guglielmi, Giuseppe

    2016-08-01

    Nutritional status is the results of nutrients intake, absorption and utilization, able to influence physiological and pathological conditions. Nutritional status can be measured for individuals with different techniques, such as CT Body Composition, quantitative Magnetic Resonance Imaging, Ultrasound, Dual-Energy X-Ray Absorptiometry and Bioimpendance. Because obesity is becoming a worldwide epidemic, there is an increasing interest in the study of body composition to monitor conditions and delay in development of obesity-related diseases. The emergence of these evidence demonstrates the need of standard assessment of nutritional status based on body weight changes, playing an important role in several clinical setting, such as in quantitative measurement of tissues and their fluctuations in body composition, in survival rate, in pathologic condition and illnesses. Since body mass index has been shown to be an imprecise measurement of fat-free and fat mass, body cell mass and fluids, providing no information if weight changes, consequently there is the need to find a better way to evaluate body composition, in order to assess fat-free and fat mass with weight gain and loss, and during ageing. Monitoring body composition can be very useful for nutritional and medical interventional. This review is focused on the use of Body Composition in Clinical Practice.

  9. Networks of Professional Supervision

    Science.gov (United States)

    Annan, Jean; Ryba, Ken

    2013-01-01

    An ecological analysis of the supervisory activity of 31 New Zealand school psychologists examined simultaneously the theories of school psychology, supervision practices, and the contextual qualities that mediated participants' supervisory actions. The findings indicated that the school psychologists worked to achieve the supervision goals of…

  10. Research and clinical practice relationship

    Directory of Open Access Journals (Sweden)

    Ashammakhi N

    2008-01-01

    Full Text Available To The Editor: I highly value and greet the authors for their editorial. Many important issues related to medical education and its future in Libya have been discussed in this paper [1]. One important point that has been addressed and I feel deserves attention is the “abnormal” relationship between clinical practice and research in Libya. From discussions with colleagues, this problem somehow has evolved from a misconception about educational and training systems that may have occurred in the past. It may also be related to the lack of attention to research that has long existed in Libya [2,3]. The other aspect, shared with many other developing countries, is the misconception of research as unimportant or a luxury aspect of medicine. When it comes to understanding how a system (including healthcare can be updated and developed, the answer is vague! One important reason is a lack of understanding of the impact that research has on developing methods. In developed countries, research is the main academic distinction that leads to appointments for coveted positions in the system and is an important factor for academic promotion. In Libya, there remain arguments about who will be awarded Chair of university clinical departments. Such a post should no doubt be given to those with established academic achievements. When highly qualified persons are at the top of the pyramid this leads to further progress and enhanced research and advancement. The authors have discussed the point of having proper search committees for leadership and faculty positions. I believe that it will help eliminate the current stagnation and help to create innovative solutions. This should lead to improved medical education, health services, and ultimately impact the quality of life of all Libyan citizens.

  11. How GPs implement clinical guidelines in everyday clinical practice

    DEFF Research Database (Denmark)

    Videbæk Le, Jette; Hansen, Helle P; Riisgaard, Helle

    2015-01-01

    . OBJECTIVE: To investigate how GPs implement clinical guidelines in everyday clinical practice and how implementation approaches differ between practices. METHODS: Individual semi-structured open-ended interviews with seven GPs who were purposefully sampled with regard to gender, age and practice form...

  12. Diagnostic discrepancies in clinical practice

    Science.gov (United States)

    Issa, Victor Sarli; Dinardi, Layara Fernanda Lipari; Pereira, Thiago Vicente; de Almeida, Lyna Kyria Rodrigues; Barbosa, Thaisa Silveira; Benvenutti, Luiz Alberto; Ayub-Ferreira, Silvia Moreira; Bocchi, Edimar Alcides

    2017-01-01

    Abstract Autopsies are the gold standard for diagnostic accuracy; however, no recent study has analyzed autopsies in heart failure (HF). We reviewed 1241 autopsies (January 2000–May 2005) and selected 232 patients with HF. Clinical and autopsy diagnoses were analyzed and discrepancies categorized according to their importance regarding therapy and prognosis. Mean age was 63.3 ± 15.9 years; 154 (66.4%) patients were male. The causes of death at autopsy were end-stage HF (40.9%), acute myocardial infarction (17.2%), infection (15.9), and pulmonary embolism 36 (15.5). Diagnostic discrepancies occurred in 191 (82.3%) cases; in 56 (24.1%), discrepancies were related to major diagnoses with potential influence on survival or treatment; pulmonary embolism was the cause of death for 24 (42.9%) of these patients. In 35 (15.1%), discrepancies were related to a major diagnosis with equivocal influence on survival or treatment; in 100 (43.1%), discrepancies did not influence survival or treatment. In multivariate analysis, age (OR: 1.03, 95% CI: 1.008–1.052, P = 0.007) and presence of diabetes mellitus (OR: 0.359, 95% CI: 0.168–0.767, P = 0.008) influenced the occurrence discrepancies. Diagnostic discrepancies with a potential impact on prognosis are frequent in HF. These findings warrant reconsideration in diagnostic and therapeutic practices with HF patients. PMID:28121951

  13. THE IMPACT OF THE FINANCIAL CRISIS ON THE THEORY AND PRACTICE OF FINANCIAL SYSTEM SUPERVISION

    Directory of Open Access Journals (Sweden)

    Roxana Heteș

    2013-04-01

    Full Text Available The recent global financial crisis has reopened the debate about macroeconomic policies’ objectives, but also the need and extent of state involvement in the functioning of the economy, either directly or indirectly. This has exposed some weaknesses in the system of regulation and supervision of the financial system and the its architecture, especially in the treatment of systemic risks and vulnerabilities, but also the financial implications of the globalization process. The global nature of financial crisis highlighted the fact that, although integrated financial markets offer a number of significant benefits, risks involved are not negligible. Therefore, to ensure the financial stability of an increasingly integrated landscape there was felt the need for reform of the financial system architecture, both nationally and internationally.

  14. A Critical Approach to Clinical Practice Guidelines

    Directory of Open Access Journals (Sweden)

    John K Marshall

    2000-01-01

    Full Text Available The rate of publication of clinical practice guidelines for the management of common medical illnesses continues to accelerate. The appropriate dissemination and uptake of high quality practice guidelines can synthesize evidence, improve patient outcomes and enhance the efficiency of health care delivery. However, the methodological rigour and relevance of the growing number of publications labelled ’clinical practice guidelines’ vary widely. Health care payers, providers and advocates must learn to appraise and interpret guideline recommendations critically. A simple and practical nine-question approach to evaluating the quality, relevance and effectiveness of clinical practice guidelines is presented.

  15. Clinical practice guidelines in patient management

    Directory of Open Access Journals (Sweden)

    Santosh Kumar

    2001-01-01

    Full Text Available Efforts have always been made to evolve certain prin-ciples to reduce the variability in the management of patients and make medical care more appropriate. These efforts have become almost a movement since 1980s as evidenced in the development of clinical practice guide-lines in all medical disciplines. This article describes the need for clinical practice guidelines and their de-velopment methods and qualities. Advantages and limi-tations of clinical practice guidelines are enumerated. The salient features of various available clinical prac-tice guidelines in urology are also described.

  16. Implementation of an intern boot camp curriculum to address clinical competencies under the new Accreditation Council for Graduate Medical Education supervision requirements and duty hour restrictions.

    Science.gov (United States)

    Krajewski, Aleksandra; Filippa, Dawn; Staff, Ilene; Singh, Rekha; Kirton, Orlando C

    2013-08-01

    Today's general surgery interns are faced with increased duty hour restrictions and stringent competency-based supervision milestone requirements (ie, from direct to indirect supervision). Working within these constraints, we instituted a unique 2-month intern curriculum (boot camp) incorporating knowledge-based, experiential, and practical components. To describe our curriculum and the effect on resident performance and teaching faculty and nursing staff perceptions. All interns underwent a 2-month (July and August 2011) boot camp curriculum consisting of two 2½-hour knowledge-based and procedural skills (SimMan) didactic sessions per week and completion of 25 core intensive introductory American College of Surgeons Fundamentals of Surgery web-based self-study modules, followed by a standardized patient clinical skills assessment. Integrated general surgery residency program at the University of Connecticut School of Medicine, Farmington. Postgraduate year 1 general surgery categorical and preliminary residents. We used several assessment tools, including an intern boot camp survey, clinical skills assessment scores, intern American Board of Surgeons In-Training Examination scores, and nursing staff and teaching faculty surveys of intern performance and aptitudes compared with the previous year's interns. Data were analyzed by independent group t test, χ2 tests of proportions, and Fisher exact test for small sample cross tables. In total, 84% (91 of 108) of intern respondents agreed or strongly agreed with the usefulness, relevance, and execution of the boot camp. Compared with the previous year's interns, the nursing staff agreed or strongly agreed that the cohort interns were better at patient assessment, collaboration, and effective communication and provided compassionate and respectful patient care. More than 40% (7 of 17) of surveyed teaching faculty agreed or strongly agreed that the cohort interns demonstrated better patient care and procedural skills

  17. 非直属临床医学院教学督导工作存在的问题及对策%Teaching supervision in the non-affiliated school of clinical medicine: Existing problems and solutions

    Institute of Scientific and Technical Information of China (English)

    施建辉; 任冰; 林勇; 石平

    2012-01-01

    Teaching supervision is essential for teaching quality control in the non-affiliated school of clinical medicine, which guarantees stabilized teaching order, strengthen management functions and deepen teaching reform. However, problems do exist in the practice of teaching supervision, such as irregular management, improper organization of supervisors, inadequate scope of supervision, obstructed information feedback and irrational assessment system. Accordingly, the authors propose the construction of an efficient teaching supervision mechanism in the non-affiliated school of clinical medicine by perfecting the supervising organization, optimizing the team of supervisors, expanding the supervision scope, unclogging the channels of information feedback and establishing a rational assessment system.%教学督导工作是非直属临床医学院教学质量监控重要组成部分,是稳定教学秩序、强化管理职能、深化教学改革的重要保证.非直属临床医学院教学督导在实施过程中存在督导组织不够健全、督导队伍不够合理、督导范围不够广泛、信息反馈不够通畅、评价体系不够科学等问题.并提出了通过健全督导组织、加强督导队伍建设、拓展督导范围、疏通反馈通道、构建评价体系等途径,构建非直属临床医学院有效教学督导机制.

  18. Supervision Experiences of Professional Counselors Providing Crisis Counseling

    Science.gov (United States)

    Dupre, Madeleine; Echterling, Lennis G.; Meixner, Cara; Anderson, Robin; Kielty, Michele

    2014-01-01

    In this phenomenological study, the authors explored supervision experiences of 13 licensed professional counselors in situations requiring crisis counseling. Five themes concerning crisis and supervision were identified from individual interviews. Findings support intensive, immediate crisis supervision and postlicensure clinical supervision.

  19. [Should we continue to use benzodiazepines in clinical practice?].

    Science.gov (United States)

    Sampogna, Gaia; Del Vecchio, Valeria; Luciano, Mario; De Rosa, Corrado; Albert, Umberto; Dell'Osso, Bernardo; Fiorillo, Andrea

    2015-06-01

    The discovery of benzodiazepines has represented a milestone in the history of pharmacological treatments and in relation to the management of anxiety, sleep and other psychiatric disorders. After several decades, these agents still represent one of the largest and most widely prescribed groups of medications, not only in the psychiatric clinical practice, but also in the whole medical field. Over the last decade, however, multiple concerns have been raised on the risks related to the prescription of benzodiazepines, for their addictive potential and for cognitive side-effects. Therefore, benzodiazepines are today considered as a double-edge sword, which should be carefully handled and preferentially prescribed by specialists (or at least under their supervision), after an adequate training. Unfortunately, this is not the case in many situations, and the need to improve training on benzodiazepines management has been recently emphasized.

  20. Evidence-based clinical practice

    DEFF Research Database (Denmark)

    Gluud, Christian

    2002-01-01

    Evidence-based medicine combines the patient's preferences with clinical experience and the best research evidence. Randomized clinical trials are considered the most valid research design for evaluating health-care interventions. However, empirical research shows that intervention effects may be...

  1. Comparison of Effectiveness of Supervised Exercise Program and Cyriax Physiotherapy in Patients with Tennis Elbow (Lateral Epicondylitis): A Randomized Clinical Trial

    OpenAIRE

    Rajadurai Viswas; Rejeeshkumar Ramachandran; Payal Korde Anantkumar

    2012-01-01

    Objective. To compare the effectiveness of supervised exercise program and Cyriax physiotherapy in the treatment of tennis elbow (lateral epicondylitis). Design. Randomized clinical trial. Setting. Physiotherapy and rehabilitation centre. Subjects. This study was carried out with 20 patients, who had tennis elbow (lateral epicondylitis). Intervention. Group A ( = 1 0 ) had received supervised exercise program. Group B ( = 1 0 ) was treated with Cyriax physiotherapy. All patients received ...

  2. Supervised and non-supervised Nordic walking in the treatment of chronic low back pain: a single blind randomized clinical trial

    DEFF Research Database (Denmark)

    Hartvigsen, Jan; Morsø, Lars; Bendix, Tom;

    2010-01-01

    further assessed using the Patient Specific Function Scale. Furthermore, information on time off work, use of medication, and concurrent treatment for their low back pain was collected. Objective measurements of physical activity levels for the supervised and unsupervised Nordic walking groups were...

  3. Improving Teachers' Practices through Supervision and Observations by School Principals: An Action Research Project

    Science.gov (United States)

    Taylor, Latasha M.

    2013-01-01

    This study focused on the impact of a new observation tool for principals to utilize and the effects it has on improving teachers' instruction and influencing best practices. The action research project explored the impact and influence that a well-developed observation tool could possess to help address areas of need; essentially, focusing on how…

  4. Positron emission tomography clinical practice

    CERN Document Server

    Valk, Peter E; Bailey, Dale L; Townsend, David W; Maisey, Michael N

    2006-01-01

    This book provides a contemporary reference to the science, technology and clinical applications of PET and PET/CT. The opening chapters summarize the scientific aspects of PET and PET/CT including physics, instrumentation, radiation dosimetry and radiation protection. A chapter on normal variants in FDG PET imaging serves as an introduction to the clinical chapters, which cover oncology applications and have been updated to include the impact of FDG PET/CT imaging in oncology. The book concludes with chapters on the use of PET and PET/CT in cardiology and neurology and PET imaging of infectio

  5. The significance of communities of practice: Norwegian nursing students' experience of clinical placement in Bangladesh.

    Science.gov (United States)

    Jørgensen, Wanja; Hadders, Hans

    2015-04-01

    The purpose of this study was to gain understanding of Norwegian students' experience of learning in clinical placement in Bangladesh without formal one-to-one supervision, by a personal mentor in the ward. Using focus group interviews with bachelor nursing students we explored the significance of 'communities of practice' in nursing practicum abroad, socialization and knowledge transfer. Seven third year bachelor nursing students enrolled in a clinical placement programme in Bangladesh participated in focus group interviews prior to their departure to Bangladesh, during their stay in Bangladesh and after their return to Norway. The Students' marginality and 'peripheral participation' triggered insight and reflection. The challenging but advantageous position of the peripheral students was heightened further due to the lack of one-to-one supervision in the clinic. Their previous experience with problem based learning and group learning was an asset that made them more resilient and helped them to cope.

  6. Digital clinical photography: Practical tips

    Directory of Open Access Journals (Sweden)

    Sharad Mutalik

    2010-01-01

    Full Text Available Photographs are the most preferred and easiest way of documentation of patient visual features. In aesthetic and cutaneous surgery, there is an increased need for proper photographic documentation, from a medicolegal view point. This article discusses the basic aspects of camera and photography which a dermatologist should be aware before he/she starts with clinical photography.

  7. Impella ventricular support in clinical practice

    DEFF Research Database (Denmark)

    Burzotta, Francesco; Trani, Carlo; Doshi, Sagar N;

    2015-01-01

    Mechanical circulatory support represents an evolving field of clinical research and practice. Currently, several cardiac assist devices have been developed but, among different institutions and countries, a large variation in indications for use and device selection exists. The Impella platform ...

  8. CT colonography. A guide for clinical practice

    Energy Technology Data Exchange (ETDEWEB)

    Mang, Thomas [Medical Univ. of Vienna (Austria). Dept. of Radiology; Schima, Wolfgang [Krankenhaus Goettlicher Heiland, Wien (Austria). Dept. of Diagnostic and Interventional Radiology; Krankenhaus der Barmherzigen Schwestern, Wien (Austria); Sankt-Josef-Krankenhaus, Wien (Austria)

    2013-07-01

    The book on CT colonography - a guide for clinical practice - covers the following issues: indications and contraindications, examination; Image interpretation; findings at CT colonography, how to generate a useful report, screening, how to train for CT colonography.

  9. Social media in clinical practice

    CERN Document Server

    Meskó, Bertalan

    2013-01-01

    The number of patients using social media and the number of applications and solutions used by medical professionals online have been sky-rocketing in the past few years, therefore the rational behind creating a well-designed, clear and tight handbook of practical examples and case studies with simple pieces of suggestions about different social media platforms is evident. While the number of e-patients is rising, the number of web-savvy doctors who can meet the expectations of these new generations of patients is not, this huge gap can only be closed by providing medical professionals with ea

  10. Loop Diuretics in Clinical Practice.

    Science.gov (United States)

    Oh, Se Won; Han, Sang Youb

    2015-06-01

    Diuretics are commonly used to control edema across various clinical fields. Diuretics inhibit sodium reabsorption in specific renal tubules, resulting in increased urinary sodium and water excretion. Loop diuretics are the most potent diuretics. In this article, we review five important aspects of loop diuretics, in particular furosemide, which must be considered when prescribing this medicine: (1) oral versus intravenous treatment, (2) dosage, (3) continuous versus bolus infusion, (4) application in chronic kidney disease patients, and (5) side effects. The bioavailability of furosemide differs between oral and intravenous therapy. Additionally, the threshold and ceiling doses of furosemide differ according to the particular clinical condition of the patient, for example in patients with severe edema or chronic kidney disease. To maximize the efficiency of furosemide, a clear understanding of how the mode of delivery will impact bioavailability and the required dosage is necessary.

  11. Impella ventricular support in clinical practice

    DEFF Research Database (Denmark)

    Burzotta, Francesco; Trani, Carlo; Doshi, Sagar N

    2015-01-01

    and the operative protocols, this working group attempted to establish the best clinical practice with the technology. The present paper reviews the main theoretical principles of Impella and provides an up-to-date summary of the best practical aspects of device use which may help others gain the maximal advantage...

  12. Neuropsychiatric Lupus in clinical practice

    Directory of Open Access Journals (Sweden)

    Helena Alessi

    Full Text Available ABSTRACT Systemic lupus erythematosus (SLE is a chronic autoimmune disease involving multiple organs, characterized by the production of autoantibodies and the development of tissue injury. The etiology of SLE is partially known, involving multiple genetic and environmental factors. As many as 50% of patients with SLE have neurological involvement during the course of their disease. Neurological manifestations are associated with impaired quality of life, and high morbidity and mortality rates. Nineteen neuropsychiatric syndromes have been identified associated with SLE, and can be divided into central and peripheral manifestations. This article reviews major neuropsychiatric manifestations in patients with SLE and discusses their clinical features, radiological findings and treatment options.

  13. Clinical Practice Guidelines for intestinal occlusion.

    Directory of Open Access Journals (Sweden)

    Rudis Miguel Monzón Rodríguez

    2009-03-01

    Full Text Available Clinical Practice Guidelines for intestinal occlusion. This document includes the main aspects related with classification, physiopathology, clinical diagnosis, complementary examinations and therapy aimed at the post-operatory treatment. It includes assessment guidelines focused on the most important aspects to be accomplished.

  14. Unfinished Business: Subjectivity and Supervision

    Science.gov (United States)

    Green, Bill

    2005-01-01

    Within the now burgeoning literature on doctoral research education, postgraduate research supervision continues to be a problematical issue, practically and theoretically. This paper seeks to explore and understand supervision as a distinctive kind of pedagogic practice. Informed by a larger research project, it draws on poststructuralism,…

  15. Contemporary management of pericardial effusion: practical aspects for clinical practice.

    Science.gov (United States)

    Imazio, Massimo; Gaido, Luca; Battaglia, Alberto; Gaita, Fiorenzo

    2017-03-01

    A pericardial effusion (PE) is a relatively common finding in clinical practice. It may be either isolated or associated with pericarditis with or without an underlying disease. The aetiology is varied and may be either infectious (especially tuberculosis as the most common cause in developing countries) or non-infectious (cancer, systemic inflammatory diseases). The management is essentially guided by the hemodynamic effect (presence or absence of cardiac tamponade), the presence of concomitant pericarditis or underlying disease, and its size and duration. The present paper reviews the current knowledge on the aetiology, classification, diagnosis, management, therapy, and prognosis of PE in clinical practice.

  16. Clinical Practice Guidelines for Cerebral Abscess Treatment

    Directory of Open Access Journals (Sweden)

    Danny Barrueta Reyes

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Cerebral Abscess Treatment. It has been defined as a festering process caused by any germ and placed inside the cerebral parenchyma; this is a diagnostic and therapeutic challenge for surgeons and general doctors since the clinical and radiological manifestations are often imprecise. This document describes its etiological agents, clinical presentation, diagnosis and treatment. It includes assessment guidelines focused on the most important aspects to be accomplished.

  17. Clinical guidelines: their implementation in general practice.

    OpenAIRE

    M Conroy; Shannon, W

    1995-01-01

    In recent years the development of clinical guidelines has received increasing attention from medical educators and those involved in standard setting, and has been initiated at both central and local levels. This review article outlines the current state of knowledge with regard to clinical guideline implementation in medical practice. It deals with the main aspects of the current guideline debate, such as, clinical freedom and doctor autonomy, the importance of ownership in guideline implem...

  18. Thrombophilia: clinical-practical aspects.

    Science.gov (United States)

    Moll, Stephan

    2015-04-01

    No consensus exists as to who should be tested for thrombophilia, mainly due to the lack of good quality clinical outcome data in relationship to presence or absence of a given thrombophilia. Testing may be considered if (a) finding a thrombophilia predicts recurrent thrombosis and, thus, influences length of anticoagulation treatment decisions; (b) identifying a thrombophilia has implications on management of asymptomatic family members who are carriers of the detected thrombophilia; (c) a patient wishes to better understand why a thrombotic event occurred. Testing may be helpful in patients with venous thromboembolism at intermediate risk of recurrence in whom the finding of a strong thrombophilia can be one of the arguments for long-term anticoagulation--the "risk-of-recurrence-triangle" may be a useful aid in this decision process. Patients whose venous thromboembolism was provoked by a major transient risk factor should not be tested for thrombophilia. Thrombophilia tests should only be ordered by health care professionals who can provide the "4P": (a) appropriately select which patient to test, (b) provide pre-test counseling, (c) properly interpret the test results, and (d) provide education and advice to the patient. If testing is embarked on in patients with venous thromboembolism, it is advisable to be done at the time of decision making whether to stop or continue anticoagulation, i.e. typically after 3 months of anticoagulant therapy. Thrombophilia testing is best not done at the time of an acute thrombotic event and while a patient is on an anticoagulant.

  19. Clinical Practice Update: Pediculosis Capitis.

    Science.gov (United States)

    Bohl, Brittany; Evetts, Jessica; McClain, Kymberli; Rosenauer, Amanda; Stellitano, Emily

    2015-01-01

    A review of the current evidence on primary treatment modalities of head lice demonstrates increasing resistance to current regimens. New and alternative therapies are now available. A treatment algorithm was created to address safety and efficacy of treatments, as well as to guide clinicians through navigation of the regimens. Through an online journal search, 59 articles were selected for the review. Literature searches were performed through PubMed, Medline, Ebsco Host, and CINAHL, with key search words of "Pediculosis capitis" and "head lice" in the title, abstract, and index. Meta-analyses and controlled clinical trials were viewed with greater weight if they had a large sample size, were statistically significant, and did not allude to bias. When resistant infestations are well-documented in a locality, changes to the treatment regimen are indicated, and alternative treatments should be considered. Recent studies and U.S. Food and Drug Administration (FDA) approvals have changed the available treatment options for Pediculosis capitis, including benzyl alcohol, topical ivermectin, spinosad, and the LouseBuster. Further, environmental management and prevention measures should be taken to avoid reinfestation and to prevent the spread of head lice. Continued study is recommended to establish long-term safety of new and alternative agents.

  20. Collective academic supervision

    DEFF Research Database (Denmark)

    Nordentoft, Helle Merete; Thomsen, Rie; Wichmann-Hansen, Gitte

    2013-01-01

    are interconnected. Collective Academic Supervision provides possibilities for systematic interaction between individual master students in their writing process. In this process they learn core academic competencies, such as the ability to assess theoretical and practical problems in their practice and present them...

  1. Development and psychometric testing of the Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale (CLES+T): the Spanish version.

    Science.gov (United States)

    Vizcaya-Moreno, M Flores; Pérez-Cañaveras, Rosa M; De Juan, Joaquín; Saarikoski, Mikko

    2015-01-01

    The Clinical Learning Environment, Supervision and Nurse Teacher scale is a reliable and valid instrument to evaluate the quality of the clinical learning process in international nursing education contexts. This paper reports the development and psychometric testing of the Spanish version of the Clinical Learning Environment, Supervision and Nurse Teacher scale. Cross-sectional validation study of the scale. 10 public and private hospitals in the Alicante area, and the Faculty of Health Sciences (University of Alicante, Spain). 370 student nurses on clinical placement (January 2011-March 2012). The Clinical Learning Environment, Supervision and Nurse Teacher scale was translated using the modified direct translation method. Statistical analyses were performed using PASW Statistics 18 and AMOS 18.0.0 software. A multivariate analysis was conducted in order to assess construct validity. Cronbach's alpha coefficient was used to evaluate instrument reliability. An exploratory factorial analysis identified the five dimensions from the original version, and explained 66.4% of the variance. Confirmatory factor analysis supported the factor structure of the Spanish version of the instrument. Cronbach's alpha coefficient for the scale was .95, ranging from .80 to .97 for the subscales. This version of the Clinical Learning Environment, Supervision and Nurse Teacher scale instrument showed acceptable psychometric properties for use as an assessment scale in Spanish-speaking countries. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Adaptation and validation of the instrument Clinical Learning Environment and Supervision for medical students in primary health care.

    Science.gov (United States)

    Öhman, Eva; Alinaghizadeh, Hassan; Kaila, Päivi; Hult, Håkan; Nilsson, Gunnar H; Salminen, Helena

    2016-12-01

    Clinical learning takes place in complex socio-cultural environments that are workplaces for the staff and learning places for the students. In the clinical context, the students learn by active participation and in interaction with the rest of the community at the workplace. Clinical learning occurs outside the university, therefore is it important for both the university and the student that the student is given opportunities to evaluate the clinical placements with an instrument that allows evaluation from many perspectives. The instrument Clinical Learning Environment and Supervision (CLES) was originally developed for evaluation of nursing students' clinical learning environment. The aim of this study was to adapt and validate the CLES instrument to measure medical students' perceptions of their learning environment in primary health care. In the adaptation process the face validity was tested by an expert panel of primary care physicians, who were also active clinical supervisors. The adapted CLES instrument with 25 items and six background questions was sent electronically to 1,256 medical students from one university. Answers from 394 students were eligible for inclusion. Exploratory factor analysis based on principal component methods followed by oblique rotation was used to confirm the adequate number of factors in the data. Construct validity was assessed by factor analysis. Confirmatory factor analysis was used to confirm the dimensions of CLES instrument. The construct validity showed a clearly indicated four-factor model. The cumulative variance explanation was 0.65, and the overall Cronbach's alpha was 0.95. All items loaded similarly with the dimensions in the non-adapted CLES except for one item that loaded to another dimension. The CLES instrument in its adapted form had high construct validity and high reliability and internal consistency. CLES, in its adapted form, appears to be a valid instrument to evaluate medical students' perceptions of

  3. Adaptation and validation of the instrument Clinical Learning Environment and Supervision for medical students in primary health care

    Directory of Open Access Journals (Sweden)

    Eva Öhman

    2016-12-01

    Full Text Available Abstract Background Clinical learning takes place in complex socio-cultural environments that are workplaces for the staff and learning places for the students. In the clinical context, the students learn by active participation and in interaction with the rest of the community at the workplace. Clinical learning occurs outside the university, therefore is it important for both the university and the student that the student is given opportunities to evaluate the clinical placements with an instrument that allows evaluation from many perspectives. The instrument Clinical Learning Environment and Supervision (CLES was originally developed for evaluation of nursing students’ clinical learning environment. The aim of this study was to adapt and validate the CLES instrument to measure medical students’ perceptions of their learning environment in primary health care. Methods In the adaptation process the face validity was tested by an expert panel of primary care physicians, who were also active clinical supervisors. The adapted CLES instrument with 25 items and six background questions was sent electronically to 1,256 medical students from one university. Answers from 394 students were eligible for inclusion. Exploratory factor analysis based on principal component methods followed by oblique rotation was used to confirm the adequate number of factors in the data. Construct validity was assessed by factor analysis. Confirmatory factor analysis was used to confirm the dimensions of CLES instrument. Results The construct validity showed a clearly indicated four-factor model. The cumulative variance explanation was 0.65, and the overall Cronbach’s alpha was 0.95. All items loaded similarly with the dimensions in the non-adapted CLES except for one item that loaded to another dimension. The CLES instrument in its adapted form had high construct validity and high reliability and internal consistency. Conclusion CLES, in its adapted form, appears

  4. Supervision and group dynamics

    DEFF Research Database (Denmark)

    Hansen, Søren; Jensen, Lars Peter

    2004-01-01

    as well as at Aalborg University. The first visible result has been participating supervisors telling us that the course has inspired them to try supervising group dynamics in the future. This paper will explore some aspects of supervising group dynamics as well as, how to develop the Aalborg model...... An important aspect of the problem based and project organized study at Aalborg University is the supervision of the project groups. At the basic education (first year) it is stated in the curriculum that part of the supervisors' job is to deal with group dynamics. This is due to the experience...... that many students are having difficulties with practical issues such as collaboration, communication, and project management. Most supervisors either ignore this demand, because they do not find it important or they find it frustrating, because they do not know, how to supervise group dynamics...

  5. A framework to facilitate self-directed learning, assessment and supervision in midwifery practice: A qualitative study of supervisors' perceptions

    NARCIS (Netherlands)

    Embo, M.; Driessen, E.; Valcke, M.; Vleuten, C.P.M. van der

    2014-01-01

    BACKGROUND: Self-directed learning is an educational concept that has received increasing attention. The recent workplace literature, however, reports problems with the facilitation of self-directed learning in clinical practice. We developed the Midwifery Assessment and Feedback Instrument (MAFI) a

  6. A framework to facilitate self-directed learning, assessment and supervision in midwifery practice: A qualitative study of supervisors' perceptions

    NARCIS (Netherlands)

    Embo, M.; Driessen, E.; Valcke, M.; Vleuten, C.P.M. van der

    2014-01-01

    BACKGROUND: Self-directed learning is an educational concept that has received increasing attention. The recent workplace literature, however, reports problems with the facilitation of self-directed learning in clinical practice. We developed the Midwifery Assessment and Feedback Instrument (MAFI) a

  7. Nursing students' experiences of and satisfaction with the clinical learning environment: the role of educational models in the simulation laboratory and in clinical practice.

    Science.gov (United States)

    Cremonini, Valeria; Ferri, Paola; Artioli, Giovanna; Sarli, Leopoldo; Piccioni, Enrico; Rubbi, Ivan

    2015-01-01

    Student satisfaction is an important element of the effectiveness of clinical placement, but there is little consensus in the literature as to the preferred model of clinical experience for undergraduate nursing students. The aim of this study was assess, for each academic year, students' perception of the roles of nurse teachers (NT) and clinical nurse supervisors (CNS) who perform tutoring in both apprenticeship and laboratories and to identify and evaluate students' satisfaction with the environment of clinical learning. This analytic cross-sectional study was conducted in a sample of 173 nursing students in the Northern Italy. The research instrument used is the Clinical learning environment, supervision and nurse teacher (CLES+T) evaluation scale. Data were statistically analysed. 94% of our sample answered questionnaires. Students expressed a higher level of satisfaction with their training experiences. The highest mean value was in the sub-dimension "Pedagogical atmosphere on the ward". Third year students expressed higher satisfaction levels in their relationship with the CNS and lower satisfaction levels in their relationship with the NT. This result may be due to the educational model that is adopted in the course, in which the simulation laboratory didactic activities of the third year are conducted by CNS, who also supervises experiences of clinical learning in the clinical practice. The main finding in this study was that the students' satisfaction with the supervisory relationship and the role of NT depend on how supervision in the clinical practice and in the simulation laboratory is organized.

  8. Clinical Engineering: Experiences of assisted professional practices

    Science.gov (United States)

    Langone, Luis; Vanetta, Marcos; Vazquez, Marcelo; Rotger, Viviana; Olivera, Juan Manuel

    2007-11-01

    In the curricula of the Biomedical Engineering career of the Facultad de Ciencias Exactas y Tecnología of the Universidad Nacional de Tucumán, Argenitna, there are the Assisted Professional Practices. Within this framework, the students have the possibility of performing practices in the clinic Sanatorio 9 de Julio. One of the objectives of these practices is to apply the concepts, methods and procedures studied along the career in the field work under real work conditions. From the point of view of the host institution, the objective is to improve the performance of the different services and areas applying the tools of Biomedical Engineering. The present work shows an example of such practices where an equipment preliminary analysis was made, its use and maintenance corresponding to the surgical unit of the clinic.

  9. Clinical Engineering: Experiences of assisted professional practices

    Energy Technology Data Exchange (ETDEWEB)

    Langone, Luis [Departamento de BioingenierIa, FACET-UNT, INSIBIO-CONICET (Argentina); Vanetta, Marcos [Departamento de BioingenierIa, FACET-UNT, INSIBIO-CONICET (Argentina); Vazquez, Marcelo [Sanatorio 9 de Julio SA PO Box 327, Zip Code (4000), Tucuman (Argentina); Rotger, Viviana I [Departamento de BioingenierIa, FACET-UNT, INSIBIO-CONICET (Argentina); Olivera, Juan Manuel [Departamento de BioingenierIa, FACET-UNT, INSIBIO-CONICET (Argentina)

    2007-11-15

    In the curricula of the Biomedical Engineering career of the Facultad de Ciencias Exactas y TecnologIa of the Universidad Nacional de Tucuman, Argenitna, there are the Assisted Professional Practices. Within this framework, the students have the possibility of performing practices in the clinic Sanatorio 9 de Julio. One of the objectives of these practices is to apply the concepts, methods and procedures studied along the career in the field work under real work conditions. From the point of view of the host institution, the objective is to improve the performance of the different services and areas applying the tools of Biomedical Engineering. The present work shows an example of such practices where an equipment preliminary analysis was made, its use and maintenance corresponding to the surgical unit of the clinic.

  10. Comparison of Effectiveness of Supervised Exercise Program and Cyriax Physiotherapy in Patients with Tennis Elbow (Lateral Epicondylitis: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Rajadurai Viswas

    2012-01-01

    Full Text Available Objective. To compare the effectiveness of supervised exercise program and Cyriax physiotherapy in the treatment of tennis elbow (lateral epicondylitis. Design. Randomized clinical trial. Setting. Physiotherapy and rehabilitation centre. Subjects. This study was carried out with 20 patients, who had tennis elbow (lateral epicondylitis. Intervention. Group A (=10 had received supervised exercise program. Group B (=10 was treated with Cyriax physiotherapy. All patients received three treatment sessions per week for four weeks (12 treatment sessions. Outcome measures. Pain was evaluated using a visual analogue scale (VAS, and functional status was evaluated by completion of the Tennis Elbow Function Scale (TEFS which were recorded at base line and at the end of fourth week. Results. Both the supervised exercise program and Cyriax physiotherapy were found to be significantly effective in reduction of pain and in the improvement of functional status. The supervised exercise programme resulted in greater improvement in comparison to those who received Cyriax physiotherapy. Conclusion. The results of this clinical trial demonstrate that the supervised exercise program may be the first treatment choice for therapist in managing tennis elbow.

  11. Implementing human factors in clinical practice

    Science.gov (United States)

    Timmons, Stephen; Baxendale, Bryn; Buttery, Andrew; Miles, Giulia; Roe, Bridget; Browes, Simon

    2015-01-01

    Objectives To understand whether aviation-derived human factors training is acceptable and useful to healthcare professionals. To understand whether and how healthcare professionals have been able to implement human factors approaches to patient safety in their own area of clinical practice. Methods Qualitative, longitudinal study using semi-structured interviews and focus groups, of a multiprofessional group of UK NHS staff (from the emergency department and operating theatres) who have received aviation-derived human factors training. Results The human factors training was evaluated positively, and thought to be both acceptable and relevant to practice. However, the staff found it harder to implement what they had learned in their own clinical areas, and this was principally attributed to features of the informal organisational cultures. Conclusions In order to successfully apply human factors approaches in hospital, careful consideration needs to be given to the local context and informal culture of clinical practice. PMID:24631959

  12. Bridging the Gap between University Supervisors and Hispanic Students' Interpretation of English Language Development Teaching Practices during Intern Teacher Fieldwork Supervision in Inner-City Middle Schools of Los Angeles

    Science.gov (United States)

    Ajayi, Lasisi

    2006-01-01

    Efforts at improving fieldwork supervision during internship have largely focused on the role of university supervisors and intern teachers. Thus students' perceptions of the instructional practices are not systematically collected, analyzed and discussed in such a way that insights from students' perceptions can inform fieldwork supervision. This…

  13. Introducing clinical audit into veterinary practice.

    OpenAIRE

    2006-01-01

    This project has been designed to increase our understanding of the clinical audit process, as it applies to veterinary practice in the UK, and to facilitate its introduction in a manner that brings maximum benefit to all stakeholders. It examines the medical scenario to define the process and glean any relevant information. It then takes the form of an action research project that examines in depth the introduction of the audit process into a small animal practice in outer NW London, in...

  14. Supervised versus non-supervised implementation of an oral health care guideline in (residential care homes: a cluster randomized controlled clinical trial

    Directory of Open Access Journals (Sweden)

    de Baat Cees

    2010-07-01

    Full Text Available Abstract Background The increase of the proportion of elderly people has implications for health care services. Advances in oral health care and treatment have resulted in a reduced number of edentulous individuals. An increasing number of dentate elderly people have tooth wear, periodontal disease, oral implants, and sophisticated restorations and prostheses. Hence, they are in need of both preventive and curative oral health care continuously. Weakened oral health due to neglect of self care and professional care and due to reduced oral health care utilization is already present when elderly people are still community-dwelling. At the moment of (residential care home admittance, many elderly people are in need of oral health care urgently. The key factor in realizing and maintaining good oral health is daily oral hygiene care. For proper daily oral hygiene care, many residents are dependent on nurses and nurse aides. In 2007, the Dutch guideline "Oral health care in (residential care homes for elderly people" was developed. Previous implementation research studies have revealed that implementation of a guideline is very complicated. The overall aim of this study is to compare a supervised versus a non-supervised implementation of the guideline in The Netherlands and Flanders (Belgium. Methods/Design The study is a cluster randomized intervention trial with an institution as unit of randomization. A random sample of 12 (residential care homes accommodating somatic as well as psycho-geriatric residents in The Netherlands as well as in Flanders (Belgium are randomly allocated to an intervention or control group. Representative samples of 30 residents in each of the 24 (residential care homes are monitored during a 6-months period. The intervention consists of supervised implementation of the guideline and a daily oral health care protocol. Primary outcome variable is the oral hygiene level of the participating residents. To determine the

  15. Discussion and Practice of Teaching Supervision in Higher Vocational Education%高职教学督导工作的探讨与实践

    Institute of Scientific and Technical Information of China (English)

    李月清

    2011-01-01

    Teaching supervision is the effective means to ensure the teaching quality in higher vocational colleges.This paper discusses the trend of teaching supervision of higher vocational education and the working principle of teaching supervisor.Combining the practice of Beijing Polytechnic College in teaching supervision,the author puts forward the working thought of teaching quality supervision.%教学督导是高职院校保证教学质量的有效手段,在保证和提高教育教学质量的方面起着举足轻重的作用。探讨了高职院校教学督导工作发展的趋势和教学督导员应遵循的工作原则,结合北京工业职业技术学院的具体做法,提出教学质量监控的工作思路。

  16. George Engel's Epistemology of Clinical Practice.

    Science.gov (United States)

    Saraga, Michael; Fuks, Abraham; Boudreau, J Donald

    2014-01-01

    George Engel's (1913-1999) biopsychosocial model, one of the most significant proposals for the renewal of medicine in the latter half of the 20th century, has been understood primarily as a multi-factorial approach to the etiology of disease and as a call to re-humanize clinical practice. This common reading of Engel's model misses the central aspect of his proposal, that the biopsychosocial model is an epistemology for clinical work. By stating the simple fact that the clinician is not dealing directly with a body, but first, and inevitably, with a person, Engel challenged the epistemology implicit in the classical clinical method-a method predicated on the possibility of direct access to the body. Framed in epistemological terms, the issue at stake is not the need to complement medical science with humane virtues, but rather to acknowledge that the object of clinical practice is not the body but the patient.

  17. Clinical Practice Guidelines for Cardiogenic Shock.

    Directory of Open Access Journals (Sweden)

    Arelys Falcón Hernández

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Cardiogenic Shock. It has been defined as the persistence of tissue hypoperfusion, usually associated to blood hypotension as the result of heart pumping failure. This document includes a review of the main aspects as concepts, aetiology, diagnosis and treatment. It includes the concept, risk factors, clinical presentations, diagnosis, and therapy based on the possibilities of our environment. It includes assessment guidelines focused on the most important aspects to be accomplished.

  18. Clinical Practice Guidelines Infective Endocarditis Treatment.

    Directory of Open Access Journals (Sweden)

    Lázaro de la Cruz Avilés

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Infective Endocarditis Treatment. Infectious disease affecting the endocardium produces vegetations and could also affect the septum, the chordae tendinae or mural endocardium. It includes concept, risk factors, classification (and special groups and an update and review of the main clinical aspects, complications and treatment stressing the antibiotic therapy. It includes assessment guidelines focused on the most important aspects to be accomplished.

  19. Clinical Practice Guidelines for cranioencephalic trauma.

    Directory of Open Access Journals (Sweden)

    Florencio Pons Moscoso

    2009-03-01

    Full Text Available Clinical Practice Guidelines for cranioencephalic trauma. It has been defined as the lesion received in the cranium, its covers and the encephalic content as a result of the action of external forces. This document includes a review of the classification, clinical presentation and methods used in the diagnosis and main treatment alternatives, stressing the neuro-monitoring. It includes assessment guidelines focused on the most important aspects to be accomplished.

  20. Clinical Practice Guidelines for Potential Donors Management

    Directory of Open Access Journals (Sweden)

    José Roque Nodal Arruebarrena

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Potential Donors Management. It has been defined as the patient in Glasgow coma with scale higher or equal to 8 who doesn´t present contradictions for transplant (possible donor and who has been diagnosed of encephalic death. This document reviews and updates concepts, lists indications and contraindications for different organs donation, clinical assessment of the donor and its treatment. It includes assessment guidelines focused on the most important aspects to be accomplished.

  1. Clinical Practice Guidelines for Acute Pulmonary Edema.

    Directory of Open Access Journals (Sweden)

    Pablo Rodríguez Díaz

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Acute Pulmonary Edema. It has been defined as an abrupt and severe failure of the left ventricular function which causes pulmonary edema or cardiac origin interfering with the normal oxygen exchange at pulmonary level. This document includes a review and update of the main clinical aspects allowing the early diagnosis and immediate therapeutic treatment. It includes assessment guidelines focused on the most important aspects to be accomplished.

  2. Clinical Practice Guidelines for Exogenous Poisoning.

    Directory of Open Access Journals (Sweden)

    Alexis Díaz Mesa

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Exogenous Poisoning. Medical emergencies determined by the exposure to different substances (drugs, medicines, physical or chemical corrosive agents, etc. It includes the classification of toxic substances, clinical diagnosis (main syndromes, and description of therapeutic variations (vital support, antidotes, absorption measurements and increase of elimination and depuration of the toxic substance. It includes assessment guidelines focused on the most important aspects to be accomplished.

  3. Clinical Practice Guidelines for paroxysmal supraventricular tachycardia.

    Directory of Open Access Journals (Sweden)

    Brandy Viera Valdés

    2009-03-01

    Full Text Available Clinical Practice Guidelines for paroxysmal supraventricular tachycardia. These are arrhythmias in which structures placed above the bifurcation of the bundle of His are involved; characterized by tachycardia with abrupt starting and ending. We comment its classification, common characteristics, general treatment and specific conduct for its different variables. It includes assessment guidelines focused on the most important aspects to be accomplished.

  4. Clinical Practice Guidelines for Critical Patients’ Nutrition.

    Directory of Open Access Journals (Sweden)

    Marta Patricia Casanova González

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Critical Patients’ Nutrition. This document includes a review and update of aspects related with nutritional assessment of patients in critical condition; indications, contraindications and procedures for enteral and parenteral nutrition and its follow up. It includes assessment guidelines focused on the most important aspects to be accomplished.

  5. Introduction: Applying Clinical Psychological Science to Practice.

    Science.gov (United States)

    Cha, Christine B; DiVasto, Katherine A

    2017-02-10

    Mental illness is a prevalent and extraordinarily complex phenomenon. Psychologists have developed distinct approaches toward understanding and treating mental illness, rooted in divergent epistemology. This introduction to the Special Issue on Clinical Psychological Science and Practice provides a brief overview of the scientist-practitioner gap, and explores one step (of many) toward bridging this divide. Seven compelling case illustrations featured in this Special Issue apply empirical findings to case formulation, treatment selection, and assessment across complex and varied clinical presentations. This issue thereby demonstrates the feasibility of integrating research and clinical expertise in mental healthcare.

  6. Supervision of Supervised Agricultural Experience Programs: A Synthesis of Research.

    Science.gov (United States)

    Dyer, James E.; Williams, David L.

    1997-01-01

    A review of literature from 1964 to 1993 found that supervised agricultural experience (SAE) teachers, students, parents, and employers value the teachers' supervisory role. Implementation practices vary widely and there are no cumulative data to guide policies and standards for SAE supervision. (SK)

  7. The practice of clinical neuropsychology in Australia.

    Science.gov (United States)

    Ponsford, Jennie

    2016-11-01

    This paper describes the development and practice of clinical neuropsychology in Australia. Clinical Neuropsychology has shown rapid growth in Australia over the past three decades. Comprehensive and specialized training programs are producing high quality graduates who are employed in a broad range of settings or private practice. Australia now has a substantial number of clinical neuropsychologists with specialist training. Whilst the majority of Australian clinical neuropsychologists still undertake assessment predominantly, there are growing opportunities for clinical neuropsychologists in rehabilitation and in a broad range of research contexts. Cultural issues relating to the assessment of Indigenous Australians and immigrants from many countries present significant challenges. Some major contributions have been made in the realms of test development and validation across various age groups. Australian clinical neuropsychologists are also contributing significantly to research in the fields of traumatic brain injury, aging and dementias, epilepsy, memory assessment, rehabilitation, substance abuse, and other psychiatric disorders. Expansion of roles of clinical neuropsychologists, in domains such as rehabilitation and research is seen as essential to underpin continuing growth of employment opportunities for the profession.

  8. Attachment style and its relationship to working alliance in the supervision of British clinical psychology trainees.

    Science.gov (United States)

    Dickson, Joanne M; Moberly, Nicholas J; Marshall, Yehuda; Reilly, James

    2011-01-01

    Although the supervisory relationship is thought to be critical in training clinical psychologists, little is known about factors affecting the supervisory alliance. We conducted an Internet survey of British clinical doctoral trainees (N = 259) in which participants rated their supervisory working alliance, parental style during childhood, pathological adult attachment behaviours and attachment style for themselves and their supervisors. Trainees' ratings of the working alliance were associated with perceptions of supervisors' attachment style, but not with perceptions of trainees' own attachment styles. Path analysis supported a causal chain linking parental indifference, compulsive self-reliance, insecure supervisor attachment style and lower ratings of the working alliance. Our results broadly replicate data from a US sample and suggest that attachment theory is helpful in understanding clinical supervisory processes.

  9. Suicidality in clinical practice: anxieties and answers.

    Science.gov (United States)

    Rudd, M David

    2006-02-01

    This issue of the Journal of Clinical Psychology: In Session is devoted to suicidality in clinical practice, with coverage of a broad range of topics. After summarizing some of the problems and recent advances in clinical suicidology, I provide a brief overview of the articles. Included are the more broadly defined issues of risk management and psychotherapy with suicidal individuals, along with more specific topics such as risk assessment, no-suicide contracts, and the risk of suicide with the use of selective serotonin reuptake inhibitors (SSRIs) by children and adolescents. Most of the articles feature case vignettes and provide practitioners with clinical recommendations, and all of the articles have clear and important clinical implications. (c) 2005 Wiley Periodicals, Inc.

  10. Good clinical practices in phase I studies.

    Science.gov (United States)

    Decousus, H; Perpoint, B; Mismetti, P; Ollagnier, M; Queneau, P

    1990-01-01

    In France, official guidelines for good clinical practices in clinical trials were issued in 1987. In December 1988, a law was passed that fixed the requirements for carrying out experiments in healthy subjects. It will be completed by official guidelines for the structures in which experiments on healthy subjects (and patients as well, when the investigation would not benefit the health of the patients) may be conducted. Hence a battery of recent legal instructions precisely state what good clinical practices are in the setting of phase I studies. Of particular importance are: subject recruitment and selection methods and procedures; specific competence of the investigator, in particular to interpret the pre-trial data; necessary and sufficient facilities to guarantee the subjects' safety; careful quality control to check all laboratory procedures; necessity of written standard operating procedures.

  11. Nursing students and the supervision of medication administration.

    Science.gov (United States)

    Reid-Seari, Kerry; Happell, Brenda; Burke, Karena J; Gaskin, Cadeyrn J

    2013-01-01

    Up to one in five medication administrations in Australian hospitals involve an error. As registered nurses (RNs) are at the forefront of medication administration, they have been the focus of attempts to reduce errors. Given that nursing students have reported errors or experiences of near misses, their practices, as well as the supervision they receive from RNs, also deserves investigation. The aim of this study was to investigate student nurses' experiences of supervision while administering medications. Students (N= 45) completed a questionnaire on their supervision experiences while administering medications. The findings revealed that 88% of students agreed that they had been directly supervised during the entirety of administration procedures. Although 7% of students reported not receiving supervision throughout medication administration, higher percentages of students indicated that they received lower levels of supervision when wards were busy (66%), when they felt under pressure to comply with the wishes of RNs (40%), when students had been in clinical settings for extended periods of time (51%), and when the RNs trusted the student nurses (37%). Approximately one third (29%) of student nurses disagreed that RNs followed the six rights when administering medications. These findings suggest that student nurses are not always adequately supervised and are at times administering medications outside the parameters of the law. Healthcare organisations need to adapt their policies and practices to ensure that the legal requirements surrounding student nurse administration of medications are being met, as well as the educational and welfare needs of neophyte nurses.

  12. Mutual assumptions and facts about nondisclosure among clinical supervisors and students in group supervision

    DEFF Research Database (Denmark)

    Nielsen, Geir Høstmark; Skjerve, Jan; Jacobsen, Claus Haugaard;

    2009-01-01

    In the two preceding papers of this issue of Nordic Psychology the authors report findings from a study of nondisclosure among student therapists and clinical supervisors. The findings were reported separately for each group. In this article, the two sets of findings are held together and compared......, so as to draw a picture of mutual assumptions and facts about nondisclosure among students and supervisors....

  13. Integrating learning assessment and supervision in a competency framework for clinical workplace education

    NARCIS (Netherlands)

    Embo, M.; Driessen, E.; Valcke, M.; Vleuten, C.P.M. van der

    2015-01-01

    Although competency-based education is well established in health care education, research shows that the competencies do not always match the reality of clinical workplaces. Therefore, there is a need to design feasible and evidence-based competency frameworks that fit the workplace reality. This t

  14. Advanced Music Therapy Supervision Training

    DEFF Research Database (Denmark)

    2009-01-01

    supervision training excerpts live in the workshop will be offered. The workshop will include demonstrating a variety of supervision methods and techniques used in A) post graduate music therapy training programs b) a variety of work contexts such as psychiatry and somatic music psychotherapy. The workshop......The presentation will illustrate training models in supervision for experienced music therapists where transference/counter transference issues are in focus. Musical, verbal and body related tools will be illustrated from supervision practice by the presenters. A possibility to experience small...

  15. Advanced Music Therapy Supervision Training

    DEFF Research Database (Denmark)

    2009-01-01

    supervision training excerpts live in the workshop will be offered. The workshop will include demonstrating a variety of supervision methods and techniques used in A) post graduate music therapy training programs b) a variety of work contexts such as psychiatry and somatic music psychotherapy. The workshop......The presentation will illustrate training models in supervision for experienced music therapists where transference/counter transference issues are in focus. Musical, verbal and body related tools will be illustrated from supervision practice by the presenters. A possibility to experience small...

  16. 论水利工程监理工作的实践与体会%Discuss the Practice and Experience of Supervision Work in Water Conservancy Project

    Institute of Scientific and Technical Information of China (English)

    黄文伟

    2014-01-01

    Combined with the author's practical experience, this paper discusses the working experience supervision work in water conservancy project and the necessary conditions and the ability that supervisor must have and puts forward sug-gestions to improve on how to achieve bet er supervision.%本文结合笔者的实际工作经验,探讨了水利工程项目监理工作的体会和作为监理必须具有的能力以及必备的条件,并对如何更好地进行监理工作提出了改进建议。

  17. Hyponatraemia diagnosis and treatment clinical practice guidelines.

    Science.gov (United States)

    Spasovski, Goce; Vanholder, Raymond; Allolio, Bruno; Annane, Djillali; Ball, Steve; Bichet, Daniel; Decaux, Guy; Fenske, Wiebke; Hoorn, Ewout J; Ichai, Carole; Joannidis, Michael; Soupart, Alain; Zietse, Robert; Haller, Maria; van der Veer, Sabine; van Biesen, Wim; Nagler, Evi; Gonzalez-Espinoza, Liliana; Ortiz, Alberto

    Hyponatremia, defined as a serum sodium concentration <135mmol/l, is the most common water-electrolyte imbalance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from mild to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay. Despite this, the management of hyponatremia patients remains problematic. The prevalence of hyponatremia in a wide variety of conditions and the fact that hyponatremia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution- and specialty-based approaches to diagnosis and treatment. To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA), represented by European Renal Best Practice (ERBP), have developed clinical practice guidelines on the diagnostic approach and treatment of hyponatremia as a joint venture of 3societies representing specialists with a natural interest in hyponatremia. In addition to a rigorous approach to the methodology and evaluation of the evidence, the document focuses on patient-positive outcomes and on providing a useful tool for clinicians involved in everyday practice. In this article, we present an abridged version of the recommendations and suggestions for the diagnosis and treatment of hyponatremia extracted from the full guide. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  18. The Bobath concept in contemporary clinical practice.

    Science.gov (United States)

    Graham, Julie Vaughan; Eustace, Catherine; Brock, Kim; Swain, Elizabeth; Irwin-Carruthers, Sheena

    2009-01-01

    Future development in neurorehabilitation depends upon bringing together the endeavors of basic science and clinical practice. The Bobath concept is widely utilized in rehabilitation following stroke and other neurological conditions. This concept was first developed in the 1950s, based on the neuroscience knowledge of those times. The theoretical basis of the Bobath concept is redefined based on contemporary neuroscience and rehabilitation science. The framework utilized in the Bobath concept for the analysis of movement and movement dysfunction is described. This framework focuses on postural control for task performance, the ability to move selectively, the ability to produce coordinated sequences of movement and vary movement patterns to fit a task, and the role of sensory input in motor behaviour and learning. The article describes aspects of clinical practice that differentiate this approach from other models of practice. Contemporary practice in the Bobath concept utilizes a problem-solving approach to the individual's clinical presentation and personal goals. Treatment is focused toward remediation, where possible, and guiding the individual towards efficient movement strategies for task performance. The aim of this article is to provide a theoretical framework on which future research into the Bobath concept can be based.

  19. Supervision in rehabilitation psychology: Application of Beatrice Wright's value-laden beliefs and principles.

    Science.gov (United States)

    Tackett, M Jan; Nash, Laurie; Stucky, Kirk Jeffrey; Nierenberg, Barry

    2016-02-01

    Clinical supervision is of critical importance for training subsequent generations of psychologists. Specialty training in rehabilitation psychology requires exposure to specific knowledge, skills, and attitudes related to disability and specialized supervision and mentorship. In the literature to date, minimal guidance exists regarding supervision training and methods specifically for rehabilitation psychologists. This article aims to provoke discussion regarding supervision practice and dissemination of the values fundamental to our specialty. The foundational wisdom of Dr. Beatrice Wright (1983) is applied for the purposes of this endeavor. Examples of clinical supervision scenarios are presented as teaching vignettes to demonstrate ways in which supervisors and mentors can incorporate this content, promote discussion, and apply it to real-world practice.

  20. How to develop guidelines for clinical practice.

    Science.gov (United States)

    Jaeschke, R; Jankowski, M; Brozek, J; Antonelli, M

    2009-09-01

    Recent decades have seen an explosion of clinical practice guidelines documents developed to inform clinicians about the best options for managing treatment, with the explicit intent to influence behaviour. As our exposure to guidelines has increased it has become clear that the process of guideline development should follow specific rules in order to avoid disagreement, misunderstanding, misleading recommendations, and confusion. In this article, we review the approach to developing clinical practice guidelines suggested by an international Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) workgroup. This approach suggests several steps for guideline development: 1. determine the purpose, scope, and intended audience; 2. select the panel of guideline authors; 3. specify the main focused clinical questions that the recommendations will address; 4. decide on the relative importance of outcomes; 5. find and summarize the evidence supporting each recommendation; 6. determine the quality of the available evidence; 7. evaluate the balance of desirable and undesirable consequences for a particular course of action; 8. formulate recommendations, including their strenght; and 9. consider a system for subsequent guideline implementation and evaluation. We aim to help the readers of practice guidelines asses those guidelines' quality and validity, as well as to assist the authors of future guidelines in systematically generating clinical recommendations.

  1. Ultrasound transducer selection in clinical imaging practice.

    Science.gov (United States)

    Szabo, Thomas L; Lewin, Peter A

    2013-04-01

    Many types of medical ultrasound transducers are used in clinical practice. They operate at different center frequencies, have different physical dimensions, footprints, and shapes, and provide different image formats. However, little information is available about which transducers are most appropriate for a given application, and the purpose of this article is to address this deficiency. Specifically, the relationship between the transducer, imaging format, and clinical applications is discussed, and systematic selection criteria that allow matching of transducers to specific clinical needs are presented. These criteria include access to and coverage of the region of interest, maximum scan depth, and coverage of essential diagnostic modes required to optimize a patient's diagnosis. Three comprehensive figures organize and summarize the imaging planes, scanning modes, and types of diagnostic transducers to facilitate their selection in clinical diagnosis.

  2. Korean Clinical Practice Guidelines: Otitis Media in Children

    Science.gov (United States)

    Lee, Hyo-Jeong; Park, Su-Kyoung; Choi, Kyu Young; Park, Su Eun; Chun, Young Myung; Kim, Kyu-Sung; Park, Shi-Nae; Cho, Yang-Sun; Kim, Young-Jae

    2012-01-01

    Acute otitis media (AOM) and otitis media with effusion (OME) are common infections in children, and their diagnosis and treatment have significant impacts on the health of children and the costs of providing national medical care. In 2009, the Korean Otologic Society organized a committee composed of experts in the field of otolaryngology, pediatrics, and family medicine to develop Korean clinical practice guidelines (CPG) for otitis media in children with the goal of meeting regional medical and social needs in Korea. For this purpose, the committee adapted existing guidelines. A comprehensive literature review was carried out primarily from 2004 to 2009 using medical search engines including data from Korea. A draft was written after a national questionnaire survey and several public audits, and it was editorially supervised by senior advisors before publication of the final report. These evidence-based guidelines for the management of otitis media in children provide recommendations to primary practitioners for the diagnosis and treatment of children younger than 15 yr old with uncomplicated AOM and OME. The guidelines include recommendations regarding diagnosis, treatment options, prevention and parent education, medical records, referral, and complementary/alternative medicine for treating pediatric otitis media. PMID:22876048

  3. Korean clinical practice guidelines: otitis media in children.

    Science.gov (United States)

    Lee, Hyo-Jeong; Park, Su-Kyoung; Choi, Kyu Young; Park, Su Eun; Chun, Young Myung; Kim, Kyu-Sung; Park, Shi-Nae; Cho, Yang-Sun; Kim, Young-Jae; Kim, Hyung-Jong; Korean Otologic Society

    2012-08-01

    Acute otitis media (AOM) and otitis media with effusion (OME) are common infections in children, and their diagnosis and treatment have significant impacts on the health of children and the costs of providing national medical care. In 2009, the Korean Otologic Society organized a committee composed of experts in the field of otolaryngology, pediatrics, and family medicine to develop Korean clinical practice guidelines (CPG) for otitis media in children with the goal of meeting regional medical and social needs in Korea. For this purpose, the committee adapted existing guidelines. A comprehensive literature review was carried out primarily from 2004 to 2009 using medical search engines including data from Korea. A draft was written after a national questionnaire survey and several public audits, and it was editorially supervised by senior advisors before publication of the final report. These evidence-based guidelines for the management of otitis media in children provide recommendations to primary practitioners for the diagnosis and treatment of children younger than 15 yr old with uncomplicated AOM and OME. The guidelines include recommendations regarding diagnosis, treatment options, prevention and parent education, medical records, referral, and complementary/alternative medicine for treating pediatric otitis media.

  4. Post-Graduate Supervision Practices in South African Universities in the Era of Democracy and Educational Change 1994-2004

    Science.gov (United States)

    Pillay, G.; Balfour, R. J.

    2011-01-01

    Supervision might be understood as the provision usually by an academic to a student of either the expert guidance in subject knowledge or genre knowledge in relation to postgraduate thesis development. The Project for Postgraduate Educational Research (PPER) team members, in the course of their field visits, sought to interview supervisors of…

  5. Facilitating the Learning Process in Design-Based Learning Practices: An Investigation of Teachers' Actions in Supervising Students

    Science.gov (United States)

    Gómez Puente, S. M.; van Eijck, M.; Jochems, W.

    2013-01-01

    Background: In research on design-based learning (DBL), inadequate attention is paid to the role the teacher plays in supervising students in gathering and applying knowledge to design artifacts, systems, and innovative solutions in higher education. Purpose: In this study, we examine whether teacher actions we previously identified in the DBL…

  6. Clinical scientists improving clinical practices: in thoughts and actions.

    Science.gov (United States)

    Apel, Kenn

    2014-04-01

    In this article, the author comments on aspects of Kamhi's (2014) article, which caused the author to think more deeply about definitions of language, theories of learning, and how these two core components of intervention prepare clinical scientists as they search the literature for new knowledge. Interprofessional collaborative practice as a model for team-based intervention in school settings is also discussed. The article addresses aspects of Kamhi's article that aligned or did not align with the author's definition of language and theory of learning and explains why considering these alignments is important for clinical scientists. Two challenges to staying current with the research base are also described, and suggestions are offered for addressing these challenges. Finally, the article provides an overview of interprofessional collaborative practice. Clinical scientists should continue to strive to use their knowledge of what language is and how it is learned, combined with the best available scientific information, to best serve their clients. Combining their thoughts and actions, they undoubtedly will continuously improve their clinical practices.

  7. Clinical Decision Support Systems: A Useful Tool in Clinical Practice

    Directory of Open Access Journals (Sweden)

    Kolostoumpis G.

    2012-01-01

    Full Text Available The possibility of supporting in decision – making shows an increase in recent years. Based on mathematic simulation tools, knowledge databases, processing methods, medical data and methods, artificial intelligence for coding of the available knowledge and for resolving complex problems arising into clinical practice. Aim: the aim of this review is to present the development of new methods and modern services, in clinical practice and the emergence in their implementation. Data and methods: the methodology that was followed included research of articles that referred to health sector and modern technologies, at the electronic data bases “pubmed” and “medline”. Results: Is a useful tool for medical experts using characteristics and medical data used by the doctors. Constitute innovation for the medical community, and ensure the support of clinical decisions with an overall way by providing a comprehensive solution in the light of the integration of computational decision support systems into clinical practice. Conclusions: Decision Support Systems contribute to improving the quality of health services with simultaneous impoundment of costs (i.e. avoid medical errors

  8. Clinical photography in the dermatology practice.

    Science.gov (United States)

    Witmer, William K; Lebovitz, Peter J

    2012-09-01

    Photography has been accepted for decades as a standard means for documenting dermatologic conditions and as an adjunct to their treatment, in both medical practice and research. The emergence of low-cost easy-to-use digital imaging systems has made good-quality photography more accessible to practitioners, while providing improved functionality in the clinical environment. Primary concerns are controlling lighting and positioning to provide a clear record of the patients skin condition and maintaining consistency over time to assure meaningful comparison of clinical end points.

  9. Medical Ethics in Contemporary Clinical Practice

    Directory of Open Access Journals (Sweden)

    John R. Williams

    2005-11-01

    Full Text Available This review article describes and analyzes ethical issues in medical practice, particularly those issues encountered by physicians in their relationships with their patients. These relationships often involve ethical conflicts between 2 or more interests, which physicians need to recognize and resolve. The article deals with 4 topics in clinical practice in which ethical conflicts occur: physicians' duty of confidentiality in a digital environment, their responsibilities for dealing with abuses of the human rights of patients, their role in clinical research, and their relationships with commercial enterprises. The ethical policies of the World Medical Association provide the basis for determining appropriate physician conduct on these matters. The article concludes with reflections on the need for international standards of medical ethics.

  10. Clinical decision making in veterinary practice

    OpenAIRE

    Everitt, Sally

    2011-01-01

    Aim The aim of this study is to develop an understanding of the factors which influence veterinary surgeons’ clinical decision making during routine consultations. Methods The research takes a qualitative approach using video-cued interviews, in which one of the veterinary surgeon’s own consultations is used as the basis of a semi-structured interview exploring decision making in real cases. The research focuses primarily on small animal consultations in first opinion practice, how...

  11. Clinical Practice Guidelines for Bacterial Meningoencephalitis.

    Directory of Open Access Journals (Sweden)

    Belkys Rodríguez Llerena

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Bacterial Meningoencephalitis. It has been defined as an acute inflammatory process caused by bacteria, often purulent, which involves the meninges, subarachnoid space around the brain, spinal cord and usually includes the ventricles. It is caused in the 80% of the patients by three bacteria: Haemophilus influenzae, Neisseria meningitides and Streptococcus pneumonia. Concepts, classification, diagnosis and treatment were reviewed. It includes assessment guidelines focused on the most important aspects to be accomplished.

  12. Clinical Practice Guidelines for Hypovolemic Shock.

    OpenAIRE

    Alba Enseñat Álvarez; Omar Bárbaro Rojas Santana; Alexis Díaz Mesa; Ariamna Fleites Gómez

    2009-01-01

    Clinical Practice Guidelines for Hypovolemic Shock. It has been defined as the persistence of tissue hypoperfusion, usually associated to blood hypotension as the result of body fluids loss. This document includes a description of the concept and different stages of the disease, aetiological classification and comments about the main elements related with diagnosis and treatment, stressing volemic restoration. It includes assessment guidelines focused on the most important aspects to be accom...

  13. Clinical Practice Guidelines for Hypovolemic Shock.

    Directory of Open Access Journals (Sweden)

    Alba Enseñat Álvarez

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Hypovolemic Shock. It has been defined as the persistence of tissue hypoperfusion, usually associated to blood hypotension as the result of body fluids loss. This document includes a description of the concept and different stages of the disease, aetiological classification and comments about the main elements related with diagnosis and treatment, stressing volemic restoration. It includes assessment guidelines focused on the most important aspects to be accomplished.

  14. Clinical Practice Guidelines for Convulsive Condition Management

    Directory of Open Access Journals (Sweden)

    Victor Rene Navarro Machado

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Convulsive Condition Management. It has been redefined as the occurrence of two or more successive convulsions without conscience recuperation between them; or the occurrence of convulsive uninterrupted activity for more than 5 minutes, including focal crisis. This document includes a review and update of conceptual, etiological and classification aspects for diagnosis and treatment, stressing the various therapy trends. It includes assessment guidelines focused on the most important aspects to be accomplished.

  15. Review of clinical medicine and religious practice.

    Science.gov (United States)

    Stewart, William C; Adams, Michelle P; Stewart, Jeanette A; Nelson, Lindsay A

    2013-03-01

    The purpose was to evaluate faith-based studies within the medical literature to determine whether there are ways to help physicians understand how religion affects patients’ lives and diseases. We reviewed articles that assessed the influence of religious practices on medicine as a primary or secondary variable in clinical practice. This review evaluated 49 articles and found that religious faith is important to many patients, particularly those with serious disease, and patients depend on it as a positive coping mechanism. The findings of this review can suggest that patients frequently practice religion and interact with God about their disease state. This spiritual interaction may benefit the patient by providing comfort, increasing knowledge about their disease, greater treatment adherence, and quality of life. The results of prayer on specific disease states appear inconsistent with cardiovascular disease but stronger in other disease states.

  16. Binge eating disorder: from clinical research to clinical practice.

    Science.gov (United States)

    Goracci, Arianna; Casamassima, Francesco; Iovieno, Nadia; di Volo, Silvia; Benbow, Jim; Bolognesi, Simone; Fagiolini, Andrea

    2015-01-01

    This case report describes the clinical course of a young woman suffering from binge eating disorder (BED) associated with obesity. It illustrates the efficacy of different medications in the treatment of BED and related conditions and is followed by the comments and clinical observations of 2 practicing psychiatrists. The issues described in this paper have important clinical implications and are topical, given that BED is now recognized as a specific disorder in the new Diagnostic and Statistical Manual of Mental Disorders, fifth edition classification system, but neither the US Food and Drug Administration nor any other regulatory agency has yet approved a drug for treatment of this disease, despite its very prevalent and disabling nature. Growing evidence from the fields of psychopathology and neurobiology, including preclinical and clinical studies, converges to support the idea that "overeating" has much in common with other behavioral addictions, and substance abuse treatment agents may show promise for the treatment of BED.

  17. Caring during clinical practice: Midwives’ perspective

    Directory of Open Access Journals (Sweden)

    Mmajapi E. Chokwe

    2013-09-01

    Full Text Available Background: Caring forms the core of nursing and midwifery. Despite caring being an important emotional aspect of midwifery and nursing, there are general public complaints about uncaring behaviour in midwifery. Therefore, there is a need to explore caring from midwives’ point of view with the hope of identifying solutions and recommendations for midwifery practice. Furthermore, the study aimed to stimulate debate and discussion about the caring behaviour of midwives.Objective: To explore caring during clinical practice as perceived and experienced by midwives.Method: The study was contextual, exploratory and qualitative. The participants were midwives working in state and private hospitals in Tshwane,South Africa where BTech II and III midwifery learners were allocated for work integrated learning (WIL. Data collection was carried out through self-report using a questionnaire and focus group. Questionnaires were distributed to 40 midwives at private and state hospitals in Tshwane. This was followed by two focus group sessions to ensure that data is enriched. The hermeneutic interpretive approach was used to analyse data, and analysis continued until saturation.Results: Themes of caring and uncaring related to patient care and midwives emerged. Thefindings illustrated that the midwives had excellent theoretical knowledge of caring, but someof them did not display caring behaviour during clinical practice.Conclusion: Some of the midwives did not display caring behaviour. Implication for practicewas provided based on the research findings. Recommendations included measures of improving caring behaviours during midwifery practice.

  18. Clinical practice: between Aristotle and Cochrane.

    Science.gov (United States)

    Fugelli, P

    1998-02-07

    Health and disease consist of amino acids and self image, cell membranes and human ideals, muscles and politics. Only to a limited extent can clinical practice be based on science. It can never be carried on in isolation from political, and cultural forces that influence patients' health behaviour. Evidence-based medicine is essential but not sufficient. A continuous relationship with patients is a conditio sine qua non for general practice. The general practitioner must be a master of pragmatic medicine. Rationality, the dominant modern trend, may be dangerous for patients and doctors: (1) advances in technology can give patients and doctors the illusion of mastering the universe; (2) patients complain of being treated like biomachines, without human touch. Another symptom of modernity is the decline of religion. But patients and doctors are by no means rational beings. God, destiny and hope are replaced by modern medico-scientific megalomania. Modern medicine is also strongly influenced by commercialization and invasion by bureaucrats. Instead of becoming a biomedical robot, the general practitioner must learn to value the Aristotelian concept of phronesis. It means practical wisdom and can only be gained by personal experience; a form of learning by doing. Good clinical practice cannot come from science alone, or from personal experience alone. It is an amalgam of scientia and phronesis.

  19. Supervision af psykoterapi via Skype

    DEFF Research Database (Denmark)

    Jacobsen, Claus Haugaard; Grünbaum, Liselotte

    2011-01-01

    clinical experience of Skype™ in supervision, mainly of psychoanalytic child psychotherapy, is presented and reflected upon. Finally, the reluctance of the Danish Board for Psychologists’s to recognize audiovisual distance supervision as part of the required training demands is discussed. It is concluded...

  20. A controlled greedy supervised approach for co-reference resolution on clinical text.

    Science.gov (United States)

    Chowdhury, Md Faisal Mahbub; Zweigenbaum, Pierre

    2013-06-01

    Identification of co-referent entity mentions inside text has significant importance for other natural language processing (NLP) tasks (e.g. event linking). However, this task, known as co-reference resolution, remains a complex problem, partly because of the confusion over different evaluation metrics and partly because the well-researched existing methodologies do not perform well on new domains such as clinical records. This paper presents a variant of the influential mention-pair model for co-reference resolution. Using a series of linguistically and semantically motivated constraints, the proposed approach controls generation of less-informative/sub-optimal training and test instances. Additionally, the approach also introduces some aggressive greedy strategies in chain clustering. The proposed approach has been tested on the official test corpus of the recently held i2b2/VA 2011 challenge. It achieves an unweighted average F1 score of 0.895, calculated from multiple evaluation metrics (MUC, B(3) and CEAF scores). These results are comparable to the best systems of the challenge. What makes our proposed system distinct is that it also achieves high average F1 scores for each individual chain type (Test: 0.897, Person: 0.852, PROBLEM: 0.855, TREATMENT: 0.884). Unlike other works, it obtains good scores for each of the individual metrics rather than being biased towards a particular metric.

  1. Public sector physiotherapists believe that staff supervision should be broad ranging, individualised, structured, and based on needs and goals: a qualitative study

    Directory of Open Access Journals (Sweden)

    Annabel A Redpath

    2015-10-01

    Full Text Available Question: What do physiotherapists consider to be the structure and content of an effective clinical supervision program for public sector staff? Design: Qualitative study using emergent-systematic focus group design. Participants: 46 physiotherapists and six physiotherapy assistants from a large, regional, Australian health service participated in one of seven focus groups. Results: Data were represented by three major categories: the content of supervision; the structure of supervision; and participants’ roles and attributes. The content of supervision should encompass all issues affecting workplace experience and performance; supervision should be individualised and needs based. For the structure of supervision, a variety of methods and formats should be available, including: scheduled and unscheduled supervision (unscheduled supervision addresses needs as they arise but its usefulness can be restricted by supervisor availability; the environment should be organised to facilitate supervision; supervision should be integrated into existing practices; and supervision should be adequately prioritised and resourced to enable sustainability. In relation to participants’ roles and attributes, respondents recommended: clearly defined supervisor and supervisee roles, responsibilities, skills and attributes are required to facilitate a constructive relationship on which successful supervision depends; the supervisee should take primary responsibility for leading and organising their supervision; the supervisor provides support and accountability and assists with goal setting and attainment; and successful supervision requires considerable knowledge and skills from the supervisee and supervisor (supervision education and training might be necessary. Conclusion: The physiotherapists’ perspectives that were identified in this study are important to consider when assessing current clinical supervision models, as well as when designing and

  2. [Informed consent in clinical practice: persistent doubts].

    Science.gov (United States)

    Kottow, Miguel

    2016-11-01

    Informed consent is the core aspect of the patient-physician relationship. Since its beginnings, clinical bioethics was opposed to the authoritarian paternalism characteristic of medicine since the 19th century. The informed consent was developed to provide patients with sufficient information to allow autonomous decisions when faced with medical diagnostic and therapeutic alternatives. In spite of bioethics’ effort to perfect informed consent, the discipline has been unable to avoid informed consent from becoming an impersonal and administrative procedure. Even though the major goal of this procedure is to provide sufficient information to allow patients an objective weighting of benefits and risks of medical practice, the uncertainties of medicine make full disclosure unattainable. Collecting more information finally leads to indecision and ultimate trust in medical advice. The clinical encounter is fundamentally a fiduciary relationship, and bioethics ought to accept that its main objective is to strengthen the trust bond that is essential to the clinical encounter. This goal may become incompatible with the quest for unlimited autonomy. Patients often will only require information as long as they distrust that medical institutions and their professionals are considering their interests and needs. The main proposal of this article is to temper bioethics’ insistence on autonomy, and accept that patients essentially seek to be protected and cared for. Informed consent ought to relent its efforts at full autonomy to the benefit of trustworthiness in medicine, and trust in clinical practice.

  3. Multicultural Supervision: What Difference Does Difference Make?

    Science.gov (United States)

    Eklund, Katie; Aros-O'Malley, Megan; Murrieta, Imelda

    2014-01-01

    Multicultural sensitivity and competency represent critical components to contemporary practice and supervision in school psychology. Internship and supervision experiences are a capstone experience for many new school psychologists; however, few receive formal training and supervision in multicultural competencies. As an increased number of…

  4. How Supervisor Experience Influences Trust, Supervision, and Trainee Learning: A Qualitative Study.

    Science.gov (United States)

    Sheu, Leslie; Kogan, Jennifer R; Hauer, Karen E

    2017-09-01

    Appropriate trust and supervision facilitate trainees' growth toward unsupervised practice. The authors investigated how supervisor experience influences trust, supervision, and subsequently trainee learning. In a two-phase qualitative inductive content analysis, phase one entailed reviewing 44 internal medicine resident and attending supervisor interviews from two institutions (July 2013 to September 2014) for themes on how supervisor experience influences trust and supervision. Three supervisor exemplars (early, developing, experienced) were developed and shared in phase two focus groups at a single institution, wherein 23 trainees validated the exemplars and discussed how each impacted learning (November 2015). Phase one: Four domains of trust and supervision varying with experience emerged: data, approach, perspective, clinical. Early supervisors were detail oriented and determined trust depending on task completion (data), were rule based (approach), drew on their experiences as trainees to guide supervision (perspective), and felt less confident clinically compared with more experienced supervisors (clinical). Experienced supervisors determined trust holistically (data), checked key aspects of patient care selectively and covertly (approach), reflected on individual experiences supervising (perspective), and felt comfortable managing clinical problems and gauging trainee abilities (clinical). Phase two: Trainees felt the exemplars reflected their experiences, described their preferences and learning needs shifting over time, and emphasized the importance of supervisor flexibility to match their learning needs. With experience, supervisors differ in their approach to trust and supervision. Supervisors need to trust themselves before being able to trust others. Trainees perceive these differences and seek supervision approaches that align with their learning needs.

  5. 构建院系教学督导运行模式的探索与实践%Exploration and practice of operating model involved in teaching supervision

    Institute of Scientific and Technical Information of China (English)

    周歧新; 颜家珍; 陈颖; 李勤耕; 赵华; 蒋君好

    2008-01-01

    Teaching supervision is an important part of management system reformation and teaching quality control in the colleges and universities. Among the supervision work the teaching supervision of fac-ulty was worth exploring because of its weak position. The operating model of supervision was involved in the working model and system during the process of teaching supervision. In this article the operating model of "five combinations" about the faculty supervision was advocated according to the practice of teaching su-pervision we took part in at the pharmacy faculty, which will be important for regularization of supervision work at the level of faculty.%教学督导是深化高校管理体制改革、构建高校教学质量监控体系的重要一环.院系一级督导是当前督导工作中的薄弱环节,值得研究和探讨.督导工作运行模式是指教学督导过程中的运作方式系统.本文结合药学院教学督导实践,提出五个结合的院系督导工作运行模式,对于规范院系督导工作、提高督导质量具有重要意义.

  6. A Contextual-Functional Meta-Framework for Counselling Supervision

    Science.gov (United States)

    Chang, Jeff

    2013-01-01

    In this paper, an approach to clinical supervision, entitled the Contextual-Functional Meta-Framework (CFM), is developed and articulated, based on a consideration of current literature and the author's extensive practice experience. First, the context for the development of the CFM, and its formative influences, are examined, followed by a review…

  7. Role modeling excellence in clinical nursing practice.

    Science.gov (United States)

    Perry, R N Beth

    2009-01-01

    Role modeling excellence in clinical nursing practice is the focus of this paper. The phenomenological research study reported involved a group of 8 nurses identified by their colleagues as exemplary. The major theme revealed in this study was that these exemplary nurses were also excellent role models in the clinical setting. This paper details approaches used by these nurses that made them excellent role models. Specifically, the themes of attending to the little things, making connections, maintaining a light-hearted attitude, modeling, and affirming others are presented. These themes are discussed within the framework of Watson [Watson, J., 1989. Human caring and suffering: a subjective model for health services. In: Watson, J., Taylor, R. (Eds.), They Shall Not Hurt: Human Suffering and Human Caring. Colorado University, Boulder, CO] "transpersonal caring" and [Bandura, A., 1997. Social Learning Theory. Prentice Hall, Englewood Cliffs, NJ] "Social Learning Theory." Particular emphasis in the discussion is on how positive role modeling by exemplary practitioners can contribute to the education of clinical nurses in the practice setting.

  8. Good manufacturing practices and clinical supplies.

    Science.gov (United States)

    Levchuk, J W

    1991-01-01

    Quality characteristics must be assured through adherence to good manufacturing practices in the production, control, and testing of drug products intended for investigational as well as commercial use. A draft guideline on the preparation of investigational new drug products, soon to be available in final form, addresses questions that have been raised regarding acceptable practices and procedures to facilitate compliance with the CGMP regulations as applied to clinical supplies. Inspections of sterile clinical supplies production can be expected to include the areas most likely to influence product safety, quality, and uniformity in the same manner as would be expected regarding the manufacture of commercial batches. Some areas of particular significance in the manufacture of parenteral clinical supplies include validation of terminal sterilization, aseptic processing, and oxygen exclusion. The validation of the aseptic handling during lyophilization requires special attention. Other CGMP concerns include the provision of a quality control unit, avoiding packaging mixups, and being prepared for an amendment to the CGMP regulations regarding terminal sterilization.

  9. Best Practices in Clinical Decision Support

    Science.gov (United States)

    Wright, Adam; Phansalkar, Shobha; Bloomrosen, Meryl; Jenders, Robert A.; Bobb, Anne M.; Halamka, John D.; Kuperman, Gilad; Payne, Thomas H.; Teasdale, S.; Vaida, A. J.; Bates, D. W.

    2010-01-01

    Background Evidence demonstrates that clinical decision support (CDS) is a powerful tool for improving healthcare quality and ensuring patient safety. However, implementing and maintaining effective decision support interventions presents multiple technical and organizational challenges. Purpose To identify best practices for CDS, using the domain of preventive care reminders as an example. Methods We assembled a panel of experts in CDS and held a series of facilitated online and inperson discussions. We analyzed the results of these discussions using a grounded theory method to elicit themes and best practices. Results Eight best practice themes were identified as important: deliver CDS in the most appropriate ways, develop effective governance structures, consider use of incentives, be aware of workflow, keep content current, monitor and evaluate impact, maintain high quality data, and consider sharing content. Keys themes within each of these areas were also described. Conclusion Successful implementation of CDS requires consideration of both technical and socio-technical factors. The themes identified in this study provide guidance on crucial factors that need consideration when CDS is implemented across healthcare settings. These best practice themes may be useful for developers, implementers, and users of decision support. PMID:21991299

  10. [Asthma clinical practice guidelines: advantages and pitfalls].

    Science.gov (United States)

    Plaza, Vicente; Bellido-Casado, Jesús; Alonso-Coello, Pablo; Rodrigo, Gustavo

    2009-01-01

    The Clinical Practice Guidelines on asthma have contributed towards unifying concepts and reaching a consensus on performances between different professional groups. However, they have failed in the overall improvement in the management of asthma, the final objective that they are meant to achieve. Today, almost 20 years after they appeared, the majority of asthmatic patients are still inadequately controlled, partly due to lack of follow up by doctors and the rest of health care staff who have to look after them. This lack of follow up of these recommendations is probably associated with a lack of well structured planning in their circulation and implementation. Also, although the recommendations of these guidelines agree in what is essential, they differ in other aspects, which in turn could be determining factors in clinical practice. The purpose of this article has been to establish the main differences in the recommendations that the principal clinical practice guidelines on the disease propose on the diagnosis, classification and treatment of asthma. To do this we have compared, The British Guideline on the Management of Asthma 2007, The Global Strategy for Asthma Management and Prevention/Global Initiative for Asthma 2006 (GINA), the National Prevention program for Education on Asthma (Programa Nacional de Prevención para la Educación del Asma) (NAEPP), the Spanish Guide for the Management of Asthma (Guía Española para el Manejo del Asma 2003) (GEMA) and the ALAT y SEPAR guides, Latin-America and Spain. Recommendations for the Prevention and Treatment of Asthma Exacerbation (América Latina y España. Recomendaciones para la Prevención y el Tratamiento de la Exacerbación Asmática 2008) (ALERTA).

  11. Clinical Practice Guidelines for Severe Asthma Treatment.

    Directory of Open Access Journals (Sweden)

    Eddy Pereira Valdes

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Severe Asthma Treatment. This disease is characterized by an overreaction of the tracheobronchial tree with hyperactivity after certain stimulus consisting of a diffuse narrowing of the respiratory ways related with an excessive contraction of the bronchial smooth muscle, hyper-secretion of mucus and mucosa edema. It is spontaneously reversible or reversible after treatment. We include a review of its definition, classification and development, stressing those elements related with ventilation. It includes assessment guidelines focused on the most important aspects to be accomplished.

  12. Clinical practice guideline: screening and diagnosing autism.

    Science.gov (United States)

    Blackwell, J

    2001-12-01

    The clinical practice guideline (CPG) reviewed in this month's column concerns the screening and diagnosis of autism. Autism is the third most common developmental disability and affects more than 1 in 500 children, or nearly 400,000 people in the United States, in some form. Primary care providers of children, including pediatric nurse practitioners (PNPs) and family nurse practitioners (FNPs), should reasonably expect to care for at least one child with autism (CWA). The American Academy of Neurology (AAN) has therefore developed guidelines to help healthcare providers facilitate the early identification of children with autism.

  13. The Sherlock Holmes method in clinical practice.

    Science.gov (United States)

    Sopeña, B

    2014-04-01

    This article lists the integral elements of the Sherlock Holmes method, which is based on the intelligent collection of information through detailed observation, careful listening and thorough examination. The information thus obtained is analyzed to develop the main and alternative hypotheses, which are shaped during the deductive process until the key leading to the solution is revealed. The Holmes investigative method applied to clinical practice highlights the advisability of having physicians reason through and seek out the causes of the disease with the data obtained from acute observation, a detailed review of the medical history and careful physical examination.

  14. Video games use patterns and parenteral supervision in a clinical sample of Hispanic adolescents 13-17 years old.

    Science.gov (United States)

    Colón-de Martí, Luz N; Rodríguez-Figueroa, Linnette; Nazario, Lelis L; Gutiérrez, Roberto; González, Alexis

    2012-01-01

    Video games have become a popular entertainment among adolescents. Although some video games are educational, there are others with high content of violence and the potential for other harmful effects. Lack of appropriate supervision of video games use during adolescence, a crucial stage of development, may lead to serious behavioral consequences in some adolescents. There is also concern about time spent playing video games and the subsequent neglect of more developmentally appropriate activities, such as completing academic tasks. Self-administered questionnaires were used to assess video game use patterns and parental supervision among 55 adolescent patients 13-17 years old (mean age 14.4 years; 56.4% males) and their parents. Parental supervision /monitoring of the adolescents video games use was not consistent and gender related differences were found regarding their video game use. Close to one third (32%) of the participants reported video game playing had interfered with their academic performance. Parents who understood video games rating system were more likely to prohibit their use due to rating. These findings underscore the need for clear and consistently enforced rules and monitoring of video games use by adolescents. Parents need to be educated about the relevance of their supervision, video games content and rating system; so they will decrease time playing and exposure to potentially harmful video games. It also supports the relevance of addressing supervision, gender-based parental supervisory styles, and patterns of video games use in the evaluation and treatment of adolescents.

  15. Biosensors in Clinical Practice: Focus on Oncohematology

    Directory of Open Access Journals (Sweden)

    Agostino Cortelezzi

    2013-05-01

    Full Text Available Biosensors are devices that are capable of detecting specific biological analytes and converting their presence or concentration into some electrical, thermal, optical or other signal that can be easily analysed. The first biosensor was designed by Clark and Lyons in 1962 as a means of measuring glucose. Since then, much progress has been made and the applications of biosensors are today potentially boundless. This review is limited to their clinical applications, particularly in the field of oncohematology. Biosensors have recently been developed in order to improve the diagnosis and treatment of patients affected by hematological malignancies, such as the biosensor for assessing the in vitro pre-treatment efficacy of cytarabine in acute myeloid leukemia, and the fluorescence resonance energy transfer-based biosensor for assessing the efficacy of imatinib in chronic myeloid leukemia. The review also considers the challenges and future perspectives of biosensors in clinical practice.

  16. Supervision Experiences of New Professional School Counselors

    Science.gov (United States)

    Bultsma, Shawn A.

    2012-01-01

    This qualitative study examined the supervision experiences of 11 new professional school counselors. They reported that their supervision experiences were most often administrative in nature; reports of clinical and developmental supervision were limited to participants whose supervisors were licensed as professional counselors. In addition,…

  17. Group supervision for general practitioners

    DEFF Research Database (Denmark)

    Galina Nielsen, Helena; Sofie Davidsen, Annette; Dalsted, Rikke;

    2013-01-01

    AIM: Group supervision is a sparsely researched method for professional development in general practice. The aim of this study was to explore general practitioners' (GPs') experiences of the benefits of group supervision for improving the treatment of mental disorders. METHODS: One long...... considered important prerequisites for disclosing and discussing professional problems. CONCLUSION: The results of this study indicate that participation in a supervision group can be beneficial for maintaining and developing GPs' skills in dealing with patients with mental health problems. Group supervision......-established supervision group was studied closely for six months by observing the group sessions, and by interviewing GPs and their supervisors, individually and collectively. The interviews were recorded digitally and transcribed verbatim. The data were analysed using systematic text condensation. RESULTS: The GPs found...

  18. Nursing supervision for care comprehensiveness.

    Science.gov (United States)

    Chaves, Lucieli Dias Pedreschi; Mininel, Vivian Aline; Silva, Jaqueline Alcântara Marcelino da; Alves, Larissa Roberta; Silva, Maria Ferreira da; Camelo, Silvia Helena Henriques

    2017-01-01

    To reflect on nursing supervision as a management tool for care comprehensiveness by nurses, considering its potential and limits in the current scenario. A reflective study based on discourse about nursing supervision, presenting theoretical and practical concepts and approaches. Limits on the exercise of supervision are related to the organization of healthcare services based on the functional and clinical model of care, in addition to possible gaps in the nurse training process and work overload. Regarding the potential, researchers emphasize that supervision is a tool for coordinating care and management actions, which may favor care comprehensiveness, and stimulate positive attitudes toward cooperation and contribution within teams, co-responsibility, and educational development at work. Nursing supervision may help enhance care comprehensiveness by implying continuous reflection on including the dynamics of the healthcare work process and user needs in care networks. refletir a supervisão de enfermagem como instrumento gerencial do enfermeiro para integralidade do cuidado, considerando suas potencialidades e limitações no cenário atual. estudo reflexivo baseado na formulação discursiva sobre a supervisão de enfermagem, apresentando conceitos e enfoques teóricos e/ou práticos. limitações no exercício da supervisão estão relacionadas à organização dos serviços de saúde embasada no modelo funcional e clínico de atenção, assim como possíveis lacunas no processo de formação do enfermeiro e sobrecarga de trabalho. Quanto às potencialidades, destaca-se a supervisão como instrumento de articulação de ações assistenciais e gerenciais, que pode favorecer integralidade da atenção, estimular atitudes de cooperação e colaboração em equipe, além da corresponsabilização e promoção da educação no trabalho. supervisão de enfermagem pode contribuir para fortalecimento da integralidade do cuidado, pressupondo reflexão cont

  19. 中医师承与临床心理督导的对照与启示%Comparison and Reflection between Supervision in Master-disciple of Traditional Chinese Medicine and Clinical Psychology

    Institute of Scientific and Technical Information of China (English)

    孙越异; 黄桂成; 徐光兴; 刘娜

    2015-01-01

    Master‐disciple of Traditional Chinese Medicine (TCM ) was a hot word in the field of TCM education .This article discussed the similarities and differences between clinical supervision of psychotherapy and master‐disciple of TCM . We suggested that some factors ,such as the model ,procession ,and role it played in education were similar with each other .However ,the institutionalization and standardization have came into being in clinical supervision of psychotherapy , but not the master‐disciple of TCM .Therefore ,this article pointed that the education of master‐disciple of TCM could take example from the development of clinical supervision of psychotherapy . At last , the article put forward four enlightenment :respect the basic situation of master‐disciple of TCM , build a systematic education model , put more attention to the strength of practiced traditional doctor out of institutions ,turn the educational model of master‐disciple of TCM from elite to institutionalization ,put the theory research of master‐disciple of TCM forward by the research method that used in the clinical supervision of psychotherapy .%中医师承制度是当前中医教育研究的热点,对中医师承与临床心理督导的异同进行了对比,认为二者在教学形式、过程、地位等方面均十分相似,但临床心理督导却实现了制度化与规范化,因此提出中医师承教育可以借鉴临床心理督导发展的经验。最后提出四点启示:应尊重师承教育在中医人才培养中的基础地位;应建设制度化、系统化的中医师承体系;应重视民间中医力量在中医师承教育中的引入;应推动中医师承由精英化向制度化转变;借鉴临床心理督导的研究方法,推动中医师承教育理论的研究。

  20. Plaque removal efficacy of powered and manual toothbrushes under supervised and unsupervised conditions: A comparative clinical study

    Directory of Open Access Journals (Sweden)

    S Kallar

    2011-01-01

    Full Text Available The present study was undertaken to determine and compare the efficacy of manual and powered toothbrushes under supervised and unsupervised conditions in 200 school-going children between 6 and 13 years of age. Two hundred school-going children aged between 6 and 13 years were selected. Children were randomly divided into two groups of 100 in each. Group 1 children were given manual brushes, while group 2 children were given powered brushes. The groups were further divided into two subgroups, with supervised brushing in subgroup A and unsupervised brushing in subgroup B. At 3, 6, 9 and 12 weeks, plaque was recorded according to Turseky-Gilmore-Glickman modification of Quingley Hein index and oral hygiene performance index. Data were statistically analyzed. Both brushes significantly reduced the plaque accumulation, though to different degrees. Powered brushes showed significant plaque reduction as compared to the manual brushes. Supervised group of both brushes showed a greater plaque reduction.

  1. Taking PDT into mainstream clinical practice

    Science.gov (United States)

    Bown, Stephen G.

    2009-06-01

    Many individuals in the field are frustrated by the slow progress getting PDT established in mainstream clinical practice. The five key reasons are: 1. Lack of adequate evidence of safety and efficacy and optimization of dosimetry. These are fundamental. The number of randomized controlled studies is still small. For some cancer applications, it is difficult to get patients to agree to be randomised, so different approaches must be taken. Anecdotal results are not acceptable to sceptics and regulators. 2. The regulatory processes. The rules get more complex every day, but there is no choice, they must be met. The full bureaucratic strength of the pharmaceutical industry is needed to address these issues. 3. Conservatism of the medical profession. Established physicians are reluctant to change practice, especially if it means referring patients to different specialists. 4. Lack of education. It is amazing how few physicians have even heard of PDT and many that have, are sceptical. The profile of PDT to both the medical profession and the general public needs to be raised dramatically. Patient demand works wonders! 5. Money. Major investment is required to run clinical trials. Pharmaceutical companies may see PDT as a threat (eg reduced market for chemotherapy agents). Licensed photosensitisers are expensive. Why not reduce the price initially, to get the technique established and stimulate demand? PDT has the potential for enormous cost savings for health service providers. With appropriate motivation and resources these problems can be addressed. Possible routes forward will be suggested.

  2. Clinical practice on the horizon: personalized medicine.

    Science.gov (United States)

    Chadwell, Katherine

    2013-01-01

    With the advent of the human genome project, we have never known so much about the uniqueness of individuals. Personalized medicine is poised to use this genetic and genomic information along with the impact of environment and clinical presentation to provide healthcare from an individual perspective. This offers the opportunity to improve our ability to diagnose and predict disease, provide earlier intervention, identify new treatment regimens, and address the safety and efficacy of drug use. The impact of personalized medicine to our current model of healthcare delivery is tremendous, and although strides have been made, there are still challenges and barriers to overcome before personalized medicine can be fully implemented. Advanced practice nurses may not be fully aware of the personalized medicine initiative or may not be well versed on genetic and genomic content, which is a key concept of personalized medicine. The role of advanced practice nurses is an integral part of the healthcare system, and as such, they are poised to be key providers and contributors to personalized medicine. The personalized medicine initiative is discussed along with examples of genetic and genomic information that lend to our understanding, diagnosis, and treatment of disease, as well as the role and responsibilities of advanced practice nurses. Resources for personalized medicine and genetic and genomic content are provided.

  3. Social networks in supervision

    DEFF Research Database (Denmark)

    Lystbæk, Christian Tang

    and practice have focused on conceptual frameworks and practical techniques of promoting reflection through conversation in general and questioning in particular. However, in recent years, supervision research has started to focus on the social and technological aspects of supervision. This calls...... is constituted by the relationality of the actors, not by the actors themselves. In other words, no one acts in a vacuum but rather always under the influence of a wide range of surrounding and interconnected factors. Actors are actors because they are in a networked relationship. Thus, focusing on social...... and space. That involves mobilised an denrolled actos, both animate and inanimate (e.g. books, computers, etc. Actor-network theory defines a symmetry between animate and inanimate, i.e. subjects and objects, because ”human powers increasingly derive from the complex interconnections if human with material...

  4. How to critically appraise a clinical practice guideline

    OpenAIRE

    Clubb, Adrian B.; Dahm, Philipp

    2011-01-01

    Purpose: Clinical practice guidelines play a critical role in guiding the evidence-based clinical practice of urology. We describe a systematic approach to critical appraisal of urology guidelines. Materials and Methods: Based on a focused clinical question derived from a clinical scenario, we identified a relevant clinical practice guideline that we critically appraised using the Users’ Guide to the Medical Literature framework as to whether the results are valid, what are the results, and c...

  5. The effect of education and supervised exercise vs. education alone on the time to total hip replacement in patients with severe hip osteoarthritis. A randomized clinical trial protocol

    DEFF Research Database (Denmark)

    Jensen, Carsten; Roos, Ewa M.; Kjærsgaard-Andersen, Per

    2013-01-01

    measures are the five subscales of the Hip disability and Osteoarthritis Outcome Score, physical activity (UCLA activity score), and patient’s global perceived effect. Other measures include pain after exercise, joint-specific adverse events, exercise adherence, general health status (EQ-5D-5L), mechanical...... muscle function and performance in physical tests. A cost-effectiveness analysis will also be performed. Discussion: To our knowledge, this is the first randomized clinical trial comparing a patient education plus supervised exercise program to patient education alone in hip osteoarthritis patients...... replacement is considered. We hypothesize that the time to hip replacement can be postponed in patients with severe hip osteoarthritis following participation in a patient education and supervised exercise program when compared to patients receiving patient education alone. Methods/design: A prospective...

  6. Hand kinematics: Application in clinical practice

    Directory of Open Access Journals (Sweden)

    Santosh Rath

    2011-01-01

    Full Text Available Pathological conditions of the hand consequent to injuries, paralysis, disease, arthritis and congenital difference results in loss or limitation of function, deformities, stiffness, inadequate power and poor position for pinch. The pathogenesis of deformities is influenced by bio-mechanical principles of joints and muscle function. The crippling impact of secondary changes due to edema, soft tissue contractures, muscle shortening and functional adaptations also have a mechanical basis. For clinicians and hand therapists, it is necessary to understand these fundamental principles of biomechanics to plan treatment modalities. Interpretation of mechanics of hand deformities in rheumatoid arthritis and paralysis will enable the treating team to identify the appropriate interventions of splinting, therapy and surgical procedures. Basic knowledge of the principles of hand clinical bio-mechanics will help the beginner to sail through the multitude of tendon transfers described in the text books of hand surgery and find the best solution for a particular clinical presentation. Similarly, knowledge of bio-mechanics will provide solutions to an experienced surgeon to plan treatment protocols for complex situations. The article presents a concise summary of the basic principles of hand bio-mechanics for common hand conditions seen in clinical practice. Understanding and applying these principles will help clinicians in planning and devising treatment options for common and complex hand conditions.

  7. Processes That Inform Multicultural Supervision: A meta-analysis.

    Science.gov (United States)

    Tohidian, Nilou B; Quek, Karen Mui-Teng

    2017-03-16

    As the fields of counseling and psychotherapy have become more cognizant that individuals, couples, and families bring with them a myriad of diversity factors into therapy, multicultural competency has also become a crucial component in the development of clinicians during clinical supervision and training. We employed a qualitative meta-analysis to provide a detailed and comprehensive description of similar themes identified in primary qualitative studies that have investigated supervisory practices with an emphasis on diversity. Findings revealed six meta-categories, namely: (a) Supervisor's Multicultural Stances; (b) Supervisee's Multicultural Encounters; (c) Competency-Based Content in Supervision; (d) Processes Surrounding Multicultural Supervision; (e) Culturally Attuned Interventions; and (f) Multicultural Supervisory Alliance. Implications for practice are discussed.

  8. Self-compassion in clinical practice.

    Science.gov (United States)

    Germer, Christopher K; Neff, Kristin D

    2013-08-01

    Self-compassion is conceptualized as containing 3 core components: self-kindness versus self-judgment, common humanity versus isolation, and mindfulness versus overidentification, when relating to painful experiences. Research evidence demonstrates that self-compassion is related to psychological flourishing and reduced psychopathology. Mindful Self-Compassion (MSC) is an 8-week training program, meeting 2.5 hours each week, designed to help participants cultivate self-compassion. MSC contains a variety of meditations (e.g., loving-kindness, affectionate breathing) as well as informal practices for use in daily life (e.g., soothing touch, self-compassionate letter writing). A detailed clinical case illustrates the journey of a client through the 8 weeks of MSC training, describing the key features of each session and the client's response.

  9. Nurses' intention to apply clinical practice guidelines.

    Science.gov (United States)

    Kogan, Ella; Tabak, Nili

    2012-12-01

    Using Ajzen and Madden's Theory of Planned Behavior, this study investigates factors which influence nurses' intention to apply clinical practice guidelines in their daily ward work. A convenience sample of 91 nurses in internal medicine wards in three Israeli hospitals answered four questionnaires. Data were processed by Pearson correlation coefficients and multivariate regression. The main findings were that burnout was negatively correlated with the intention to work according to guidelines and that professionalism (in the sense of a tendency to follow taught procedure rather than personal judgment) was positively correlated with it. Furthermore, nurses who perceive their behavioral control and subjective norms to be positive will be the most determined to work according to guidelines, provided they personally command the necessary resources to do so.

  10. [Toxoplasmosis in pregnancy - questions in clinical practice].

    Science.gov (United States)

    Geleneky, Markéta

    2013-06-01

    Toxoplasmosis acquired during pregnancy is a serious disease that may significantly affect fetal development and cause irreversible or therapeutically hardly influenced damage to the newborn. Early and correct diagnosis of the disease in the mother is essential for determining prognosis and further diagnostic and therapeutic procedures. The case study combines a number of factors to be encountered in clinical practice which may complicate diagnostic considerations. One of them is the existence of a rare phenomenon of reinfection - its possible effects on prenatal screening and other interpretations of such findings. Another problem is the evaluation of the origin of sonographically confirmed fetopathy in relation to Toxoplasma etiology and the choice of next steps that should follow in this situation. Finally, the text discusses the selection of postnatal examinations so that they sufficiently contribute to decision-making about the newborn's treatment initiation.

  11. Clinical Practice Guidelines: Whose Practice Are We Guiding?

    Science.gov (United States)

    Harvey, Morgan; Bowe, Sarah N; Laury, Adrienne M

    2016-09-01

    The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) has just released an update to the clinical practice guideline (CPG) on otitis media with effusion. This common condition is frequently managed by primary care providers; however, their awareness and utilization of the AAO-HNSF CPGs are unknown. We performed a cross-sectional survey to assess familiarity with otologic diagnoses, evaluation skills, and guidelines. Only 38.5% of respondents use pneumatic otoscopy, and roughly 50% utilize a CPG for management of otitis media or for referral for tympanostomy tube insertion. Providers predominantly use the acute otitis media guideline from the American Academy of Pediatrics. In this single-institution study, providers are largely unaware of the AAO-HNSF CPGs and could benefit from additional training, including workshops taught by otolaryngologists within individual health care systems or development of a national otolaryngology medical student curriculum. A more immediate option includes referencing our CPGs on specialty societies' websites or newsletters.

  12. IMPACT OF PHYSIOTHERAPIST-DESIGNED SUPERVISED EXERCISE PROTOCOL ON MUSCLE STRENGTH, AND AUTONOMIC PARAMETERS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: A CLINICAL TRIAL

    Directory of Open Access Journals (Sweden)

    Renu B. Pattanshetty

    2015-04-01

    Full Text Available Background and Objectives: Type 2 diabetes mellitus is a heterogeneous group of disorders characterized by variable degree of insulin resistance, impaired insulin secretion, and increased glucose production. Physical activity is central to the management type 2 diabetes. There is less evidence to suggest the efficacy of combined effect of physiotherapist- designed supervised exercise protocol on muscle strength and autonomic parameters in such subjects. Hence, the present study was designed to evaluate effect of physiotherapist designed supervised exercise protocol of muscle strength and autonomic parameters in this subject population. Material and Methods: This clinical trial was conducted in thirty (30 adult subjects with type 2 diabetes mellitus including both males and females in the age group of 18 to 65 years. All subjects received physiotherapist designed supervised exercise training protocol consisting of aerobic, resistance & flexibility training. Pre-exercise and post-exercise outcome measurements were taken at baseline, 7th & 14th day in the form of 1-RM for muscle strength and autonomic parameters. Results: Statistical analysis of outcomes at baseline, 7th day and 14th day showed statistically significant difference in strength (p=0.0001, and reduction in autonomic parameters (p=0.0001 Conclusion: The therapist designed exercise protocol has shown to improve muscle strength , mean systolic blood pressure, diastolic blood pressure, pulse rate, pulse pressure, mean arterial pressure, rate pressure product. The protocol has also proved to be safe since no adverse event was noted post exercise.

  13. SMARTWheel: From concept to clinical practice.

    Science.gov (United States)

    Cooper, Rory A

    2009-09-01

    Wheelchair prescription is complex with thousands of choices and options. Theoretically, a higher quality or innovative wheelchair that is appropriately matched to the user and their unique needs will increase participation. It is well accepted that there is an alarmingly high incidence of carpal tunnel syndrome, and rotator cuff injuries among manual wheelchair users. Since the initial conceptualization, the SMART(Wheel) was intended to better understand the physiological and physical effects of wheelchair propulsion on the body. Initially, little was known about wheelchair propulsion and the SMART(Wheel) transformed the nascent field of wheelchair propulsion biomechanics. Although still an important area of clinical research, the SMART(Wheel) has been critical to the study of the relationship between the type of wheelchair, set-up, activity, technique, anatomy, and physiology and repetitive strain injury. There has been growing evidence that the wheelchair-user interaction explains a substantial portion of the risk of developing a degenerative injury and on community participation. A noteworthy contribution of this work was the release of the clinical practice guideline, entitled, Preservation of Upper Limb Function Following Spinal Cord Injury in 2005. The SMART(Wheel) has been used by other scientists in areas that were not originally envisioned to be applications. It has been used to support the design of tools for developing a trail mapping rating and description system. It has also supported the design of accessible pedestrian walkways standards, accessible playground surfaces, and to evaluate carpets for wheelchair accessibility. It is likely that there are more new areas of exploration to emerge. This article describes the evolution of the SMART(Wheel) as new technologies became available and its applications in the field of wheelchair biomechanics and clinical service delivery.

  14. Evaluation of resources for contact lens practice in private contact lens clinics of Muscat, Oman

    Directory of Open Access Journals (Sweden)

    Rajiv Khandekar

    2009-01-01

    Materials and Methods: This study was conducted between May and July 2006. A team of optometrists and health inspectors visited clinics and collected information about the infrastructure, available human resources, and materials used in the CL practice. We used a pre-tested close-ended questionnaire to collect responses of the practitioners and observations of the field staff. Statistical Method: Univariate parametric type of analysis. Results: The team visited 67 CL clinics and interviewed 75 CL practitioners. Proper hand washing facility was available at 61 clinics. Thirty-nine practitioners had> 10 years of experience in dispensing contact lenses. Only 13 clinics had a bio-microscope. None of the clinics had legal documents signed by both providers and end users of the contact lens. Conclusions: Contact lens has received less attention in areas outside the developed world. The CL practice in the private sectors of Oman needs to be strengthened. Minimum standards, standard operating procedures for CL practice, and its periodic supervision would be useful.

  15. Does Research Degree Supervisor Training Work? The Impact of a Professional Development Induction Workshop on Supervision Practice

    Science.gov (United States)

    McCulloch, Alistair; Loeser, Cassandra

    2016-01-01

    Supervisor induction and continued professional development programmes constitute good practice and are enshrined in institutional policies and national codes of practice. However, there is little evidence about whether they have an impact on either supervisors' learning or day-to-day practice. Set in a discussion of previous literature, this…

  16. An innovative clinical practicum to teach evidence-based practice.

    Science.gov (United States)

    Brancato, Vera C

    2006-01-01

    A clinical practicum was successfully implemented for RN to BSN students to apply evidence-based practice to actual clinical problems affecting nursing practice. The author describes how this practicum was implemented and the requisite resources and support systems. This senior-level capstone course enabled students to understand and value a lifelong learning approach to evidence-based practice.

  17. The importance of practice guidelines in clinical care.

    Science.gov (United States)

    Sciarra, Erica

    2012-01-01

    This position paper is a brief review of the importance of practice guidelines in clinical use. Emphasis is placed on evidence-based practice guidelines and research. This position paper attests to the importance of the use of guidelines that direct clinical nursing practice.

  18. CHRONIC HEART FAILURE: CLINICAL GUIDELINES AND REAL CLINICAL PRACTICE

    Directory of Open Access Journals (Sweden)

    E. K. Shavarova

    2016-01-01

    Full Text Available Aim. Expert assessment of real clinical practice compliance with national guidelines on management of patients with chronic heart failure (HF before the opening of the Expert Center of HF treatment.Material and methods. All patients admitted to 2 city clinical hospitals of Moscow with HF were included into the register. Clinical, demographic, laboratory and instrumental characteristics and medical treatment before and during hospitalization were evaluated, as well as recommendations contained in the discharge summary.Results. 300 patients with HF were included into the register. The mean age was 75 years (39, 95; the proportion of men – 44%. 95% of patients had HF IIIV (NYHA, among them 24% HF II, 61% HF III, 15% HF IV (NYHA. HF with reduced ejection fraction (HFrEF was found in 45% of patients. 22% of the patients did not receive medical treatment before admission. 34% of patients with HFrEF received ACE inhibitors/angiotensin receptor blockers (ARBs, of which only 23% in effective dose. β-blockers were prescribed in 41% of HFeEF patients, of which 22% in the target dose. A third of patients needed in mineralocorticoid receptor antagonists (MRA received spironolactone. During hospitalization 81% of HFrEF patients received ACEI therapy, 12% – ARBs, 91% – β-blockers, 90% – MRA, 81% – loop diuretics and 13% – thiazide diuretics. According to the discharge summary 5% of patients did not receive post-discharge blocker of the renin-angiotensin-aldosterone system without explanation in the medical documentation. β-blocker with proven efficacy was prescribed to 70% of HFrEF patients. Spironolactone was recommended after discharge in 89% of HFrEF patients.Conclusion. Implementation of register of hospitalized patients with HF gives an opportunity to identify shortcomings in the provision of medical care both in outpatient and inpatient stages. 

  19. PRACTICAL ASPECTS OF APIXABAN USE IN CLINICAL PRACTICE: VIEW POINT OF CLINICAL PHARMACOLOGIST

    Directory of Open Access Journals (Sweden)

    D. A. Sychev

    2015-09-01

    Full Text Available Apixaban is a "new" oral anticoagulant, direct Xa factor inhibitor with a good evidence base of the efficacy in the prevention of ischemic stroke in patients with atrial fibrillation. The article is devoted to apixaban use in clinical practice: examination before apixaban administration, clinical situation when laboratory control and monitoring are needed, drugs interactions (at the level of CYP3A4, P-gp, management of patients with bleeding because of apixaban therapy (including antidotes application, perioperative management of patients receiving apixaban.

  20. PRACTICAL ASPECTS OF APIXABAN USE IN CLINICAL PRACTICE: VIEW POINT OF CLINICAL PHARMACOLOGIST

    Directory of Open Access Journals (Sweden)

    D. A. Sychev

    2015-01-01

    Full Text Available Apixaban is a "new" oral anticoagulant, direct Xa factor inhibitor with a good evidence base of the efficacy in the prevention of ischemic stroke in patients with atrial fibrillation. The article is devoted to apixaban use in clinical practice: examination before apixaban administration, clinical situation when laboratory control and monitoring are needed, drugs interactions (at the level of CYP3A4, P-gp, management of patients with bleeding because of apixaban therapy (including antidotes application, perioperative management of patients receiving apixaban.

  1. A Model for Using Triadic Supervision in Counselor Preparation Programs

    Science.gov (United States)

    Lawson, Gerard; Hein, Serge F.; Getz, Hildy

    2009-01-01

    The Council for Accreditation of Counseling and Related Educational Programs (2001) has approved the use of triadic supervision as an alternative to individual supervision in clinical instruction. However, literature describing this mode of supervision is very limited. A model for triadic supervision is described, including presession planning,…

  2. [Domains in the clinical practice of Clinical Nursing Experts in Germany and their correspondence with the internationally described "Advanced Nursing Practice"].

    Science.gov (United States)

    Mendel, Simon; Feuchtinger, Johanna

    2009-06-01

    In spite of a growing trend toward academic education and increasing numbers of "nursing experts" functioning as change agents in Germany, actual nursing experts as in the internationally described Advanced Nursing Practice (ANP) are scarce. Drawing from a ten-year experience in implementing the international concept, the University Hospital Freiburg (UKF), Germany, constitutes a notable exception, as it presently employs ten clinically practicing nursing experts. Based on this background of educating nursing experts, this presentation aims at describing the implementation of the nursing expert's role and its fit and conformance with the international ANP. A 3-stage Delphi design was used for interviewing all the nursing experts at the hospital (n = 10) about their expert opinions; in addition, all nursing managers (n = 7) as well as unit and team leaders (n = 49) were asked about their opinion to relevant functions and domains of nursing experts. The following clinical practice domains of nursing experts were identified: Direct patient care, patient education, support and supervision of nurses, maintenance and expansion of professional skills and knowledge of the nursing staff, counselling of managers, quality assurance and organizational development, theory to practice transfer, nursing research, maintenance of own professional skills and knowledge and continuing education, and publicity work. Additionally, a three-year nursing education, a longer lasting professional experience, a degree in nursing science or nursing education, and specialist skills in the respective area of expertise were identified as credentials for nursing expert practice. The nursing expert concept at UKF shows elements of the international ANP with similarities to the role of a Clinical Nurse Specialist.

  3. Clinical Practice Patterns of Canadian Couple/Marital/Family Therapists

    Science.gov (United States)

    Beaton, John; Dienhart, Anna; Schmidt, Jonathan; Turner, Jean

    2009-01-01

    This clinical practice pattern survey had two unique aspects. It was a national survey of American Association for Marriage and Family Therapy (AAMFT) members in Canada that included all AAMFT membership categories, including student, affiliate, associate, clinical, and supervisor. It compared practice pattern data for clinical members from Canada…

  4. Clinical anatomy as practiced by ancient Egyptians.

    Science.gov (United States)

    Loukas, Marios; Hanna, Michael; Alsaiegh, Nada; Shoja, Mohammadali M; Tubbs, R Shane

    2011-05-01

    Egypt is famously known for its Nile and pyramids, yet not many people know that Egypt made possible the origin of the anatomical sciences. Several ancient papyri guide us through the Egyptians' exploration of the human body and how they applied anatomical knowledge to clinical medicine to the best of their knowledge. It is through records, such as the Edwin Smith, Ebers, and Kahun papyri and other literature detailing the work of the Egyptian embalmers, physicians, and Greek anatomists, that we are able to take a glimpse into the evolution of the anatomical sciences from 3000 B.C. to 250 B.C. It is through the Egyptian embalmer that we were able to learn of some of the first interactions with human organs and their detailed observation. The Egyptian physician's knowledge, being transcribed into the Ebers and Edwin Smith papyri, enabled future physicians to seek reference to common ailments for diagnosing and treating a variety of conditions ranging from head injuries to procedures, such as trans-sphenoidal surgery. In Alexandria, Herophilus, and Erasistratus made substantial contributions to the anatomical sciences by beginning the practice of human dissection. For instance, Herophilus described the anatomy of the heart valves along with Erasistratus who demonstrated how blood was prevented from flowing retrograde under normal conditions. Hence, from various records, we are able to unravel how Egypt paved the road for study of the anatomical sciences.

  5. [Surgical clinical studies and their practical realization].

    Science.gov (United States)

    Uhl, W; Wente, M N; Büchler, M W

    2000-06-01

    The employment of the optimal therapeutic option according to the best current knowledge is called evidence-based medicine (EBM). Moreover, considering the cost explosion in public health systems, EBM should contribute towards economical and targeted use of the restricted resources and towards quality assurance in medicine. Obviously, this is applicable to the operative specialties and can be termed as evidence-based surgery. Surgeons have to do their "homework" about this subject and to perform randomized controlled trials (the gold standard with the greatest evidence) on a large scale, in order to come up to this expectation in future. Evidence-based therapy is essential for the preservation and especially for the further development and evolution of high-quality surgery with, at the same time, quality assurance in the new millenium. This article presents the definition of EBM and its implication in the operative fields. Fundamental principles for the practical conduct of clinical randomized controlled trials are defined and the specific problems in surgery are discussed.

  6. Clinical practice guideline: Bell's Palsy executive summary.

    Science.gov (United States)

    Baugh, Reginald F; Basura, Gregory J; Ishii, Lisa E; Schwartz, Seth R; Drumheller, Caitlin Murray; Burkholder, Rebecca; Deckard, Nathan A; Dawson, Cindy; Driscoll, Colin; Gillespie, M Boyd; Gurgel, Richard K; Halperin, John; Khalid, Ayesha N; Kumar, Kaparaboyna Ashok; Micco, Alan; Munsell, Debra; Rosenbaum, Steven; Vaughan, William

    2013-11-01

    The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue featuring the new Clinical Practice Guideline: Bell's Palsy. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 11 recommendations developed encourage accurate and efficient diagnosis and treatment and, when applicable, facilitate patient follow-up to address the management of long-term sequelae or evaluation of new or worsening symptoms not indicative of Bell's palsy. There are myriad treatment options for Bell's palsy; some controversy exists regarding the effectiveness of several of these options, and there are consequent variations in care. In addition, there are numerous diagnostic tests available that are used in the evaluation of patients with Bell's palsy. Many of these tests are of questionable benefit in Bell's palsy. Furthermore, while patients with Bell's palsy enter the health care system with facial paresis/paralysis as a primary complaint, not all patients with facial paresis/paralysis have Bell's palsy. It is a concern that patients with alternative underlying etiologies may be misdiagnosed or have an unnecessary delay in diagnosis. All of these quality concerns provide an important opportunity for improvement in the diagnosis and management of patients with Bell's palsy.

  7. Adherence to EBM guidelines in clinical practice.

    Science.gov (United States)

    Khafizianova, R Kh; Burykin, I M

    2015-01-01

    Adequate and rational pharmacotherapy is an important element of rehabilitation of patients with myocardial infarction. Orders of the Ministry of Health of the Russian Federation, domestic and international guidelines, and scientific publications - all contain a complete algorithm for rational pharmacotherapy [1, 2]. These documents are based on the principles of evidence-based medicine (EBM) and help practicing physicians to carry out individualized and rational pharmacotherapy. However, clinical studies have shown low adherence of physicians to clinical guidelines. In the Russian Federation the death rate from cardiovascular diseases is higher than in developed countries. Thus, studies of the causes of high cardiovascular mortality are needed. To assess adherence of practicing physicians to principles of evidence-based medicine in treating patients after myocardial infarction at the stage of rehabilitation. A retrospective analysis of 157 cases of patients in rehabilitation after myocardial infarction for the years 2006 and 2009 was undertaken.We analyzed the list of drugs, prescribed to patients during the period of rehabilitation, drug combinations, regimens and pharmacoepidemiological parameters. We used the following rehabilitation criteria: blood pressure control, smoking cessation, and weight control. Recommendations of controlled physical activities have also been studied. Patient care was compared with the guideline recommendations. Statistical analysis was performed using the OLAP system. 65 patients with myocardial infarction received rehabilitation therapy in 2006, and 92 - in 2009. It was found, that in 2006 physicians prescribed an average of 4.5 drugs per patient, and in 2009 - 4.6 drugs per patient. The average number of cardiovascular drugs (category C of ATC classification) per patient was 2.9 in 2006, and 2.6 - in 2009. Polypharmacy was found in half of the patients.In terms of evidence-based medicine, an important element in the rehabilitation

  8. The complexities of power in feminist multicultural psychotherapy supervision.

    Science.gov (United States)

    Arczynski, Alexis V; Morrow, Susan L

    2017-03-01

    The goal of the present study was to understand how current feminist multicultural supervisors understand and implement their feminist multicultural principles into clinical supervision. We addressed this aim by answering the following research question: How do self-identified feminist multicultural psychotherapy supervisors conceptualize and practice feminist supervision that is explicitly multicultural? The perspectives of 14 participant supervisors were obtained by using semistructured initial interviews, follow-up interviews, and feedback interviews and were investigated via a feminist constructivist grounded theory design and analysis. Most participants identified as counseling psychologists (n = 12), women (n = 11) and temporarily able-bodied (n = 11); but they identified with diverse racial/ethnic, sexual, spiritual/religious, generational, and nationality statuses. A 7-category empirical framework emerged that explained how the participants anticipated and managed power in supervision. The core category, the complexities of power in supervision, explained how participants conceptualized power in supervisory relationships. The 6 remaining categories were bringing history into the supervision room, creating trust through openness and honesty, using a collaborative process, meeting shifting developmental (a)symmetries, cultivating critical reflexivity, and looking at and counterbalancing the impact of context. Limitations of the study, implications for research, and suggestions to use the theoretical framework to transform supervisory practice and training are discussed. (PsycINFO Database Record

  9. Conceptualizing clinical nurse leader practice: an interpretive synthesis.

    OpenAIRE

    Bender, M.

    2016-01-01

    BACKGROUND: The Institute of Medicine's Future of Nursing report identifies the clinical nurse leader as an innovative new role for meeting higher health-care quality standards. However, specific clinical nurse leader practices influencing documented quality outcomes remain unclear. Lack of practice clarity limits the ability to articulate, implement and measure clinical nurse leader-specific practice and quality outcomes. PURPOSE AND METHODS: Interpretive synthesis design and grounded theory...

  10. The practice-unit centered clinical database--the implementation.

    OpenAIRE

    Bryner, U. M.

    1991-01-01

    A clinical database system under the name ClinTrac has been developed for the purpose of acquiring, processing, storing, analyzing, and communicating clinical information. The core of this system consists of a practice-unit centered database.

  11. Ethics in education supervision

    Directory of Open Access Journals (Sweden)

    Fatma ÖZMEN

    2008-06-01

    Full Text Available Supervision in education plays a crucial role in attaining educational goals. In addition to determining the present situation, it has a theoretical and practical function regarding the actions to be taken in general and the achievement of teacher development in particular to meet the educational goals in the most effective way. For the education supervisors to act ethically in their tasks while achieving this vital mission shall facilitate them to build up trust, to enhance the level of collaboration and sharing, thus it shall contribute to organizational effectiveness. Ethics is an essential component of educational supervision. Yet, it demonstrates rather vague quality due to the conditions, persons, and situations. Therefore, it is a difficult process to develop the ethical standards in institutions. This study aims to clarify the concept of ethics, to bring up its importance, and to make recommendations for more effective supervisions from the aspect of ethics, based on the literature review, some research results, and sample cases reported by teachers and supervisors.

  12. Reliability of Mini-CEX Assessment of Medical Students in General Practice Clinical Attachments.

    Science.gov (United States)

    Eggleton, Kyle; Goodyear-Smith, Felicity; Paton, Lois; Falloon, Karen; Wong, Chris; Lack, Liza; Kennelly, John; Fishman, Tana; Moyes, Simon A

    2016-09-01

    Mini Clinical Evaluation eXercise (mini-CEX) involves observation of routine clinical encounters, initially developed to assess clinical competencies of postgraduate doctors. This study aimed to measure its inter-rater reliability in assessment of medical students in general practice settings. General practitioners (GPs) supervising medical students were invited to complete online teaching on how to conduct a mini-CEX. This included three randomly presented scripted films of clinical scenarios representing different levels of student performance. Consenting participants completed an online mini-CEX. Mean marks were calculated for each case, Intraclass Correlation Coefficients (ICC) for overall clinical and four individual competencies, one-way analysis of variance to compare scores, and internal consistency measured by Cronbach's alpha. RESULTS were collated for the first 100 completing GPs, majority aged 40-59 years (71%), male (59%), New Zealand European (58%). Forty-four percent were in rural practice, with 21 mean years in practice. Mean mini-CEX grades increased as standardized performance increased, indicating that GPs reliably agreed about ranking of student performance from poor to very good. The intraclass correlation coefficient (ICC) for overall clinical competency was 0.78 (95% confidence interval 0.48-0.99), indicating good reliability regarding their agreement with each other. A Cronbach's alpha calculated with the overall scores was 0.85, indicating good internal consistency. Mini-CEXs in undergraduate general practice attachments provide a reliable measure of assessing performance. However, they may be less useful in identifying exceptional performance or weaknesses in key competencies. In addition, caution must be applied in relying upon mini-CEXs to supply a summative assessment.

  13. Applications of collaborative helping maps: supporting professional development, supervision and work teams in family-centered practice.

    Science.gov (United States)

    Madsen, William C

    2014-03-01

    Collaborative, family-centered practice has become an influential approach in helping efforts across a broad spectrum of human services. This article draws from previous work that presented a principle-based, practice framework of Collaborative Helping and highlighted the use of Collaborative Helping maps as a tool both to help workers think their way through complex situations and to provide a guideline for constructive conversations between families and helpers about challenging issues. It builds on that work to examine ways to utilize Collaborative Helping maps at worker, supervisory, and organizational levels to enhance and sustain collaborative, family-centered practice and weave its core values and principles into the everyday fabric of organizational cultures in human service agencies and government agencies that serve poor and marginalized families and communities.

  14. Rules for Supervision and Inspection of Offshore Oil Industry

    Institute of Scientific and Technical Information of China (English)

    Dai Zhongliang; Song Lisong

    1994-01-01

    @@ In short,safety supervision and technique inspection mean the safety supervision by the government,and the inspection by technical organization,and those are put into practice by a series of administrative rules and regulations.

  15. Supervised training and home-based rehabilitation in patients with stabilized ankylosing spondylitis on TNF inhibitor treatment: a controlled clinical trial with a 12-month follow-up.

    Science.gov (United States)

    Masiero, Stefano; Poli, Patrizia; Bonaldo, Lara; Pigatto, Maurizia; Ramonda, Roberta; Lubrano, Ennio; Punzi, Leonardo; Maffulli, Nicola

    2014-06-01

    To assess the 12-month's follow-up effects on pain, mobility, and physical function outcomes of a supervised training and home-based rehabilitation for ankylosing spondylitis patients stabilized with TNF-inhibitor therapy. Controlled clinical trial (sequentially determined allocation) with 12-months' follow-up. Patients' homes. A total of 69 subjects were allocated to either a rehabilitation programme (rehabilitation group, n = 22), an educational-behavioural programme (educational group, n = 24), and to neither programme (control group, n = 23). Rehabilitation programme included supervised training and home exercises (stretching, strengthening, aerobic, chest, and spine/hip joint flexibility exercises); educational-behavioural programme included information on ankylosing spondylitis, pain and stress mechanisms, and control. Spinal pain intensity, Bath Ankylosing Spondylitis Metrology Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Disease Activity Index, chest expansion, and cervical and lumbar spine active range of motion measured by a pocket goniometer. At baseline, the three groups exhibited comparable demographic characteristics and basal evaluations. Intra-group changes in the rehabilitation group from baseline to 12 months yielded statistically significant gains (p Ankylosing Spondylitis Disease Activity Index (p = 0.012 and p = 0.050), and in some goniometric measurements as cervical rotation (p = 0.007 and p = 0.014), toraco-lumbar rotation (p = 0.009 and p = 0.050), and total cervical movements (p = 0.009 and p = 0.001). In comparison with the educational-behavioural programme or no intervention, supervised training and home exercises improved long-term outcome in patients with ankylosing spondylitis. © The Author(s) 2013.

  16. Librarian contributions to clinical practice guidelines.

    Science.gov (United States)

    Cruse, Peggy; Protzko, Shandra

    2014-01-01

    Librarians have become more involved in developing high quality systematic reviews. Evidence-based practice guidelines are an extension of systematic reviews and offer another significant area for librarian involvement. This column highlights opportunities and challenges for the librarian working on guideline panels and provides practical considerations for meaningful contributions to the guideline creation process.

  17. Narcissistic interpersonal problems in clinical practice.

    Science.gov (United States)

    Kealy, David; Ogrodniczuk, John S

    2011-01-01

    Pathological narcissism is associated with significant interpersonal problems, which are unlikely to be acknowledged by narcissistic patients as clinical issues. Although a substantial clinical and theoretical literature deals with narcissism, a succinct overview of core narcissistic interpersonal problems is lacking, particularly in terms of their presentation in clinical settings. This article provides a descriptive overview of the major types of interpersonal problems associated with pathological narcissism: dominance, vindictiveness, and intrusiveness. We outline how these problems can manifest in patients' relations with others and in treatment situations. Clinical vignettes are provided to highlight the presentation of narcissistic interpersonal dysfunction in various types of clinical encounters, and to facilitate discussion of treatment implications.

  18. IT support for administrative planning of clinical practice.

    Science.gov (United States)

    Florin, Jan; Joustra-Enquist, Ingrid; Hedberg, Lars

    2006-01-01

    The administration of clinical practice placements for nursing students is a highly complex and information driven task. This demonstration is intended to give insight into the web based system KliPP (a Swedish acronym for Clinical Practice Planning) and to discuss the possibilities for further development and use.

  19. Trancranial Doppler: value in clinical practice.

    Science.gov (United States)

    Martinelli, O; Benedetti-Valentini, F

    2009-08-01

    The value of TCD in clinical practice is well established since it can be used to measure cerebral vasomotor reactivity and to detect and grade vasospasm (VSP) following subarachnoid haemorrhage and cerebral blood perfusion consequences of extracranial ICA stenosis or occlusion. Intracranial steno-occlusive disease can be detected more reliably by transcranial color-coded imaging (TCCI) that provides a two-dimensional imaging of parenchymal and vascular anatomy of brain too. In patients with suspected brain TCD diagnostic criteria for brain death have a sensitivity of 91 to 100% and specificity of 97 to 100% and they are particularly useful when clinical and EEG evaluations are difficult. TCD is a sensitive technique for real time detection of microembolic signals (MES) from prosthetic cardiac valves, myocardial infarction site, atrial fibrillation, aortic arch atheroma and this suggests the use of TCD for monitoring response to antithrombotic therapy. There is also a high correlation between contrast-enhanced TCD and trans-esophageal echocardiography for detecting paradoxical embolism through right-to-left cardiac or pulmonary shunts. Microembolization detected by TCD monitoring may confirm features of unstable carotid artery plaques as imaged by Duplex scanning and there is an increasing evidence that asymptomatic MES from unstable carotid plaques are an independent factor for ischemic stroke. TCD can be used as a monitoring tool during cardiac surgery and cerebrovascular operations to determine critical hemodynamic changes in cerebral arteries and to identify high-intensity transients referred to air or particulate emboli. Several research studies of the past 10 years have shown that MES may be detected by TCD during all phases of CEA and CAS and that sustained microembolism after carotid flow restoration is an indication of impending postoperative or post-procedural occlusion. Our series showed a clear difference between the number of patients with MES and the

  20. Evidence-based risk recommendations for best practices in the training of qualified exercise professionals working with clinical populations.

    Science.gov (United States)

    Warburton, Darren E R; Bredin, Shannon S D; Charlesworth, Sarah A; Foulds, Heather J A; McKenzie, Don C; Shephard, Roy J

    2011-07-01

    This systematic review examines critically "best practices" in the training of qualified exercise professionals. Particular attention is given to the core competencies and educational requirements needed for working with clinical populations. Relevant information was obtained by a systematic search of 6 electronic databases, cross-referencing, and through the authors' knowledge of the area. The level and grade of the available evidence was established. A total of 52 articles relating to best practices and (or) core competencies in clinical exercise physiology met our eligibility criteria. Overall, current literature supports the need for qualified exercise professionals to possess advanced certification and education in the exercise sciences, particularly when dealing with "at-risk" populations. Current literature also substantiates the safety and effectiveness of exercise physiologist supervised stress testing and training in clinical populations.

  1. Evaluating developmental screening in clinical practice

    Directory of Open Access Journals (Sweden)

    Peter Dawson

    2014-12-01

    Full Text Available Objective: To demonstrate a method of evaluating accuracy of developmental screening modeled on the evidence-based medical literature. Method: A retrospective review was performed on 418 children screened with the Denver II by a trained technician. Two models for analyzing screening data were examined, using predictive values and likelihood ratios (LR+ and LR−. Results: The technician, working at 20% time, screened 44% of eligible children. There were 129/418 (31% children with Suspect Denver II results, 115/418 who were referred, 81/115 (70% who were evaluated by Early Intervention, and 64/81 (79% who qualified for services. The uncorrected positive predictive value for the Denver II alone (44% was insufficient to meet the preset standard of 60%, but the LR+ of 4.16 indicated a significant contribution of test information to improving predictive value. Combining test results with information from the parent–technician conference to achieve a referral decision resulted in an uncorrected predictive value of 56%, which rose with correction for children referred but not evaluated to 72% (LR+ 10.33. Negative predictive values and likelihood ratios of a negative test and a non-referral decision achieved recommended levels. Parents who expressed concern were significantly more likely to complete recommended evaluation than those who did not (82% vs 58%, p < .01. Results were in the same range as in published studies with other screening tests but showed three areas for improvement: screening more children, more carefully supervising some referral decisions, and getting more children to evaluation. Conclusion: Levels of predictive accuracy above 60% can be obtained by combining different types of information about development to make decisions about referral for more complete evaluation. Systematic study of such combinations could lead to improved predictive accuracy of screening programs and support attempts to close the gap between referral

  2. District nurse clinics: accountability and practice.

    Science.gov (United States)

    Griffith, Richard; Tengnah, Cassam

    2013-02-01

    The numbers of district nurse clinics are continuing to grow in primary care and they provide timely and more cost effective intervention for patients. The clinics provide exciting opportunities for district nurses but also carry an increased risk of exposure to liability. This article discusses some of the key areas of accountability underpinning the duty of care of district nurses working in nurse-led clinics.

  3. Best practice in clinical facilitation of undergraduate nursing students.

    Science.gov (United States)

    Needham, Judith; McMurray, Anne; Shaban, Ramon Z

    2016-09-01

    Clinical facilitation is critical to successful student clinical experience. The research reported in this paper used an interpretive case study to explore perspectives of clinical facilitators on what constitutes best practice in clinical facilitation of undergraduate nursing students. Eleven clinical facilitators from South East Queensland, Australia, participated in focus groups, interviews and a concept mapping exercise to gather their perspectives on best practice. The data gathered information regarding their prior and current experiences as registered nurses and facilitators, considering reasons they became clinical facilitators, their educational background and self-perceived adequacy of their knowledge for clinical facilitation. Analysis was through constant comparison. Findings of the study provided in-depth insight into the role of clinical facilitators, with best practice conceptualised via three main themes; 'assessing', 'learning to facilitate' and 'facilitating effectively'. While they felt there was some autonomy in the role, the clinical facilitators sought a closer liaison with academic staff and feedback about their performance, in particular their assessment of the students. Key strategies identified for improving best practice included educational support for the clinical facilitators, networking, and mentoring from more experienced clinical facilitators. When implemented, these strategies will help develop the clinical facilitators' skills and ensure quality clinical experiences for undergraduate nursing students.

  4. Content analysis of resident evaluations of faculty anesthesiologists: supervision encompasses some attributes of the professionalism core competency.

    Science.gov (United States)

    Dexter, Franklin; Szeluga, Debra; Hindman, Bradley J

    2017-05-01

    Anesthesiology departments need an instrument with which to assess practicing anesthesiologists' professionalism. The purpose of this retrospective analysis of the content of a cohort of resident evaluations of faculty anesthesiologists was to investigate the relationship between a clinical supervision scale and the multiple attributes of professionalism. From July 1, 2013 to the present, our department has utilized the de Oliveira Filho unidimensional nine-item supervision scale to assess the quality of clinical supervision of residents provided by our anesthesiologists. The "cohort" we examined included all 13,664 resident evaluations of all faculty anesthesiologists from July 1, 2013 through December 31, 2015, including 1,387 accompanying comments. Words and phrases associated with the core competency of professionalism were obtained from previous studies, and the supervision scale was analyzed for the presence of these words and phrases. The supervision scale assesses some attributes of anesthesiologists' professionalism as well as patient care and procedural skills and interpersonal and communication skills. The comments that residents provided with the below-average supervision scores included attributes of professionalism, although numerous words and phrases related to professionalism were not present in any of the residents' comments. The de Oliveira Filho clinical supervision scale includes some attributes of anesthesiologists' professionalism. The core competency of professionalism, however, is multidimensional, and the supervision scale and/or residents' comments did not address many of the other established attributes of professionalism.

  5. Design of the multicenter standardized supervised exercise training intervention for the claudication: exercise vs endoluminal revascularization (CLEVER) study.

    Science.gov (United States)

    Bronas, Ulf G; Hirsch, Alan T; Murphy, Timothy; Badenhop, Dalynn; Collins, Tracie C; Ehrman, Jonathan K; Ershow, Abby G; Lewis, Beth; Treat-Jacobson, Diane J; Walsh, M Eileen; Oldenburg, Niki; Regensteiner, Judith G

    2009-11-01

    The CLaudication: Exercise Vs Endoluminal Revascularization (CLEVER) study is the first randomized, controlled, clinical, multicenter trial that is evaluating a supervised exercise program compared with revascularization procedures to treat claudication. In this report, the methods and dissemination techniques of the supervised exercise training intervention are described. A total of 217 participants are being recruited and randomized to one of three arms: (1) optimal medical care; (2) aortoiliac revascularization with stent; or (3) supervised exercise training. Of the enrolled patients, 84 will receive supervised exercise therapy. Supervised exercise will be administered according to a protocol designed by a central CLEVER exercise training committee based on validated methods previously used in single center randomized control trials. The protocol will be implemented at each site by an exercise committee member using training methods developed and standardized by the exercise training committee. The exercise training committee reviews progress and compliance with the protocol of each participant weekly. In conclusion, a multicenter approach to disseminate the supervised exercise training technique and to evaluate its efficacy, safety and cost-effectiveness for patients with claudication due to peripheral arterial disease (PAD) is being evaluated for the first time in CLEVER. The CLEVER study will further establish the role of supervised exercise training in the treatment of claudication resulting from PAD and provide standardized methods for use of supervised exercise training in future PAD clinical trials as well as in clinical practice.

  6. A Gestalt Approach to Group Supervision

    Science.gov (United States)

    Melnick, Joseph; Fall, Marijane

    2008-01-01

    The authors define and then describe the practice of group supervision. The role of creative experiment in assisting supervisees who perceive themselves as confused, moving in circles, or immobilized is described. Fictional case examples illustrate these issues in supervision. The authors posit the "good fit" of Gestalt theory and techniques with…

  7. Applying Services Marketing Principles to Postgraduate Supervision

    Science.gov (United States)

    Dann, Stephen

    2008-01-01

    Purpose: The paper aims to describe the application of two key service quality frameworks for improving the delivery of postgraduate research supervision. The services quality frameworks are used to identify key areas of overlap between services marketing practice and postgraduate supervision that can be used by the supervisor to improve research…

  8. Applying Services Marketing Principles to Postgraduate Supervision

    Science.gov (United States)

    Dann, Stephen

    2008-01-01

    Purpose: The paper aims to describe the application of two key service quality frameworks for improving the delivery of postgraduate research supervision. The services quality frameworks are used to identify key areas of overlap between services marketing practice and postgraduate supervision that can be used by the supervisor to improve research…

  9. A Gestalt Approach to Group Supervision

    Science.gov (United States)

    Melnick, Joseph; Fall, Marijane

    2008-01-01

    The authors define and then describe the practice of group supervision. The role of creative experiment in assisting supervisees who perceive themselves as confused, moving in circles, or immobilized is described. Fictional case examples illustrate these issues in supervision. The authors posit the "good fit" of Gestalt theory and techniques with…

  10. Vagus nerve stimulation in clinical practice.

    Science.gov (United States)

    Farmer, Adam D; Albu-Soda, Ahmed; Aziz, Qasim

    2016-11-02

    The diverse array of end organ innervations of the vagus nerve, coupled with increased basic science evidence, has led to vagus nerve stimulation becoming a management option in a number of clinical disorders. This review discusses methods of electrically stimulating the vagus nerve and its current and potential clinical uses.

  11. Evaluation of the process of patient education recording and its compliance with patient perception and satisfaction after the implementation of clinical supervision: An embedded evaluation

    Directory of Open Access Journals (Sweden)

    Parvaneh Khorasani

    2016-02-01

    Full Text Available Background: Currently, patient education has been regarded as one of the important components of treatment in healthcare centers. Clinical provision, which is one of the legal tools with training-support dimensions, can evaluate the adaptation between the implemented procedures and planned activities. This study aimed to evaluate the process of patient education recording, compliance of education recording with patient perception and satisfaction after the implementation of clinical supervision. Methods: This longitudinal, embedded evaluation study was conducted during 2013-2015 to evaluate the effectiveness of a nurse-led role expansion program through action research. Evaluation process was carried out in three stages of designing the supervision program, as well as establishment and evaluation of this system using available sampling on 786 research units (medical records of patients being discharged at Al Zahra Educational Center, affiliated to Isfahan University of Medical Sciences, Isfahan, Iran. Supervisory checklists were completed and the perception of patients was presented in the design stage. Afterwards, a designed patient satisfaction survey was used, reliability and validity of which was confirmed. In the establishment stage, the structure of monitoring program was designed with the assessment of eight supervisors. Meanwhile, 2333 checklists and surveys were completed at the time of hospital discharge in the stage of program evaluation during a course of 12 months. Data analysis was performed in SPSS version 18 using one-way ANOVA and Pearson’s correlation coefficient. Results: In this study, mean score of recorded patient education for 12 months was 88.5±21.75. Moreover, mean scores of patient satisfaction with the education process and compliance of patient perception with recorded education were 73±25.13 and 47.17±21.48, respectively. According to these results, a significant reduction was observed in the mentioned scores on

  12. Good clinical practice : Historical background and key aspects

    NARCIS (Netherlands)

    Otte, Andreas; Maier-Lenz, Herbert; Dierckx, Rudi A.

    Clinical research trials (both academic and industry sponsored) are increasingly playing a role in various medical disciplines, including younger fields of clinical trial interest, such as nuclear medicine research. Knowledge for and compliance with good clinical practice (GCP) is essential for

  13. Good clinical practice: Historical background and key aspects

    NARCIS (Netherlands)

    Otte, A.; Maier-Lenz, H.; Dierckx, R.A.

    2005-01-01

    Clinical research trials (both academic and industry sponsored) are increasingly playing a role in various medical disciplines, including younger fields of clinical trial interest, such as nuclear medicine research. Knowledge for and compliance with good clinical practice (GCP) is essential for anyo

  14. Good clinical practice : Historical background and key aspects

    NARCIS (Netherlands)

    Otte, A; Maier-Lenz, H; Dierckx, RA

    2005-01-01

    Clinical research trials (both academic and industry sponsored) are increasingly playing a role in various medical disciplines, including younger fields of clinical trial interest, such as nuclear medicine research. Knowledge for and compliance with good clinical practice (GCP) is essential for anyo

  15. Monitoring clinical trials: a practical guide.

    Science.gov (United States)

    Molloy, Síle F; Henley, Patricia

    2016-12-01

    This article describes the processes and procedures involved in planning, conducting and reporting monitoring activities for large Clinical Trials of Investigational Medicinal Products (CTIMPs), focusing on those conducted in resource-limited settings. © 2016 John Wiley & Sons Ltd.

  16. Clinical evidence for Japanese population based on prospective studies--linking clinical trials and clinical practice.

    Science.gov (United States)

    Ogawa, Hisao; Kojima, Sunao

    2009-10-01

    "Evidence-based medicine (EBM)" implies effective and high quality practice for patients based on well-grounded medical science. The success of clinical trials in Japan is essential to build original evidence specific for Japanese patients. Based on this concept, we have performed several large-scale clinical trials to provide EBM, including the Japanese Antiplatelets Myocardial Infarction Study [JAMIS; clinical improvement in acute myocardial infarction (AMI) patients with antiplatelet therapy], the Japanese beta-Blockers and Calcium Antagonists Myocardial Infarction (JBCMI; comparison of the effects of beta-blockers and calcium antagonists on cardiovascular events in post-AMI patients), a multicenter study for aggressive lipid-lowering strategy by HMG-CoA reductase inhibitors in patients with AMI (MUSASHI; effects of statin therapy on cardiovascular events in patients with AMI), and the Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes (JPAD trial; efficacy of low-dose aspirin therapy for primary prevention of atherosclerotic events in type 2 diabetic patients). The results of these prospective studies were directly linked with clinical practice. We have acquired the know-how of large-scale clinical trials; an important point is to have passion for "buildup evidence specific for the Japanese" and to recruit subjects for enrollment after explaining the significance of "clinical trials for the Japanese".

  17. Conceptual models used in clinical practice.

    Science.gov (United States)

    Wardle, M G; Mandle, C L

    1989-02-01

    Nurses' difficulties in articulation of conceptual models may be due to several factors--not the least of which are the existence of discrete theories for each area of nursing specialization, dissociation in curricula of theory from practice, a holistic conceptual framework that may be inadequately defined at the process level, and an impulse toward idealism on the part of the nurses themselves. These observations challenge both the theorists and the practitioners of modern nursing to describe more clearly the definition of quality for the science and art of nursing. Nurses are beginning to grasp the idea of holism. It is not the summation of parts to make a whole. Holism is the identification of life patterns, which are reflective of the whole. Nurses in practice and research are starting to create methods of inquiry that portray the wholeness of the autonomous person in continual, dynamic change and exchange with a changing universe. These initial explorations are leading to the evolution of the concepts of person, environment, and health into a distinctive theoretical base for nursing practice. In practice, research, and education, nurses must be committed to excellent, current descriptions of these human life patterns.

  18. Clinical Practice Realities: World and African Perspectives

    African Journals Online (AJOL)

    and challenges in nursing and midwifery practice are explored. These are ... teaching the highest provision of patient care. Seek- ... One of the strategies put in place by the ... ment of the e-learning program, a three year program after which ...

  19. Neurobiology of Addictions: Implications for Clinical Practice.

    Science.gov (United States)

    Spence, Richard T., Ed.; DiNitto, Diana M., Ed.; Straussner, Shulamith Lala Ashenberg, Ed.

    This book offers helping professionals an introduction to the neurobiological aspects of substance abuse. It presents the basic information on the subject, including the various neurobiological theories of addiction, and places them in a psychosocial context. In addition to connecting the theoretical information with practical applications, the…

  20. [Evidence-based clinical guidelines in dental practice 6. Guidelines for clinical practice in dental education].

    Science.gov (United States)

    van der Sanden, W J M; Gorter, R; Tams, J

    2015-09-01

    In response to the initiatives of the Kennisinstituut Mondzorg (Institute for Knowledge Translation in Oral Care), the importance of effective education in the area of guidelines is increasing. Future dentists will, after all, be confronted with new guidelines and need to be able to integrate them in their daily practice. Various guidelines and protocols have been established within the 3 dental schools. For students and instructors, however, the motivation for these guidelines and protocols is not always sufficiently clear. In addition, the terms guideline, clinical practice guideline and protocol are used interchangeably, resulting in terminological confusion. Embedding within and coordination with theoretical education is also still limited in all programmes and it is proposed that the 3 dental schools collaborate on this issue. Finally, it is advised to replace the term 'evidence-based' with 'evidence-informed' because this indicates more clearly that other factors (patients opinion, available financial means, etc.) play a role in the final choice of treatment in a specific situation.

  1. Change in stated clinical practice associated with participation in the Dental Practice-Based Research Network

    DEFF Research Database (Denmark)

    Gilbert, Gregg H; Richman, Joshua S; Qvist, Vibeke

    2010-01-01

    Clinical researchers have attempted many methods to translate scientific evidence into routine clinical practice, with varying success. Practice-based research networks (PBRNs) provide an important, practitioner-friendly venue to test these methods. Dentist practitioner-investigators from the Den...

  2. Social constructionism and supervision: experiences of AAMFT supervisors and supervised therapists.

    Science.gov (United States)

    Hair, Heather J; Fine, Marshall

    2012-10-01

    A phenomenological research process was used to investigate the supervision experience for supervisors and therapists when supervisors use a social constructionist perspective. Participants of the one-to-one interviews were six AAMFT Approved Supervisors and six therapists providing counseling to individuals, couples and families. The findings suggest supervisors were committed to their self-identified supervision philosophy and intentionally sought out congruence between epistemology and practice. The shared experience of therapists indicates they associated desirable supervision experiences with their supervisors' social constructionist perspective. Our findings also indicated that supervisors' and therapists' understanding of social constructionism included the more controversial concepts of agency and extra-discursiveness. This research has taken an empirical step in the direction of understanding what the social constructionist supervision experience is like for supervisors and therapists. Our findings suggest a linkage between epistemology and supervision practice and a satisfaction with the supervision process. © 2012 American Association for Marriage and Family Therapy.

  3. Pharmacy Administration and Clinical Practice Research Agenda.

    Science.gov (United States)

    Hepler, Charles D.

    1987-01-01

    Research needs for pharmacy administration and clinical pharmacy include study of the relationship of pharmacists and society, management methods for providing health care services, pharmacist training and socialization, competence evaluation, formative and summative research on drug use control, and organizational decision making. (MSE)

  4. Clinical practice: swallowing problems in cerebral palsy.

    NARCIS (Netherlands)

    Erasmus, C.E.; Hulst, K. van; Rotteveel, J.J.; Willemsen, M.A.A.P.; Jongerius, P.H.

    2012-01-01

    Cerebral palsy (CP) is the most common physical disability in early childhood. The worldwide prevalence of CP is approximately 2-2.5 per 1,000 live births. It has been clinically defined as a group of motor, cognitive, and perceptive impairments secondary to a non-progressive defect or lesion of the

  5. Asymptomatic Bacteriuria in Clinical Urological Practice

    DEFF Research Database (Denmark)

    Cai, Tommaso; Mazzoli, Sandra; Lanzafame, Paolo;

    2016-01-01

    Asymptomatic bacteriuria (ABU) is a common clinical condition that often leads to unnecessary antimicrobial use. The reduction of antibiotic overuse for ABU is consequently an important issue for antimicrobial stewardship and to reduce the emergence of multidrug resistant strains. There are two i...... a protective role in preventing symptomatic recurrence, particularly when Enterococcus faecalis (E. faecalis) has been isolated....

  6. A brain cancer pathway in clinical practice

    DEFF Research Database (Denmark)

    Laursen, Emilie Lund; Rasmussen, Birthe Krogh

    2012-01-01

    Danish healthcare seeks to improve cancer survival through improved diagnostics, rapid treatment and increased focus on cancer prevention and early help-seeking. In neuro-oncology, this has resulted in the Integrated Brain Cancer Pathway (IBCP). The paper explores how the pathway works...... in the initial phase in a clinical setting with emphasis on pathway criteria....

  7. Clinical practice: swallowing problems in cerebral palsy.

    NARCIS (Netherlands)

    Erasmus, C.E.; Hulst, K. van; Rotteveel, J.J.; Willemsen, M.A.A.P.; Jongerius, P.H.

    2012-01-01

    Cerebral palsy (CP) is the most common physical disability in early childhood. The worldwide prevalence of CP is approximately 2-2.5 per 1,000 live births. It has been clinically defined as a group of motor, cognitive, and perceptive impairments secondary to a non-progressive defect or lesion of the

  8. Pharmacy Administration and Clinical Practice Research Agenda.

    Science.gov (United States)

    Hepler, Charles D.

    1987-01-01

    Research needs for pharmacy administration and clinical pharmacy include study of the relationship of pharmacists and society, management methods for providing health care services, pharmacist training and socialization, competence evaluation, formative and summative research on drug use control, and organizational decision making. (MSE)

  9. The impact of supervision on stock management and adherence to treatment guidelines: a randomized controlled trial.

    Science.gov (United States)

    Trap, B; Todd, C H; Moore, H; Laing, R

    2001-09-01

    Ensuring the availability of essential drugs and using them appropriately are crucial if limited resources for health care are to be used optimally. While training of health workers throughout Zimbabwe in drug management (including stock management and rational drug use) resulted in significant improvements in a variety of drug use indicators, these achievements could not be sustained, and a new strategy was introduced based on the supervision of primary health care providers. This was launched in 1995 with a training course in supervisory skills for district pharmacy staff. In order to evaluate the impact of the supervision and the effectiveness of the training programme, adherence to standard treatment guidelines (STG) and stock management protocols was evaluated in a randomized controlled trial. The study compared three different groups of health facilities: those that received supervision for either use of STG (n = 23) or stock management (n = 21) - each facility acting as control for the other area of supervision - and a comparison group of facilities which received no supervision (n = 18). On-the-spot supervision by a specially trained pharmacy staff, based around identified deficiencies, took place at the start of the study and 3 months later. The evaluation compared performance on a variety of drug management indicators at baseline and 6-8 months after the second supervisory visit. The results of the study showed that, following supervision, overall stock management improved significantly when compared with the control and comparison groups. Similar improvements were demonstrated for adherence to STG, although the effect was confounded by other interventions. The study also showed that supervision has a positive effect on improving performance in areas other than those supervised, and demonstrated that pharmacy technicians with limited clinical skills can be trained to influence primary health care workers to positively improve prescribing practices

  10. 关于加强我国疫苗临床试验监管的思考(下)%Considerations on strengthening the supervision of vaccine clinical trials in China (Part Ⅱ)

    Institute of Scientific and Technical Information of China (English)

    高荣

    2013-01-01

    In the new situation of the development of vaccine clinical trials, the regulatory authorities need to build the comprehensive three-dimensional vaccine clinical trial regulatory model, whose premise and basis is qualification for vaccine clinical trial institution, to improve the effectiveness of supervision. This paper presented the implementation proposals of qualification for vaccine clinical trial institution, and explored the implementation of the building the comprehensive three-dimensional vaccine clinical trial regulatory model, including the process supervision, previous supervision and postmortem supervision.%在新的疫苗临床试验发展形势下,监管部门应通过构建疫苗临床试验全方位立体监管模式来提高疫苗临床试验监管效能,其前提和基础是开展疫苗临床试验机构资格认定.本文提出了疫苗临床试验机构资格认定的实施方案建议,并探索了构建包括过程监管、事前监管和事后监管在内的疫苗临床试验全方位立体监管模式的实施方法.

  11. A Postdoctoral Fellowship in Industrial Clinical Pharmacy Practice.

    Science.gov (United States)

    Barone, Joseph; And Others

    1985-01-01

    A postdoctoral pharmacy fellowship is described that provides training in industrial clinical pharmacy practice and related tasks associated with the development of new pharmaceuticals, through experience in industrial and hospital settings and in research projects. (MSE) PUBTYPE[141

  12. Ambulatory Blood Pressure Monitoring – Clinical Practice Recommendations

    Directory of Open Access Journals (Sweden)

    Katalin Mako

    2016-09-01

    Full Text Available Ambulatory blood pressure monitoring (ABPM became a subject of considerable scientific interest. Due to the increasing use of the ABPM in everyday clinical practice it is important that all the users have a correct knowledge on the clinical indications, the methodology of using the device including some technical issues and the interpretation of results. In the last years several guidelines and position papers have been published with recommendations for the monitoring process, reference values, for clinical practice and research. This paper represents a summary of the most important aspects related to the use of ABPM in daily practice, being a synthesis of recommendations from the recent published guidelines and position papers. This reference article presents the practical and technical issues of ABPM, the use of this method in special situations, the clinical interpretation of measured values including the presentation of different ABPM patterns, derived parameters, the prognostic significance and the limitations of this method.

  13. A Postdoctoral Fellowship in Industrial Clinical Pharmacy Practice.

    Science.gov (United States)

    Barone, Joseph; And Others

    1985-01-01

    A postdoctoral pharmacy fellowship is described that provides training in industrial clinical pharmacy practice and related tasks associated with the development of new pharmaceuticals, through experience in industrial and hospital settings and in research projects. (MSE) PUBTYPE[141

  14. Ethics in Rehabilitation Counselor Supervision.

    Science.gov (United States)

    Blackwell, Terry L.; Strohmer, Douglas C.; Belcas, Eva M.; Burton, Kathryn A.

    2002-01-01

    Article is an exploration of some of the ethical issues facing rehabilitation counselors who provide clinical supervision. Ethical issues related to competence, evaluation and due process, dual relationships, confidentiality, and informed consent are discussed. (Contains 28references, 2 tables, and 1 appendix.) (Author)

  15. Nursing students' evaluation of quality indicators during learning in clinical practice.

    Science.gov (United States)

    Jansson, Inger; Ene, Kerstin W

    2016-09-01

    A supportive clinical learning environment is important for nursing students' learning. In this study, a contract between a county and a university involving a preceptor model of clinical education for nursing students is described. The aim of this study was to describe nursing students' clinical education based on quality indicators and to describe the students' experiences of what facilitated or hindered the learning process during their clinical practice. During autumn 2012 and spring 2013, 269 student evaluations with quantitative and qualitative answers were filled out anonymously. Quantitative data from the questionnaires concerning the quality indicators: Administration/information, Assessments/examinations and Reflection were processed to generate descriptive statistics that revealed gaps in what the preceptor model demands and what the students reported. The answers from the qualitative questions concerning the quality indicator Learning were analysed using content analysis. Four categories emerged: Independence and responsibility, continuity of learning, time, and the competence and attitudes of the staff. The study underlines that reflection, continuity, communication and feedback were important for the students' learning process, whereas heavy workload among staff and being supervised by many different preceptors were experienced as stressful and hindering by students. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. [Hypnotic communication and hypnosis in clinical practice].

    Science.gov (United States)

    Wehrli, Hans

    2014-07-02

    In addition to usual medical care it is often critical to consider the patient's inner world in order to sensitively differentiate between harmful and helpful suggestive elements. The respective abilities in terms of hypnotic communication can be easily learned. Confident, empathic attention and a calm, understanding and figurative language narrowing the focus on positive emotions and positive change, which have been shown to improve the patient's chances of healing, are of particular importance. Proper clinical hypnosis goes one step further: it makes explicit use of suggestions, trance, and trance phenomena. The major clinical indications for hypnosis include psychosomatic disorders, anxiety disorders, obsessive-compulsive disorders, depression, and pain syndromes. Hypnosis can also be employed as an adjunct for surgical therapy.

  17. Evaluating clinical dermatology practice in medical undergraduates.

    Science.gov (United States)

    Casanova, J M; Sanmartín, V; Martí, R M; Morales, J L; Soler, J; Purroy, F; Pujol, R

    2014-06-01

    The acquisition of competences (the set of knowledge, skills and attitudes required to perform a job to a professional level) is considered a fundamental part of medical training. Dermatology competences should include, in addition to effective clinical interviewing and detailed descriptions of skin lesions, appropriate management (diagnosis, differentiation, and treatment) of common skin disorders and tumors. Such competences can only be acquired during hospital clerkships. As a way of certifying these competences, we propose evaluating the different components as follows: knowledge, via clinical examinations or critical incident discussions; communication and certain instrumental skills, via structured workplace observation and scoring using a set of indicators; and attitudes, via joint evaluation by staff familiar with the student. Copyright © 2012 Elsevier España, S.L. and AEDV. All rights reserved.

  18. Risk management in clinical practice. Part 10. Periodontology.

    Science.gov (United States)

    Baker, P; Needleman, I

    2010-12-11

    A sizeable proportion of patients in clinical practice will have some form of periodontal disease and most of these patients can be well managed in primary care. Unfortunately, dento-legal claims regarding inappropriate periodontal care are increasing rapidly and are now one of the most common reasons for litigation in dentistry. In this paper we will look at aspects of contemporary management of periodontal disease in clinical practice and offer guidance for examination, management and referral.

  19. Literature and medicine: contributions to clinical practice.

    Science.gov (United States)

    Charon, R; Banks, J T; Connelly, J E; Hawkins, A H; Hunter, K M; Jones, A H; Montello, M; Poirer, S

    1995-04-15

    Introduced to U.S. medical schools in 1972, the field of literature and medicine contributes methods and texts that help physicians develop skills in the human dimensions of medical practice. Five broad goals are met by including the study of literature in medical education: 1) Literary accounts of illness can teach physicians concrete and powerful lessons about the lives of sick people; 2) great works of fiction about medicine enable physicians to recognize the power and implications of what they do; 3) through the study of narrative, the physician can better understand patients' stories of sickness and his or her own personal stake in medical practice; 4) literary study contributes to physicians' expertise in narrative ethics; and 5) literary theory offers new perspectives on the work and the genres of medicine. Particular texts and methods have been found to be well suited to the fulfillment of each of these goals. Chosen from the traditional literary canon and from among the works of contemporary and culturally diverse writers, novels, short stories, poetry, and drama can convey both the concrete particularity and the metaphorical richness of the predicaments of sick people and the challenges and rewards offered to their physicians. In more than 20 years of teaching literature to medical students and physicians, practitioners of literature and medicine have clarified its conceptual frameworks and have identified the means by which its studies strengthen the human competencies of doctoring, which are a central feature of the art of medicine.

  20. Characteristics and Clinical Practices of Rural Marriage and Family Therapists

    Science.gov (United States)

    Morris, James

    2007-01-01

    This report presents a subset of data collected from the American Association for Marriage and Family Therapy (AAMFT) Practice Research Network project conducted in 2002. A sample of 47 clinical members of AAMFT who indicated they practiced in a rural community provided descriptive information on demographic characteristics, training, clinical…

  1. Active Interventions in Clinical Practice: Contributions of Gestalt Therapy.

    Science.gov (United States)

    Lammert, Marilyn; Dolan, Mary M.

    1983-01-01

    Describes two dimensions of Gestalt therapy that can enhance clinical practice--orientation to the present and active-experimental style--and examines them in relation to some traditional principles of practice. Gestalt theory offers a method of discovery that is a combination of phenomenology and behaviorism. (JAC)

  2. Shared decision making: a model for clinical practice

    NARCIS (Netherlands)

    Elwyn, G.; Frosch, D.; Thomson, R.; Joseph-Williams, N.; Lloyd, A.; Kinnersley, P.; Cording, E.; Tomson, D.; Dodd, C.; Rollnick, S.; Edwards, A.; Barry, M.

    2012-01-01

    The principles of shared decision making are well documented but there is a lack of guidance about how to accomplish the approach in routine clinical practice. Our aim here is to translate existing conceptual descriptions into a three-step model that is practical, easy to remember, and can act as a

  3. Mandatory Clinical Practice for Dental and Dental Hygiene Faculty.

    Science.gov (United States)

    Cameron, Cheryl A.; And Others

    1982-01-01

    Dental and dental hygiene faculty should maintain their clinical skills through regular practice, to improve their ability to relate to students through instruction, provide an additional source of income, and improve their image in the community. Institutional policies fostering and regulating faculty practice plans are suggested. (Author/MSE)

  4. Shared decision making: a model for clinical practice

    NARCIS (Netherlands)

    Elwyn, G.; Frosch, D.; Thomson, R.; Joseph-Williams, N.; Lloyd, A.; Kinnersley, P.; Cording, E.; Tomson, D.; Dodd, C.; Rollnick, S.; Edwards, A.; Barry, M.

    2012-01-01

    The principles of shared decision making are well documented but there is a lack of guidance about how to accomplish the approach in routine clinical practice. Our aim here is to translate existing conceptual descriptions into a three-step model that is practical, easy to remember, and can act as a

  5. Evidence-based practice for the busy nurse practitioner: part one: relevance to clinical practice and clinical inquiry process.

    Science.gov (United States)

    Facchiano, Lynda; Snyder, Charlene Hoffman

    2012-10-01

    Evidence-based practice (EBP) continues to gain momentum within health care. The purpose of this four-part EBP series is to provide an introductory overview of the EBP process, emphasizing EBP steps one through three, in order to assist nurse practitioners (NPs) in building EBP skills that can be integrated into clinical practice. The relevance of EBP to the NP's clinical practice, an introduction to the EBP process steps, and clinical inquiry process begin the series. Scientific literature review, gray literature, and online evidence-based practice databases and resources. EBP has become increasingly important to NPs, yet there is evidence suggesting it is not being fully implemented in clinical practice. EBP is one way to keep the busy NP's knowledge up to date, enhance clinical judgment, and augment the existing provider-client decision-making process. The principles of EBP have become the cornerstone strategy for NPs to translate research findings into clinical practice. Practicing in an ever-changing healthcare environment, NPs have a responsibility to provide their clients with the best available evidence, while incorporating that evidence into the provider-client decision-making process. ©2012 The Author(s) Journal compilation ©2012 American Academy of Nurse Practitioners.

  6. [Impact of digital technology on clinical practices: perspectives from surgery].

    Science.gov (United States)

    Zhang, Y; Liu, X J

    2016-04-09

    Digital medical technologies or computer aided medical procedures, refer to imaging, 3D reconstruction, virtual design, 3D printing, navigation guided surgery and robotic assisted surgery techniques. These techniques are integrated into conventional surgical procedures to create new clinical protocols that are known as "digital surgical techniques". Conventional health care is characterized by subjective experiences, while digital medical technologies bring quantifiable information, transferable data, repeatable methods and predictable outcomes into clinical practices. Being integrated into clinical practice, digital techniques facilitate surgical care by improving outcomes and reducing risks. Digital techniques are becoming increasingly popular in trauma surgery, orthopedics, neurosurgery, plastic and reconstructive surgery, imaging and anatomic sciences. Robotic assisted surgery is also evolving and being applied in general surgery, cardiovascular surgery and orthopedic surgery. Rapid development of digital medical technologies is changing healthcare and clinical practices. It is therefore important for all clinicians to purposefully adapt to these technologies and improve their clinical outcomes.

  7. Clinical practice guideline: tonsillitis II. Surgical management.

    Science.gov (United States)

    Windfuhr, Jochen P; Toepfner, Nicole; Steffen, Gregor; Waldfahrer, Frank; Berner, Reinhard

    2016-04-01

    In 2013, a total of 84,332 patients had undergone extracapsular tonsillectomies (TE) and 11,493 a tonsillotomy (TT) procedure in Germany. While the latter is increasingly performed, the number of the former is continually decreasing. However, a constant number of approximately 12,000 surgical procedures in terms of abscess-tonsillectomies or incision and drainage are annually performed in Germany to treat patients with a peritonsillar abscess. The purpose of this part of the clinical guideline is to provide clinicians in any setting with a clinically focused multi-disciplinary guidance through the surgical treatment options to reduce inappropriate variation in clinical care, improve clinical outcome and reduce harm. Surgical treatment options encompass intracapsular as well as extracapsular tonsil surgery and are related to three distinct entities: recurrent episodes of (1) acute tonsillitis, (2) peritonsillar abscess and (3) infectious mononucleosis. Conservative management of these entities is subject of part I of this guideline. (1) The quality of evidence for TE to resolve recurrent episodes of tonsillitis is moderate for children and low for adults. Conclusions concerning the efficacy of TE on the number of sore throat episodes per year are limited to 12 postoperative months in children and 5-6 months in adults. The impact of TE on the number of sore throat episodes per year in children is modest. Due to the heterogeneity of data, no firm conclusions on the effectiveness of TE in adults can be drawn. There is still an urgent need for further research to reliably estimate the value of TE compared to non-surgical therapy of tonsillitis/tonsillo-pharyngitis. The impact of TE on quality of life is considered as being positive, but further research is mandatory to establish appropriate inventories and standardized evaluation procedures, especially in children. In contrast to TE, TT or comparable procedures are characterized by a substantially lower postoperative

  8. Serum amyloid a in clinical practice

    Directory of Open Access Journals (Sweden)

    Jovanović Dijana B.

    2004-01-01

    Full Text Available Serum amyloid A (SAA is an acute phase first class protein discovered a quarter of the century ago. Its concentration depends on clinical findings of the patient, illness activity and the therapy applied. SAA increases moderately to markedly (100-1000 mg/l in bacterial and fungal infections, invasive malignant diseases, tissue injuries in the acute myocardial infarction and autoimmune diseases such as rheumatoid arthritis and vasculitis. Mild elevation (10-100 mg/l is often seen in viral infections, systemic lupus erythematosus and localized inflammation or tissue injuries in cystitis and cerebral infarction. SAA as sensitive, non-invasive parameter is used in organ transplantation where early and correct diagnosis is needed as well as where prompt therapy is required. Besides acute kidney allograft rejection, SAA is used in the diagnosis of rejection after liver transplantation, simultaneous pancreas and kidney transplantation and also in bone marrow transplantation (acute „graft vs. host disease". Simultaneous determination of C-reactive protein (CRP and SAA may point to acute kidney allograft rejection. Standard immunosuppressive therapy with cyclosporine A and prednisolone significantly suppresses the acute phase CRP reaction both in operation itself and acute rejection, but not in infection. On the other hand, SAA rejection in operation, acute allograft rejection and infection is present in spite of cyclosporine A and steroids therapy. Different reaction of SAA and CRP in transplant patients to cyclosporine A therapy helps in differentiation between the infection and rejection. Although CRP and SAA are sensitive and acute phase reactants, their serum concentrations cannot be valued as prognostic and diagnostic criteria without creatinine serum concentration and clinical findings. In addition, they offer important information for clinical diagnosis as well as the kind of therapy.

  9. Clinical Activity in General Practice and Cancer

    DEFF Research Database (Denmark)

    Hjertholm, Peter

    2015-01-01

    BACKGROUND AND AIMS Cancer is a common, serious disease and early diagnosis is a cornerstone in the effort to improve the outcome from cancer disease. The general practitioner (GP) plays a crucial role in achieving this goal. Little is known about GPs’ suspicion of cancer and the activities the GPs...... institute in relation to such suspicion. Knowledge is also sparse on any effects of different diagnostic activities in general practice. The overall aims of this thesis were therefore: -to describe how often Danish GPs suspected cancer or other serious diseases and how they acted on the suspicion......, and to analyse how a suspicion influenced the demand for health care services and predicted a future diagnosis of serious disease - to investigate whether variation in GPs’ diagnostic activity influences cancer patients’ prognosis in relation to prostate-specific antigen (PSA) testing and prostate cancer...

  10. [Obsessions before Freud: history and clinical practice].

    Science.gov (United States)

    Huertas, Rafael

    2014-01-01

    The article analyses the significance of the concept of "obsession" in nineteenth-century alienism. From a clinical point of view, Esquirol's description was completed by other authors (Jules Falret, Legrand du Saulle). In the area of psychopathological studies, French alienism, with Morel's emotional delirium or Janet's psychasthenia, defended the emotional theory, as opposed to the intellectual disorder proposed by German doctors. Lastly, the importance of the cultural framework is stressed in the appearance of obsessive symptoms and their interpretation. Along these lines, the article discusses the relationship of religious scruples to melancholy or the appearance of diagnostic categories subject to fin de siècle codes and mentalities.

  11. A Supervision of Solidarity

    Science.gov (United States)

    Reynolds, Vikki

    2010-01-01

    This article illustrates an approach to therapeutic supervision informed by a philosophy of solidarity and social justice activism. Called a "Supervision of Solidarity", this approach addresses the particular challenges in the supervision of therapists who work alongside clients who are subjected to social injustice and extreme marginalization. It…

  12. Clinical Practice Guideline for Vitamin D

    Science.gov (United States)

    Tarver, William J.

    2013-01-01

    Vitamin D and its metabolites have clinical significance because they play a critical function in calcium homeostasis and bone metabolism. Although not all of the pathologic mechanisms have been adequately described, vitamin D insufficiency and deficiency, as measured by low levels of 25-OH vitamin D, are associated with a variety of clinical conditions including osteoporosis, falls and fractures in the elderly, decreased immune function, bone pain, and possibly colon cancer and cardiovascular health.2 Apart from inadequate dietary intake, patients may present with low levels of vitamin D if they receive inadequate sunlight. The astronaut population is potentially vulnerable to low levels of vitamin D for several reasons. Firstly, they may train for long periods in Star City, Russia, which by virtue of its northern latitude receives less sunlight in winter months. Secondly, astronauts are deprived of sunlight while aboard the International Space Station (ISS). In addition, ISS crew members are exposed to microgravity for prolonged durations and are likely to develop low bone mineral density despite the use of countermeasures. Therefore, closely monitoring and maintaining adequate vitamin D levels is important for the astronaut corps.

  13. Translating Regenerative Biomaterials Into Clinical Practice.

    Science.gov (United States)

    Stace, Edward T; Dakin, Stephanie G; Mouthuy, Pierre-Alexis; Carr, Andrew J

    2016-01-01

    Globally health care spending is increasing unsustainably. This is especially true of the treatment of musculoskeletal (MSK) disease where in the United States the MSK disease burden has doubled over the last 15 years. With an aging and increasingly obese population, the surge in MSK related spending is only set to worsen. Despite increased funding, research and attention to this pressing health need, little progress has been made toward novel therapies. Tissue engineering and regenerative medicine (TERM) strategies could provide the solutions required to mitigate this mounting burden. Biomaterial-based treatments in particular present a promising field of potentially cost-effective therapies. However, the translation of a scientific development to a successful treatment is fraught with difficulties. These barriers have so far limited translation of TERM science into clinical treatments. It is crucial for primary researchers to be aware of the barriers currently restricting the progression of science to treatments. Researchers need to act prospectively to ensure the clinical, financial, and regulatory hurdles which seem so far removed from laboratory science do not stall or prevent the subsequent translation of their idea into a treatment. The aim of this review is to explore the development and translation of new treatments. Increasing the understanding of these complexities and barriers among primary researchers could enhance the efficiency of biomaterial translation. © 2015 Wiley Periodicals, Inc.

  14. Present Status of Radiotherapy in Clinical Practice

    Science.gov (United States)

    Duehmke, Eckhart

    Aims of radiation oncology are cure from malignant diseases and - at the same time preservation of anatomy (e.g. female breast, uterus, prostate) and organ functions (e.g. brain, eye, voice, sphincter ani). At present, methods and results of clinical radiotherapy (RT) are based on experiences with natural history and radiobiology of malignant tumors in properly defined situations as well as on technical developments since World War II in geometrical and biological treatment planning in teletherapy and brachytherapy. Radiobiological research revealed tolerance limits of healthy tissues to be respected, effective total treatment doses of high cure probability depending on histology and tumor volume, and - more recently - altered fractionation schemes to be adapted to specific growth fractions and intrinsic radiosensitivities of clonogenic tumor cells. In addition, Biological Response Modifiers (BRM), such as cis-platinum, oxygen and hyperthermia may steepen cell survival curves of hypoxic tumor cells, others - such as tetrachiordekaoxid (TCDO) - may enhance repair of normal tissues. Computer assisted techniques in geometrical RT-planning based on individual healthy and pathologic anatomy (CT, MRT) provide high precision RT for well defined brain lesions by using dedicated linear accelerators (Stereotaxy). CT-based individual tissue compensators help with homogenization of distorted dose distributions in magna field irradiation for malignant lymphomas and with total body irradiation (TBI) before allogeneic bone marrow transplantation, e.g. for leukemia. RT with fast neutrons, Boron Neutron Capture Therapy (BNCT), RT with protons and heavy ions need to be tested in randomized trials before implementation into clinical routine.

  15. Lost in translation? Moving contingency management and cognitive behavioral therapy into clinical practice.

    Science.gov (United States)

    Carroll, Kathleen M

    2014-10-01

    In the treatment of addictions, the gap between the availability of evidence-based therapies and their limited implementation in practice has not yet been bridged. Two empirically validated behavioral therapies, contingency management (CM) and cognitive behavioral therapy (CBT), exemplify this challenge. Both have a relatively strong level of empirical support but each has weak and uneven adoption in clinical practice. This review highlights examples of how barriers to their implementation in practice have been addressed systematically, using the Stage Model of Behavioral Therapies Development as an organizing framework. For CM, barriers such as cost and ideology have been addressed through the development of lower-cost and other adaptations to make it more community friendly. For CBT, barriers such as relative complexity, lack of trained providers, and need for supervision have been addressed via conversion to standardized computer-assisted versions that can serve as clinician extenders. Although these and other modifications have rendered both interventions more disseminable, diffusion of innovation remains a complex, often unpredictable process. The existing specialty addiction-treatment system may require significant reforms to fully implement CBT and CM, particularly greater focus on definable treatment goals and performance-based outcomes.

  16. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for use of tumor markers in clinical practice

    DEFF Research Database (Denmark)

    Sturgeon, Catharine M; Hoffman, Barry R; Chan, Daniel W

    2008-01-01

    BACKGROUND: This report presents updated National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines summarizing quality requirements for the use of tumor markers. METHODS: One subcommittee developed guidelines for analytical quality relevant to serum and tissue-based tumor...

  17. A manifesto for clinical pharmacology from principles to practice.

    Science.gov (United States)

    Aronson, Jeffrey K

    2010-07-01

    1. This is a manifesto for UK clinical pharmacology. 2. A clinical pharmacologist is a medically qualified practitioner who teaches, does research, frames policy, and gives information and advice about the actions and proper uses of medicines in humans and implements that knowledge in clinical practice. Those without medical qualifications who practise some aspect of clinical pharmacology could be described as, say, 'applied pharmacologists'. 3. Clinical pharmacology is operationally defined as a translational discipline in terms of the basic tools of human pharmacology (e.g. receptor pharmacology) and applied pharmacology (e.g. pharmacokinetics) and how they are used in drug discovery and development and in solving practical therapeutic problems in individuals and populations. 4. Clinical pharmacologists are employed by universities, health-care services, private organizations (such as drug companies), and regulatory agencies. They are mentors and teachers, teaching laboratory science, clinical science, and all aspects of practical drug therapy as underpinned by the science of pharmacology; they write and edit didactic and reference texts; researchers, covering research described by the operational definition; clinicians, practising general medicine, clinical toxicology, other medical specialties, and general practice; policy makers, framing local, national, and international medicines policy, including formularies, licensing of medicines and prescribing policies. 5. The future of clinical pharmacology depends on the expansion and maintenance of a central core of practitioners (employed by universities or health-care services), training clinical pharmacologists to practise in universities, health-care services, private organizations, and regulatory agencies, and training other clinicians in the principles and practice of clinical pharmacology.

  18. Digoxin in clinical practice: sorting out the facts.

    Science.gov (United States)

    Doi, S A; Landless, P N

    1995-01-01

    The aim of this review is to sort out from the huge amount of facts related to digoxin in the literature those pertinent to current clinical practice. Seven aspects of digoxin are discussed: its mechanism of action, therapeutic controversy, clinical efficacy, avoidance of toxicity, manifestations of toxicity, indications, and its use in coronary artery disease.

  19. Improving Clinical Practices for Children with Language and Learning Disorders

    Science.gov (United States)

    Kamhi, Alan G.

    2014-01-01

    Purpose: This lead article of the Clinical Forum addresses some of the gaps that exist between clinical practice and current knowledge about instructional factors that influence learning and language development. Method: Topics reviewed and discussed include principles of learning, generalization, treatment intensity, processing interventions,…

  20. Conducting research in clinical psychology practice: Barriers, facilitators, and recommendations.

    Science.gov (United States)

    Smith, Kirsten V; Thew, Graham R

    2017-09-01

    The combination of clinical psychologists' therapeutic expertise and research training means that they are in an ideal position to be conducting high-quality research projects. However, despite these skills and the documented benefits of research to services and service users, research activity in practice remains low. This article aims to give an overview of the advantages of, and difficulties in conducting research in clinical practice. We reviewed the relevant literature on barriers to research and reflected on our clinical and research experiences in a range of contexts to offer practical recommendations. We considered factors involved in the planning, sourcing support, implementation, and dissemination phases of research, and outline suggestions to improve the feasibility of research projects in post-qualification roles. We suggest that research leadership is particularly important within clinical psychology to ensure the profession's continued visibility and influence within health settings. Clinical implications Emerging evidence suggests that clinical settings that foster research are associated with better patient outcomes. Suggestions to increase the feasibility of research projects in clinical settings are detailed. Limitations The present recommendations are drawn from the authors' practical experience and may need adaptation to individual practitioners' settings. This study does not attempt to assess the efficacy of the strategies suggested. © 2017 The Authors. British Journal of Clinical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.

  1. The importance of fluid balance in clinical practice.

    Science.gov (United States)

    Scales, Katie; Pilsworth, Julie

    This article reviews the physiology that underpins normal fluid balance and discusses how fluid balance can be affected by illness. Clinical assessment of hydration and the importance of fluid balance record keeping are explained. Recommendations are made to improve fluid balance management in clinical practice and the professional importance of record keeping is highlighted.

  2. Smartphones in Clinical Nursing Practice: A Multiphased Approach to Implementation and Deployment

    Science.gov (United States)

    Johnson, Brad; Davison, C. J.; Moralejo, Lisa

    2013-01-01

    Students in the undergraduate nursing program at the University of Calgary-Qatar are required to work with patients in clinical settings under faculty supervision. One of the main goals of clinical courses is to provide students with the opportunity to learn in context and "just-in-time," a much more realistic and memorable learning…

  3. NEUROSYPHILIS IN THERAPEUTIC PRACTICE: CLINICAL OBSERVATION

    Directory of Open Access Journals (Sweden)

    N. A. Shostak

    2017-01-01

    Full Text Available Objective: to describe a clinical case of neurosyphilis diagnosed in a therapeutic inpatient facility.Materials and methods. Female patient T., 61, was hospitalized in the therapeutic department of a general hospital with referral diagnosis of “Stage II hypertensive heart disease, risk 4. Hypertensive crisis of 03.12.2015” with complaints of general fatigue, episodes of transient memory loss with full recovery, unstable blood pressure level. The patient was examined: She underwent treponemal and nontreponemal serological tests for antibodies against Treponema рallidum, hepatitis, human immunodeficiency virus; electrocardiogram; angiography of carotid and vertebral arteries; magnetic resonance imaging (MRI  of the brain with contrast; serological and microscopic examinations of the cerebrospinal fluid (CSF.Results. The patient»s medical history described episodes of transient global amnesia with full memory recovery, more frequent in the last year; arterial hypertension; chronic urinary tract infection; and chronic cholecystitis with frequent courses of antibacterial therapy (ceftriaxone. Since 1986, a positive serological reaction for syphilis was observed (Wassermann reaction (WR +++ due to a history of primary syphilis. Considering reliable history of syphilis, positive serum confirmation tests for syphilis (nontreponemal: rapid plasma reagin test 3+; treponemal: passive hemagglutination reaction 4+, antibodies against T. pallidum (total – present, history of neuropsychological symptoms (transient amnesia and acute neurological symptoms before hospitalization (transient ischemic attack, brain MRI data (2 lesions of cerebral circulation disorders of ischemic type in the cortical branches of left and right mesencephalic arteries, a diagnosis of neurosyphilis was proposed, and lumbar puncture was performed for confirmation. Inflammatory characteristics of the CSF (cytosis 19/3, neutrophilia up to 12 cells, insignificant lymphocytosis up

  4. Portal of Clinical Practice Guidelines: Digital Strategy for the Dissemination of Clinical Practice Guidelines Developed in Colombia

    OpenAIRE

    Suárez Obando, Fernando; Médico, MSc. Miembro del Departamento de Epidemiología y Bioestadística, así como del Instituto de Genética Humana, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia.; Gómez Restrepo, Carlos; Médico MSc. Miembro del Departamento de Epidemiología y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia.; Camacho Sánchez, Jhon Jairo; MSc. Miembro del Departamento de Epidemiología y Bioestadística Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia.; De La Hoz Bradford, Ana Maria; Médico MSc. Miembro del Departamento de Epidemiología y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia.; Ruiz Morales, Álvaro; Médico MSc. Miembro del Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia.; Maldonado Rivera, Patricia; Médico. Miembro del Departamento de Epidemiología y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia.; López, Pilar; Médico. Miembro del Departamento de Epidemiología y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia.

    2016-01-01

    Introduction: In response to the necessity of concise,accurate and practical information to supportclinical decision making, the Colombian government,in partnership with universities and scientificsocieties, has heavily invested in the developmentof clinical practice guidelines (CPG). Objectives:To develop a Web portal for the dissemination andcommunication of CPG and its clinical recommendations.Methodology: Development of the ColombianGPC web portal based on the principlesof adult learning,...

  5. Applying HIV testing guidelines in clinical practice.

    Science.gov (United States)

    Mahoney, Megan R; Fogler, Jess; Weber, Shannon; Goldschmidt, Ronald H

    2009-12-15

    An estimated one fourth of persons with human immunodeficiency virus (HIV) are not aware they are infected. Early diagnosis of HIV has the potential to ensure optimal outcomes for infected persons and to limit the spread of the virus. Important barriers to testing among physicians include insufficient time, reimbursement issues, and lack of patient acceptance. Current HIV testing guidelines address many of these barriers by making the testing process more streamlined and less stigmatizing. The opt-out consent process has been shown to improve test acceptance. Formal pretest counseling and written consent are no longer recommended by the Centers for Disease Control and Prevention. Nevertheless, pretest discussions provide an opportunity to give information about HIV, address fears of discrimination, and identify ongoing high-risk activities. With increased HIV screening in the primary care setting, more persons with HIV could be identified earlier, receive timely and appropriate care, and get treatment to prevent clinical progression and transmission.

  6. Clinical practice: swallowing problems in cerebral palsy.

    Science.gov (United States)

    Erasmus, Corrie E; van Hulst, Karen; Rotteveel, Jan J; Willemsen, Michel A A P; Jongerius, Peter H

    2012-03-01

    Cerebral palsy (CP) is the most common physical disability in early childhood. The worldwide prevalence of CP is approximately 2-2.5 per 1,000 live births. It has been clinically defined as a group of motor, cognitive, and perceptive impairments secondary to a non-progressive defect or lesion of the developing brain. Children with CP can have swallowing problems with severe drooling as one of the consequences. Malnutrition and recurrent aspiration pneumonia can increase the risk of morbidity and mortality. Early attention should be given to dysphagia and excessive drooling and their substantial contribution to the burden of a child with CP and his/her family. This review displays the important functional and anatomical issues related to swallowing problems in children with CP based on relevant literature and expert opinion. Furthermore, based on our experience, we describe a plan for approach of investigation and treatment of swallowing problems in cerebral palsy.

  7. [Clinical presentation of tuberculosis in routine practice].

    Science.gov (United States)

    Dinser, R; Frerix, M; Müller-Ladner, U

    2012-10-01

    Since the beginning of the biologics era tuberculosis is known to be a potential life-threatening complication during treatment of patients with rheumatic diseases. National and international societies have developed recommendations for tuberculosis screening and treatment of patients at risk for development of tuberculosis. Owing to the relative rareness of overt tuberculosis in patients with rheumatic diseases, the experience of individual rheumatologists with this complication is limited. Therefore, we have analyzed the tuberculosis cases from 2006-2011 in our rheumatology referral center (treating more than 1,500 inpatient and 8,000 outpatient cases every year) to obtain a real-life picture more than 10 years after initiation of the first application of biologics outside of controlled clinical trials. We identified 4 cases that illustrate the difficulties of diagnosis and treatment.

  8. Neuroleptic malignant syndrome in clinical practices

    Directory of Open Access Journals (Sweden)

    Bugarinović Snežana M.

    2016-01-01

    Full Text Available Topic: Neuroleptic Malignant Syndrome is a rare but specific lethal reaction to neuroleptics / antipsychotics.It occurs in 0.02% to 3.3% of patients in the treatment applying conventional neuroleptic drugs. Neuroleptic malignant syndrome is associated with highly potent antipsychotic drugs. However, it can occur more frequently in patients treated with atypical antipsychotics such as clozapine. Topic position in medical public: Neuroleptic malignant syndrome is critical medical condition, potentially threatening complication associated with side effects of neuroleptic drugs. High levels of creatine kinase (CK and leukocytosis are associated with neuroleptic malignant syndrome. Future action: Neuroleptic malignant syndrome as a psychiatric entity requires permanent research, early diagnosis, adequate therapy, exchange of clinical experiences, and what's of particular importance, rational antipsychotic administration.

  9. Communication course for midwives teaching students in clinical practice

    DEFF Research Database (Denmark)

    Nielsen, Annegrethe; Pedersen, Pernille Mølholt

    2016-01-01

    BACKGROUND The course was initiated by the midwifery department at University College North Denmark in cooperation with the leaders of the maternity units where the affiliated students have their clinical education. The purpose of the course was to enhance the quality of communication education......-clinically (Rosenbaum et al. 2013) and our own experience teaching Danish midwifery students indicates the same problem in our program. Providing an opportunity for the clinical teachers to learn, discuss and practice communication issues with each other and with theoretical teachers can represent an important...... taking place in clinical practice and try to align the educational efforts in school and clinical settings for the benefit of the students PERSPECTIVES It is known that students in medical education find that clinical learning experiences do not reinforce the communication skills they learn pre...

  10. The role of MRI in musculoskeletal practice: a clinical perspective

    Science.gov (United States)

    Dean Deyle, Gail

    2011-01-01

    This clinical perspective presents an overview of current and potential uses for magnetic resonance imaging (MRI) in musculoskeletal practice. Clinical practice guidelines and current evidence for improved outcomes will help providers determine the situations when an MRI is indicated. The advanced competency standard of examination used by physical therapists will be helpful to prevent overuse of musculoskeletal imaging, reduce diagnostic errors, and provide the appropriate clinical context to pathology revealed on MRI. Physical therapists are diagnostically accurate and appropriately conservative in their use of MRI consistent with evidence-based principles of diagnosis and screening. PMID:22851878

  11. Exploring accountability of clinical ethics consultants: practice and training implications.

    Science.gov (United States)

    Weise, Kathryn L; Daly, Barbara J

    2014-01-01

    Clinical ethics consultants represent a multidisciplinary group of scholars and practitioners with varied training backgrounds, who are integrated into a medical environment to assist in the provision of ethically supportable care. Little has been written about the degree to which such consultants are accountable for the patient care outcome of the advice given. We propose a model for examining degrees of internally motivated accountability that range from restricted to unbounded accountability, and support balanced accountability as a goal for practice. Finally, we explore implications of this model for training of clinical ethics consultants from diverse academic backgrounds, including those disciplines that do not have a formal code of ethics relating to clinical practice.

  12. [Malignant biliary obstruction, general review and clinical practice].

    Science.gov (United States)

    Bonnel, Didier; André, Thierry; Mader, Benoît; Lefebvre, Jean-François; Bensoussan, Emmanuel; Liguory, Claude

    2013-05-01

    This review recalls the clinical, anatomic, physiopathological and etiological features necessary in the management of patients with neoplastic bile duct obstruction and exposes the current practice concerning endoscopic and radiologic palliative drainage. Clinical practice according to the clinical situations is explained. This review exposes complications management for patients having undergone an endoscopic or percutaneous drainage of the biliary ducts, the particular case of periportal stenosis, the respective indications of endoscopic and transhepatic percutaneous drainage, usual immediate evolution according to the type of the stenosis and the technique used as well as the management in case of stent obstruction.

  13. NHS Lanarkshire's leadership development programme's impact on clinical practice.

    Science.gov (United States)

    Sutherland, Angela M; Dodd, Frances

    2008-01-01

    The purpose of this paper is to explore the effect of a clinical leadership programme on senior clinicians within National Health Service Lanarkshire, in terms of key constituents for fostering leadership development, specific skills developed and impact this has had on clinical practice. A qualitative research design was employed over several stages, involving 44 senior clinical managers, with member validation substantiating findings and thematic analysis used to analyse data collected. The programme's impact was evident in acknowledged change to participants' attitude, behaviour and performance with examples conveyed to demonstrate both the effect on clinical practice and perceived organisational benefits gained. The use of role play, scenario planning and enquiry-based learning approaches were deemed critical in achieving such change. Time constraints merited two different cohorts being examined simultaneously during the various stages of the programme. A longitudinal study is underway encompassing the evaluations of several cohorts through various stages of the programme to enable time-based comparisons to be made and enhance the rigour and scrutiny of the programme's impact on clinical practice. The paper is foremost in determining structure and processes employed on the programme, specific leadership skills developed, subsequent effect on clinical practice and perceived organisational benefits gained but not necessarily contemplated by staff prior to embarking on the programme, such as the emergence of communities of practice.

  14. Opinions of Japanese rheumatology physicians regarding clinical practice guidelines.

    Science.gov (United States)

    Higashi, Takahiro; Nakayama, Takeo; Fukuhara, Shunichi; Yamanaka, Hisashi; Mimori, Tsuneyo; Ryu, Junnosuke; Yonenobu, Kazuo; Murata, Norikazu; Matsuno, Hiroaki; Ishikawa, Hajime; Ochi, Takahiro

    2010-04-01

    To examine the views of rheumatology physicians concerning clinical practice guidelines in Japan, and changes to them following the dissemination of new guidelines for rheumatoid arthritis (RA) in 2004. Two cross-sectional questionnaire surveys, the first conducted before publication of new evidence-based RA clinical practice guidelines and the second conducted after implementation. Rheumatology-focused practices in Japan. A random sample of physicians registered with the Japan Rheumatism Foundation who satisfied the registration criteria with regard to experience with RA care. The percentage of guideline users increased from 48 to 60% following publication of the new RA guidelines in 2004 (P < 0.01). The majority agreed that clinical practice guidelines support decision-making in practice, although the proportion of supportive responses decreased slightly in the second survey, from 83 to 77% (P < 0.01) for decision-making, while concern about restricting physician autonomy increased from 18 to 22% (P = 0.01). While only 39% of physicians felt that clinical practice guidelines would contribute to malpractice litigation, the proportion of physicians who were concerned that clinical practice guidelines would be used to bring legal action against providers was larger than that who expected they would defend providers (58 vs 30%, P < 0.001). Clinical practice guidelines are well accepted among Japanese rheumatology physicians, albeit that the proportion decreased slightly after the introduction of new guidelines. One reason for this may be concern about the use of the guidelines in malpractice litigation. To facilitate implementation, trends in physician support for the guidelines should be closely monitored.

  15. Good supervision and PBL

    DEFF Research Database (Denmark)

    Otrel-Cass, Kathrin

    This field study was conducted at the Faculty of Social Sciences at Aalborg University with the intention to investigate how students reflect on their experiences with supervision in a PBL environment. The overall aim of this study was to inform about the continued work in strengthening supervision...... at this faculty. This particular study invited Master level students to discuss: • How a typical supervision process proceeds • How they experienced and what they expected of PBL in the supervision process • What makes a good supervision process...

  16. Truth telling in medical practice: students' opinions versus their observations of attending physicians' clinical practice.

    Science.gov (United States)

    Tang, Woung-Ru; Fang, Ji-Tseng; Fang, Chun-Kai; Fujimori, Maiko

    2013-07-01

    Truth telling or transmitting bad news is a problem that all doctors must frequently face. The purpose of this cross-sectional study was to investigate if medical students' opinions of truth telling differed from their observations of attending physicians' actual clinical practice. The subjects were 275 medical clerks/interns at a medical center in northern Taiwan. Data were collected on medical students' opinions of truth telling, their observations of physicians' clinical practice, students' level of satisfaction with truth telling practiced by attending physicians, and cancer patients' distress level when they were told the truth. Students' truth-telling awareness was significantly higher than the clinical truth-telling practice of attending physicians (ptruth telling of attending physicians (mean ± SD=7.33 ± 1.74). However, our data also show that when cancer patients were informed of bad news, they all experienced medium to above average distress (5.93 ± 2.19). To develop the ability to tell the truth well, one must receive regular training in communication skills, including experienced attending physicians. This study found a significant difference between medical students' opinions on truth telling and attending physicians' actual clinical practice. More research is needed to objectively assess physicians' truth telling in clinical practice and to study the factors affecting the method of truth telling used by attending physicians in clinical practice. Copyright © 2012 John Wiley & Sons, Ltd.

  17. Daptomycin, a lipopeptide antibiotic in clinical practice.

    Science.gov (United States)

    Weis, Florian; Beiras-Fernandez, Andres; Schelling, Gustav

    2008-08-01

    Gram-positive cocci are one of the leading causes of infections in clinical medicine. Since the invention of antibiotic substances, multidrug resistance is a major problem in the treatment of such infections. Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for 60% of nosocomial infections in the US. The first-choice drug used in these cases is the glycopeptide vancomycin; however, vancomycin is associated with a significant number of adverse side effects, such as nephro- and ototoxicity. Thus, the discovery of new drugs against MRSA and other multidrug-resistant cocci is of utmost interest. Daptomycin, a lipopeptide, is one of these new drugs and has been successfully used in the treatment of complicated skin and skin-structure infections and right-sided endocarditis. Because of its potency and pharmacological profile, it is increasingly used for new indications not yet approved by the FDA. The purpose of this article is to provide an overview of daptomycin, with particular emphasis on potential new indications for which it could be used in the future.

  18. Clinical practice: Obstructive renal candidiasis in infancy.

    Science.gov (United States)

    Bisht, Veena; Voort, Judith VanDer

    2011-10-01

    Renal candidiasis is an increasingly common condition affecting predominantly premature infants receiving neonatal intensive care or term infants with urogenital tract anomalies. Multiple risk factors are usually present. Although rare, some infants develop an obstructive uropathy due to fungal balls, and this requires prompt detection and intervention to preserve kidney function. The management of obstructive renal bezoars is challenging and not well summarised in the past. This is mainly due to scarce literature confined to case reports or case series only. This review clarifies various definitions used in relation to renal candidiasis and identifies infants particularly at risk of obstruction. Clinical presentation, diagnosis and the role of imaging are discussed. A summary of the recent literature is provided to outline the range of existing treatment options available with published drug dosages and mode of delivery used. No single approach is successful in all cases and clinicians need to be aware of the different options available: apart from adequate urinary drainage and use of systemic +/- local antifungal agents, additional treatment with fibrinolytic agents and/or endoscopic or open surgical removal may be required. A new simplified algorithm for use in management is proposed. We hope this review will help clinicians in their management of patients presenting with this complex and challenging diagnosis.

  19. Classroom Supervision and Informal Analysis of Behavior. A Manual for Supervision.

    Science.gov (United States)

    Hull, Ray; Hansen, John

    This manual for supervision addresses itself to those with responsibility for helping teachers develop into skilled professionals through use of a rational plan of feedback and assistance. It describes the supervision cycle and outline simple and practical techniques to collect effective data that will assist the classroom teacher. The manual has…

  20. The practice of clinical chemistry in the European Union.

    Science.gov (United States)

    Sanders, Gerard T; Beastall, Graham H; Kohse, Klaus P; Zérah, Simone; Jansen, Rob; Köller, Ursula; Blaton, Vic; Lund, Erik; Parviainen, Markku; Charret, Jo; Gurr, Eberhard; Nicholou, Hara; Kenny, Desmond; Pazzagli, Mario; Opp, Matthias; Willems, Hans; Martins, Maria do Carmo; Queraltó, José M; Landin, Britta; Yu, Anna; McMurray, Janet

    2002-02-01

    The European Communities Confederation of Clinical Chemistry has been actively engaged in raising the level of clinical chemistry in the European Union. Closer contacts between the national societies for clinical chemistry have resulted in more comparable programs for postgraduate training of clinical chemists, closer similarity of contents and practice of the profession in the different countries, and the official registration of professionals. This article reviews some of the characteristics of professional organisation, practice, and regulation in the fifteen European Union countries. Many similarities appear. In half of the countries microbiology, blood-banking and transfusion medicine fall within the domain of clinical chemistry. The minimum number of years for training (university and postgraduate) is eight, but in practice this will extend to 10 or more years. Official regulation of the profession by law exists in a minority of countries. Continuing education and re-registration have not been officially instituted yet in any country, but these issues will be the next steps forward. In those countries that prepare themselves for entering the European Union, training and practice of clinical chemistry are moving towards the common standards of the European Communities Confederation of Clinical Chemistry.

  1. Clients' Views of Live Supervision and Satisfaction with Therapy.

    Science.gov (United States)

    Locke, Lisa D.; McCollum, Eric E.

    2001-01-01

    Examines clients' perceptions of live supervision and their satisfaction with therapy in a university-based training clinic for marriage and family therapists. Results indicate that clients were generally satisfied with therapy and found the live-supervision process satisfactory as long as the perceived helpfulness of live supervision outweighed…

  2. Does Live Supervision Make a Difference? A Multilevel Analysis

    Science.gov (United States)

    Silverthorn, Brandon C.; Bartle-Haring, Suzanne; Meyer, Kevin; Toviessi, Paula

    2009-01-01

    While the benefit of live supervision on clinical training is largely unquestioned, research that examines how live supervision affects the therapeutic process is lacking. Although marriage and family therapy has embraced this method of supervision, there is little empirical evidence suggesting it "works." This study uses hierarchical linear…

  3. Integrating Creativity into Supervision Using Bernard's Discrimination Model

    Science.gov (United States)

    Koltz, Rebecca L.

    2008-01-01

    Clinical supervision is an important aspect of counselor education. Much of traditional supervision is conducted from a logical standpoint; however, some supervisees may be better served when supervisors integrate both logic and creativity. This article presents the integration of creative activities into supervision using Bernard's Discrimination…

  4. [Scientific, practical and educational aspects of clinical epidemiology].

    Science.gov (United States)

    Briko, N I

    2012-01-01

    This article defines clinical epidemiology and describes its goal and objectives. The author claims that clinical epidemiology is a section of epidemiology which underlies the development of evidence-based standards for diagnostics, treatment and prevention and helps to select the appropriate algorithm for each clinical case. The study provides a comprehensive overview of the relationship between clinical epidemiology and evidence-based medicine. Epidemiological research is shown to be methodological basis of clinical epidemiology and evidence-based medicine with randomized controlled trials being the "gold standard" for obtaining reliable data. The key stages in the history of clinical epidemiology are discussed and further development of clinical epidemiology and the integration of courses on clinical epidemiology in education is outlined for progress in medical research and health care practice.

  5. Modified PIOPED criteria used in clinical practice.

    Science.gov (United States)

    Freitas, J E; Sarosi, M G; Nagle, C C; Yeomans, M E; Freitas, A E; Juni, J E

    1995-09-01

    To assess the use of modified PIOPED scintigraphic criteria for lung scan (V/Q) interpretation to detect pulmonary embolism (PE), we prospectively applied these criteria in suspected PE patients referred for V/Q from 9/1/92 to 2/7/94. PIOPED criteria were modified by placing a moderate segmental perfusion mismatch in the intermediate instead of low probability of PE category and using the "stripe sign." Patients were studied by six-view V/Q imaging using 74 MBq (2 mCi) 99mTc-MAA followed by 148-370 MBq (4-10 mCi) 99mTc-DTPA aerosol, contrast pulmonary selective angiography and Doppler sonography with leg compression as needed. Patients underwent follow-up (mean 13.9 mo) to detect subsequent thromboembolic events. In this study group, 1000 patients were studied by V/Q followed by angiography in 133 patients. The distribution of V/Q-assigned PE probabilities was: high probability 5.7%, intermediate 17.4%, low 41.4% and normal 35.5%. Group A patients (133) underwent angiography, which resulted in the determination of a 27.1% PE prevalence. Group B patients (867) did not have angiograms; the clinical prevalence of PE was 7.5%. In the total study population, the positive predictive value of a high probability V/Q study for PE (10.1% prevalence) was 98.2%, intermediate probability V/Q study for PE was 24.1% and a low probability study for PE was only 0.5%. Modified PIOPED V/Q interpretation criteria afford better angioproven PE discrimination between intermediate (31.8% PE prevalence) and low (5.5% PE prevalence) probability V/Q results than reported for PIOPED intermediate (32.6% PE prevalence) and low (16.3% PE prevalence) probability V/Q interpretation criteria.

  6. Practice standards for quality clinical decision-making in nursing.

    Science.gov (United States)

    Arries, E

    2006-03-01

    The purpose of this study is to formulate practice standards for quality clinical decision-making in nursing. Clinical decision-making is a critical component of nursing practice, as the life of the patient is at stake. The quality of clinical decision-making is, therefore, essential in delivering quality nursing care. The facilitation of quality clinical decision-making in nursing requires the development of standards to monitor, evaluate and implement remedial actions that improve on the quality of clinical decision-making (Muller, 2002:203; Beyea & Nicoll, 1999: 495). However, there are no such practice standards against which the quality of clinical decision-making by nurses can be evaluated and assessed. A qualitative, explorative, descriptive and standard formulation research design (Mouton & Marais, 1990:45-46; Muller, 1990:49-55) has been followed to develop standards for quality clinical decision-making in nursing. Standard development was based on the principles described by Muller (in Booyens, 1998: 607-608; 636-637), and consists of development and quantification phases that are modified to meet the requirements for instrument development, as described by Lynn (1986: 382-385). The formulation of these practice-standards was derived deductively from a conceptual framework. The conceptual framework was constructed based on an exploration and description of the expectations of the stakeholders about quality clinical decision-making in nursing and a literature study on clinical decision-making. To ensure the credibility of the standards for clinical decision-making in nursing, principles of logic, prolonged engagement, triangulation, peer-group discussion, dense description, step-wise repetition and an investigative audit (Lincoln & Guba, 1985:289-331) were adhered to. Two experts were consulted to validate the standards for quality clinical decision-making in nursing.

  7. Practice standards for quality clinical decision-making in nursing

    Directory of Open Access Journals (Sweden)

    E Arries

    2006-09-01

    Full Text Available The purpose of this study is to formulate practice standards for quality clinical decision making in nursing. Clinical decision-making is a critical component of nursing practice, as the life of the patient is at stake. The quality of clinical decision-making is, therefore, essential in delivering quality nursing care. The facilitation of quality clinical decision-making in nursing requires the development of standards to monitor, evaluate and implement remedial actions that improve on the quality of clinical decision-making (Muller, 2002:203; Beyea & Nicoll, 1999:495. However, there are no such practice standards against which the quality of clinical decision-making by nurses can be evaluated and assessed. A qualitative, explorative, descriptive and standard formulation research design (Mouton & Marais, 1990:45-46; Muller, 1990:49-55 has been followed to develop standards for quality clinical decision-making in nursing. Standard development was based on the principles described by Muller (in Booyens, 1998:607-608; 636-637, and consists of development and quantification phases that are modified to meet the requirements for instrument development, as described by Lynn (1986:382-385. The formulation of these practice-standards was derived deductively from a conceptual framework. The conceptual framework was constructed based on an exploration and description of the expectations of the stakeholders about quality clinical decisionmaking in nursing and a literature study on clinical decision-making. To ensure the credibility of the standards for clinical decision-making in nursing, principles of logic, prolonged engagement, triangulation, peer-group discussion, dense description, stepwise repetition and an investigative audit (Lincoln & Guba, 1985:289-331 were adhered to. Two experts were consulted to validate the standards for quality clinical decisionmaking in nursing.

  8. DYNAMICALLY EVOLVING CLINICAL PRACTICES AND IMPLICATIONS FOR PREDICTING MEDICAL DECISIONS

    Science.gov (United States)

    CHEN, JONATHAN H; GOLDSTEIN, MARY K; ASCH, STEVEN M; ALTMAN, RUSS B

    2015-01-01

    Automatically data-mining clinical practice patterns from electronic health records (EHR) can enable prediction of future practices as a form of clinical decision support (CDS). Our objective is to determine the stability of learned clinical practice patterns over time and what implication this has when using varying longitudinal historical data sources towards predicting future decisions. We trained an association rule engine for clinical orders (e.g., labs, imaging, medications) using structured inpatient data from a tertiary academic hospital. Comparing top order associations per admission diagnosis from training data in 2009 vs. 2012, we find practice variability from unstable diagnoses with rank biased overlap (RBO)0.6. Predicting admission orders for future (2013) patients with associations trained on recent (2012) vs. older (2009) data improved accuracy evaluated by area under the receiver operating characteristic curve (ROC-AUC) 0.89 to 0.92, precision at ten (positive predictive value of the top ten predictions against actual orders) 30% to 37%, and weighted recall (sensitivity) at ten 2.4% to 13%, (P<10−10). Training with more longitudinal data (2009-2012) was no better than only using recent (2012) data. Secular trends in practice patterns likely explain why smaller but more recent training data is more accurate at predicting future practices. PMID:26776186

  9. Can surveying practitioners about their practices help identify priority clinical practice guideline topics?

    Directory of Open Access Journals (Sweden)

    Chambers Alexandra

    2003-12-01

    Full Text Available Abstract Background Clinical practice guidelines are systematically developed statements designed to assist in patient and physician clinical decision making for specific clinical circumstances. In order to establish which guideline topics are priorities, practitioners were surveyed regarding their current practice. Methods One hundred ninety-seven practitioners in Ontario, Canada were mailed a survey exploring their current practice or opinion regarding the prophylactic use of anticonvulsant drugs in patients with malignant glioma who had never had a seizure. The survey consisted of seven questions regarding the relevance of a guideline on the subject to the practitioner's practice, the proportion of clinical cases involving anticonvulsant use, knowledge of existing guidelines on this topic, interest in reviewing a completed practice guideline and three clinical scenarios. Results There were 122 respondents who returned the survey (62% rate of return. Eighty percent of the practitioners who responded indicated that less than 25% of their clinical cases involved the use of anticonvulsants; however, only 16% of respondents indicated that a practice guideline would be irrelevant to their practice. Eighty percent of respondents volunteered to review a draft version of a practice guideline on the use of anticonvulsants. The survey presented the practitioners with three scenarios where anticonvulsants in patients with brain tumours may be appropriate: peri-operatively in patients without seizures, postoperatively in patients currently using anticonvulsants, and thirdly in patients not currently using anticonvulsants or undergoing surgery. In contrast to the third situation, the first two situations yielded considerable variation in practitioner response. Conclusion The survey established that there is some variation present in the current practice of anticonvulsant use in the patients with brain tumours. Whether there is an optimal treatment practice

  10. Reexamination of the ethics of placebo use in clinical practice.

    Science.gov (United States)

    Asai, Atsushi; Kadooka, Yasuhiro

    2013-05-01

    A placebo is a substance or intervention believed to be inactive, but is administered by the healthcare professional as if it was an active medication. Unlike standard treatments, clinical use of placebo usually involves deception and is therefore ethically problematic. Our attitudes toward the clinical use of placebo, which inevitably includes deception or withholding information, have a tremendous effect on our practice regarding truth-telling and informed consent. A casual attitude towards it weakens the current practice based on shared decision-making and mutual trust between patients and healthcare professionals. Issues concerning the clinical use of placebo are thus intimately related to patient-provider relationships, the public's trust in medicine, and medical education. A review of recent survey studies suggests that the clinical use of placebo appears to be fairly well accepted among healthcare professionals and is common in clinical settings in various countries. However, we think that an ethical discussion is urgently needed because of its controversial nature. If judged to be ethically wrong, the practice should end. In the present paper, we discuss the ethicality of the clinical use of placebo with deception and argue against it, concluding that it is unethical and should be banned. We will show that most arguments in favor of the clinical use of placebo can be refuted and are therefore incorrect or weak. These arguments will be presented and examined individually. Finally, we will briefly consider issues relevant to the clinical use of placebo without deception.

  11. Academic physiatry. Balancing clinical practice and academic activities.

    Science.gov (United States)

    Grabois, M

    1992-04-01

    The need for continued and diversified growth of both scholarly and clinical activities within academic physical medicine and rehabilitation (PM&R) departments is discussed with reference to the demands placed on academic departments by the various components of their mission, such as administration, clinical service, education and research. The expansion and improvement of clinical services should include the following components: program development, resources needed, finances required and marketing. Clinical subspecialization of faculty and solid affiliation with nonacademic hospitals and rehabilitation facilities is essential for academic PM&R. The faculty should include three categories: clinical faculty, clinical-research faculty and research faculty. Adequate financial resources must comprise an appropriate balance of academic funds, clinical income and grant sources. Clinical funds will play a greater role as other sources of funds diminish. Any practice plan must recognize the equality of the differing faculty members' practices, whether their interests are clinical, educational or research-oriented. The expansion and intensification of clinical programs by academy PM&R departments could increase competition in the medical community. Sensitivity to the perceptions of other practitioners and institutions, careful planning and cooperation will help the field grow and improve levels of care for the patients we serve in light of the changing medical care environment.

  12. Logic Learning Machine and standard supervised methods for Hodgkin's lymphoma prognosis using gene expression data and clinical variables.

    Science.gov (United States)

    Parodi, Stefano; Manneschi, Chiara; Verda, Damiano; Ferrari, Enrico; Muselli, Marco

    2016-06-27

    This study evaluates the performance of a set of machine learning techniques in predicting the prognosis of Hodgkin's lymphoma using clinical factors and gene expression data. Analysed samples from 130 Hodgkin's lymphoma patients included a small set of clinical variables and more than 54,000 gene features. Machine learning classifiers included three black-box algorithms (k-nearest neighbour, Artificial Neural Network, and Support Vector Machine) and two methods based on intelligible rules (Decision Tree and the innovative Logic Learning Machine method). Support Vector Machine clearly outperformed any of the other methods. Among the two rule-based algorithms, Logic Learning Machine performed better and identified a set of simple intelligible rules based on a combination of clinical variables and gene expressions. Decision Tree identified a non-coding gene (XIST) involved in the early phases of X chromosome inactivation that was overexpressed in females and in non-relapsed patients. XIST expression might be responsible for the better prognosis of female Hodgkin's lymphoma patients.

  13. The real relationship in psychotherapy supervision.

    Science.gov (United States)

    Watkins, C Edward

    2011-01-01

    While the real relationship has long been addressed in psychoanalysis and psychotherapy, the matter of the real relationship in psychotherapy supervision has yet to receive any attention. Ample supervisory focus has indeed been given to the working alliance and transference-countertransference configuration (including parallel processes), but after a century of psychotherapy supervision, any mention whatsoever of real relationship phenomena is absent. In this paper, the following hypotheses are proposed: The real relationship (1) is a crucial component of the supervision relationship that has transtheoretical implications; (2) exists from the moment supervision begins until its end; (3) is the forever silent yet forever substantive contributor to supervisory process and outcome; (4) exerts a significant impact on (a) the development and establishment of the supervisory working alliance and (b) the unfolding and eventual utilization of the transference-countertransference experience in the supervisory situation; (5) consists of at least two dimensions in supervision--realism and genuineness--that vary along valence and magnitude continua (building on the works of Greenson and Gelso), and (6) deserves a place of eminence equal to the working alliance and transference-countertransference configuration if supervision theory, practice, and research are to be most fully informed. The possibility of using recent real relationship research in psychotherapy as a prototype to inform future research in supervision is presented, and two case examples are provided to illustrate the seeming power of real relationship phenomena in psychotherapy supervision.

  14. Dual Perspectives on Theory in Clinical Practice: Practice Makes Perfect: The Incompatibility of Practicing Speech and Meaningful Communication.

    Science.gov (United States)

    Kamhi, Alan G.

    2000-01-01

    This article uses a case study to suggest that some children view speech-language therapy as a separate situation for learning practicing new sounds and language forms whereas the purpose of talking outside of therapy is meaningful communication. Clinical implications of this potential incompatibility between practicing speech and communicating…

  15. Feedback: an essential element of student learning in clinical practice.

    Science.gov (United States)

    Clynes, Mary P; Raftery, Sara E C

    2008-11-01

    Clinical practice is an essential component of the nursing curriculum. In order for the student to benefit fully from the experience regular performance feedback is required. Feedback should provide the student with information on current practice and offer practical advice for improved performance. The importance of feedback is widely acknowledged however it appears that there is inconsistency in its provision to students. The benefits of feedback include increased student confidence, motivation and self-esteem as well as improved clinical practice. Benefits such as enhanced interpersonal skills and a sense of personal satisfaction also accrue to the supervisor. Barriers to the feedback process are identified as inadequate supervisor training and education, unfavourable ward learning environment and insufficient time spent with students. In addition to the appropriate preparation of the supervisor effective feedback includes an appreciation of the steps of the feedback process, an understanding of the student response to feedback and effective communication skills.

  16. Developing an advanced practice nurse-led liver clinic.

    Science.gov (United States)

    McAfee, Jean L

    2012-01-01

    End-stage liver disease (ESLD) is a leading cause of digestive disease deaths in the United States and continues to increase exponentially every year. Best practice does not currently recognize or utilize a clinic practice model for ESLD management. Advanced practice registered nurses (APRNs) can impact ESLD disease management by implementing an outpatient clinic care model to focus on treatment compliance, patient education, improvement of patient outcomes, and reduction in hospital admission rates for ESLD patients. A review of 15 research articles was completed to determine the impact APRNs can make on chronic care of ESLD patients. Results from the review support APRN analysis, assessment, diagnosis, treatment, intervention, and evaluation of ESLD patients. The literature reviewed also demonstrates that ESLD patients have improved symptom management when maintained in an outpatient setting, allowing for decreased hospital and insurance expenditures. Following evaluation of the evidence, it was concluded that an APRN-led ESLD clinic merits further study.

  17. Defining competencies in psychology supervision: a consensus statement.

    Science.gov (United States)

    Falender, Carol A; Cornish, Jennifer A Erickson; Goodyear, Rodney; Hatcher, Robert; Kaslow, Nadine J; Leventhal, Gerald; Shafranske, Edward; Sigmon, Sandra T; Stoltenberg, Cal; Grus, Catherine

    2004-07-01

    Supervision is a domain of professional practice conducted by many psychologists but for which formal training and standards have been largely neglected. In this article, supervision is proposed as a core competency area in psychology for which a number of elements reflecting specific knowledge, skills, and values must be addressed to ensure adequate training and professional development of the trainee. Supra-ordinate factors of supervision viewed as permeating all aspects of professional development are proposed. These include the perspective that professional development is a lifelong, cumulative process requiring attention to diversity in all its forms, as well as legal and ethical issues, personal and professional factors, and self- and peer-assessment. A competencies framework is presented with particular elements representing knowledge (e.g., about psychotherapy, research, etc.), skills (including supervising modalities, relationship skills, etc.), values (e.g., responsibility for the clients and supervisee rests with supervisor, etc.), and meta-knowledge. Social contextual factors and issues of education and training, assessment, and future directions also are addressed, with specific elements listed. Suggestions for future work in this area are addressed, including the need to refine further and operationalize competences, develop clear expectations for accreditation and licensure regarding supervision competencies, and expand the description of developmental levels of supervisors from minimal to optimal competence. This is one of a series of articles published together in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.

  18. 三明市农产品质量安全监管的实践与建议%Practice and Proposals of Quality Safety Supervision of Agricultral Products in Sanming

    Institute of Scientific and Technical Information of China (English)

    林森知; 杨孝彩; 陈巧红

    2011-01-01

    The specific practice about supervision of quality and safety of agricultural products is introduced in this article. According to the principal problem in work,we offer some measures such as accentuating the study, expanding propaganda, intensifying training, perfecting system, establishing mechanisms, strengthening the supervision, improving the quality, increasing input, and assuring the operation.%介绍了三明市农产品质量安全监管的主要做法,并针对目前农产品质量安全监管工作中存在的主要问题,提出了加强学习、扩大宣传,加大培训、提高水平,完善体系、建立机制,加强监管、提高质量,增加投入、确保运作等应对措施.

  19. Nursing students learning to utilize nursing research in clinical practice.

    Science.gov (United States)

    Mattila, Lea-Riitta; Eriksson, Elina

    2007-08-01

    The purpose of the study was to examine the significance of a learning assignment in relation to research skills and learning of nursing students in clinical practice. The learning assignment included an oral presentation of a nursing research article, which the students gave to their fellow students and ward nurses. The students also chaired the discussion after the presentation. The target group for the study was nursing students of a Finnish polytechnic who had been studying for 2-2 1/2 years and had accomplished a minimum of 120 ECTS credits of the total of 210 ECTS credits. When participating in the study, the students were completing a six-week clinical practice of optional studies. The data were collected with a questionnaire designed for the study. It consisted of six open-ended questions. Three of the questions were related to learning of research skills. Two questions were concerned with learning during the ongoing clinical practice. The final question inquired the students' views on the development of the learning assignment. The students received the questionnaire before the commencement of their clinical practice, and they returned it to the other researcher after their clinical practice. The questionnaire was given to 80 students, of which 50 returned it; the response rate was 63%. The data were analysed by content analysis question by question. According to the results, the learning assignment advanced the understanding of research concepts for the majority of the students. In particular, the students reported that the oral presentation clarified the research concepts, and the structure of a scientific article was also elucidated. The students stated that the assignment generated ideas concerning the development of nursing care. In relation to the ongoing clinical practice, the assignment advanced patient encounters and interaction, and bearing responsibility the most. Proposals for the further development of the learning assignment were expressed by

  20. Shared-learning experience during a clinical pharmacy practice experience.

    Science.gov (United States)

    Zakaria, Syahiera Farhana; Awaisu, Ahmed

    2011-05-10

    To implement a shared learning approach through fourth-year students' mentorship of third-year students and to assess the perceptions of the mentored students on the value of their shared learning experience. We introduced the shared learning experience in clinical pharmacy and pharmacotherapeutic practice experiences involving 87 third-year and 51 fourth-year students. Both student groups undertook the practice experiences together, with third-year students working in smaller groups mentored by fourth-year students. A majority of the students (> 75%) believed that they learned to work as a team during their practice experiences and that the shared learning approach provided an opportunity to practice their communication skills. Similarly, most respondents (> 70%) agreed that the new approach would help them become effective members of the healthcare team and would facilitate their professional relationships in future practice. Almost two-thirds of the students believed that the shared learning enhanced their ability to understand clinical problems. However, about 31% of the pharmacy students felt that they could have learned clinical problem-solving skills equally well working only with peers from their own student group. The pharmacy students in the current study generally believed that the shared-learning approach enhanced their ability to understand clinical problems and improved their communication and teamwork skills. Both groups of students were positive that they had acquired some skills through the shared-learning approach.

  1. The psychiatric cultural formulation: translating medical anthropology into clinical practice.

    Science.gov (United States)

    Aggarwal, Neil Krishan

    2012-03-01

    This article reviews proposed revisions to the DSM-IV Outline for Cultural Formulation for clinical practice. The author begins by exploring the theoretical development of and assumptions involved in the Cultural Formulation. A case presentation is then used to demonstrate shortcomings in the current implementation of the Cultural Formulation based on older definitions of culture. Finally, the author recommends practical questions based on the growing anthropological literature concerning the interpersonal elements of culture and the social course of illness. A simple clear format that clinically translates social science concepts has the potential to increase use of the Cultural Formulation by all psychiatrists, not just those specializing in cultural psychiatry.

  2. Benefits of nurse teachers returning to clinical practice.

    Science.gov (United States)

    Glossop, D; Hoyles, A; Lees, S; Pollard, C

    This article outlines an action research study developed to facilitate nurse teachers returning to clinical practice. The article explores how the teachers established partnerships with clinicians through which they were able to share the experience of returning to an area of nursing that they had previously only visited. It discusses four categories: expectations of self and others; entering someone else's world; more awareness of student needs; and teaching theory and practising nursing. These categories emerged following the analysis of journals, focus group interviews and individual interviews and led to a number of recommendations concerning the implications for other teachers wishing to return to clinical practice.

  3. Capacity development through reflective practice and collaborative research among clinic supervisors in rural South Africa--a case study.

    Science.gov (United States)

    Lehmann, U; Blom, W; Dlanjwa, M; Fikeni, L; Hewana, N; Madlavu, N; Makaula, V; Pennacchini, M; Seal, S; Sivuku, T; Snyman, K

    2004-03-01

    This article provides an example of one form of action research, collaborative enquiry, in the health sector. It argues that collaborative inquiry is a powerful tool to develop reflective capacity among health workers and can facilitate the ownership of learning and the production of usable knowledge. It reports the results of a research project investigating the roles and functions of clinic supervisors in three districts in the Eastern Cape Province, South Africa. Clinics are the cornerstone of the new district-based health system. They are staffed primarily by nurses and are often the only contact point for large parts of the rural population. In conditions of remoteness and isolation, clinic staff depend upon personal interaction with clinic supervisors to enable them to function productively. Yet experience has shown that supervisors do not always fulfil this role. This project aimed at gaining insight into the status of clinic supervision, understanding the factors that hinder effective supervision and making recommendations for improvements. Using a participative approach of Collaborative Inquiry, a team of 10 clinic supervisors and the research co-ordinator collected data reflecting on their own practice over a period of 5 months. These data were then jointly analysed and written up. The participating clinic supervisors went through several periods of uncertainty, when many of them asked themselves why they agreed to this project. However, the engagement with stakeholders and colleagues and the joint analysis of research data soon proved to be a valuable source of insight. There was unanimity in the end that the research process had been very valuable and enabling.

  4. A wellness framework for pediatric nursing clinical practice.

    Science.gov (United States)

    Spurr, Shelley; Bally, Jill; Ogenchuk, Marcella; Peternelj-Taylor, Cindy

    2011-01-01

    This article presents a proposed holistic Framework for Exploring Adolescent Wellness specific to the discipline of nursing. Conceptualized as a practical adolescent wellness assessment tool, the framework attends to the physical, spiritual, psychological and social dimensions of adolescent health. Through the discussion of a reconstructed case study the framework's application to nursing practice is illustrated. Nurses are distinctly positioned to promote adolescent wellness. This approach facilitates the exploration of the multiple influences on the health of adolescents, across a variety of clinical practice specialties and settings, by nurses of varying experiences.

  5. Clinical neuropsychology in Israel: history, training, practice and future challenges.

    Science.gov (United States)

    Vakil, Eli; Hoofien, Dan

    2016-11-01

    This is an invited paper for a special issue on international perspectives on training and practice in clinical neuropsychology. We provide a review of the status of clinical neuropsychology in Israel, including the history of neuropsychological, educational, and accreditation requirements to become a clinical neuropsychologist and to practice clinical neuropsychology. The information is based primarily on the personal knowledge of the authors who have been practicing clinical neuropsychology for over three decades and hold various administrative and academic positions in this field. Second, we conducted three ad hoc surveys among clinical and rehabilitation psychologists; heads of academic programs for rehabilitation and neuropsychology; and heads of accredited service providers. Third, we present a literature review of publications by clinical neuropsychologists in Israel. Most of the clinical neuropsychologists are graduates of either rehabilitation or clinical training programs. The vast majority of neuropsychologists are affiliated with rehabilitation psychology. The training programs (2-3 years of graduate school) provide solid therapeutic and diagnostic skills to the students. Seventy-five percent of the participants in this survey are employed at least part-time by public or state-funded institutions. Israeli neuropsychologists are heavily involved in case management, including vocational counseling, and rehabilitation psychotherapy. Conclusions and future goals: Although clinical neuropsychologists in Israel are well educated and valued by all health professionals, there are still several challenges that must be addressed in order to further advance the field and the profession. These included the need for Hebrew-language standardized and normalized neuropsychological tests and the application of evidence-based interventions in neuropsychological rehabilitation.

  6. Clinical Practice Guidelines for Cardiopulmonary and Cerebral Resuscitation.

    Directory of Open Access Journals (Sweden)

    Victor Rene Navarro Machado

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Cardiopulmonary and Cerebral Resuscitation. It is the group of procedures that should be accomplished to restore circulation and ventilation in a patient with cardiac arrest, including actions to reintegrate upper neurological functions after restoring cardiac function. This document includes a review of concepts, aetiology and updates the main clinical aspects related with diagnosis and treatment aimed at the post-resuscitation syndrome. It includes assessment guidelines focused on the most important aspects to be accomplished.

  7. A model for ethical practices in clinical phonetics and linguistics.

    Science.gov (United States)

    Powell, Thomas W

    2007-01-01

    The emergence of clinical phonetics and linguistics as an area of scientific inquiry gives rise to the need for guidelines that define ethical and responsible conduct. The diverse membership of the International Clinical Phonetics and Linguistics Association (ICPLA) and the readership of this journal are uniquely suited to consider ethical issues from diverse perspectives. Accordingly, this paper introduces a multi-tiered six-factor model for ethical practices to stimulate discussion of ethical issues.

  8. Integrating research, clinical practice and translation: the Singapore experience.

    Science.gov (United States)

    Liu, Jiang; Wong, Damon Wing Kee; Zhang, Zhuo; Lee, Beng-Hai; Gao, Xinting; Yin, Fengshou; Zhang, Jielin; Htoo, Min Thet

    2013-01-01

    We introduce the experiences of the Singapore ocular imaging team, iMED, in integrating image processing and computer-aided diagnosis research with clinical practice and knowledge, towards the development of ocular image processing technologies for clinical usage with potential impact. In this paper, we outline key areas of research with their corresponding image modalities, as well as providing a systematic introduction of the datasets used for validation.

  9. Clinical Practice Guidelines for Pre-eclampsia and Eclampsia Treatment.

    Directory of Open Access Journals (Sweden)

    Frank Carlos Alvarez Li

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Pre-eclampsia and Eclampsia Treatment. This disease is part of a group of conditions known as hypertensive disease in pregnancy that have in common the existence of high blood pressure. This document includes a review and update of the main clinical aspects, concepts, classification and treatment stressing the use of drugs that cause hypotension and magnesium sulphate. It includes assessment guidelines focused on the most important aspects to be accomplished.

  10. Impact of an audiology clinic in one general practice.

    Science.gov (United States)

    Khunti, K; Carr, M

    1997-01-01

    There is a large demand for the provision of hearing aids. However, there are lengthy delays involved between referral and fitment of National Health Service (NHS) hearing aids. This report shows that a general practice based audiology clinic can lead to an increase in the number of patients referred and fitted with a hearing aid. The introduction of the clinic also led to reduced waiting times for patients to be fitted with hearing aids. PMID:9474829

  11. Clinical Practice Guidelines for Vascular Catheter Infections Treatment.

    Directory of Open Access Journals (Sweden)

    Belkys Rodríguez Llerena

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Vascular Catheter Infections Treatment. It has been defined as the presence of local or systemic signs without other obvious infection site, plus the microbiologic evidence involving the catheter. This document includes a review and update of concepts, main clinical aspects, and treatment and stresses the importance of prophylactic treatment. It includes assessment guidelines focused on the most important aspects to be accomplished.

  12. Rethinking Research Supervision: Some Reflections from the Field of Employment Relations

    Science.gov (United States)

    Bingham, Cecilie; Durán-Palma, Fernando

    2014-01-01

    This essay offers some reflections for the theory and practice of research supervision drawn from the field of employment relations. It argues that rethinking supervision in terms of the employment relationship can advance dialogue and debate about supervision. This is twofold. (1) Reframing supervision in terms of the employment relationship can…

  13. "We Teach Plastic Lessons to Please Them": The Influence of Supervision on the Practice of English Language Student Teachers in Kenya

    Science.gov (United States)

    Ochieng' Ong'ondo, Charles; Borg, Simon

    2011-01-01

    This article analyses the process of supervision by teacher educators and its influence on English language student teachers during a practicum in Kenya. The student teachers were enrolled in a four-year Bachelor of Education course for teaching English at secondary school level. Drawing on the perspectives of teacher educators, co-operating…

  14. Differences in Perceptions of the Importance of Subject Matter Knowledge and How These Shaped Supervision and Assessment of Student Teachers on Teaching Practice

    Science.gov (United States)

    Mudavanhu, Young

    2015-01-01

    The purpose of the study was to establish lecturers and student teachers' perceptions of the importance of subject matter knowledge and how these views affected supervision and assessment of pre-service and in-service science teachers at University of Mashonaland (pseudonym) in Zimbabwe. The study was largely qualitative and used group…

  15. Evidence-based clinical practice guidelines for cholelithiasis 2016.

    Science.gov (United States)

    Tazuma, Susumu; Unno, Michiaki; Igarashi, Yoshinori; Inui, Kazuo; Uchiyama, Kazuhisa; Kai, Masahiro; Tsuyuguchi, Toshio; Maguchi, Hiroyuki; Mori, Toshiyuki; Yamaguchi, Koji; Ryozawa, Shomei; Nimura, Yuji; Fujita, Naotaka; Kubota, Keiichi; Shoda, Junichi; Tabata, Masami; Mine, Tetsuya; Sugano, Kentaro; Watanabe, Mamoru; Shimosegawa, Tooru

    2017-03-01

    Cholelithiasis is one of the commonest diseases in gastroenterology. Remarkable improvements in therapeutic modalities for cholelithiasis and its complications are evident. The Japanese Society of Gastroenterology has revised the evidence-based clinical practice guidelines for cholelithiasis. Forty-three clinical questions, for four categories-epidemiology and pathogenesis, diagnosis, treatments, and prognosis and complications-were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This article preferentially describes the clinical management of cholelithiasis and its complications. Following description of the diagnosis performed stepwise through imaging modalities, treatments of cholecystolithiasis, choledocholithiasis, and hepatolithiasis are introduced along with a flowchart. Since there have been remarkable improvements in endoscopic treatments and surgical techniques, the guidelines ensure flexibility in choices according to the actual clinical environment. The revised clinical practice guidelines are appropriate for use by clinicians in their daily practice.

  16. Good Clinical Practice Guidance and Pragmatic Clinical Trials: Balancing the Best of Both Worlds.

    Science.gov (United States)

    Mentz, Robert J; Hernandez, Adrian F; Berdan, Lisa G; Rorick, Tyrus; O'Brien, Emily C; Ibarra, Jenny C; Curtis, Lesley H; Peterson, Eric D

    2016-03-01

    Randomized, clinical trials are commonly regarded as the highest level of evidence to support clinical decisions. Good Clinical Practice guidelines have been constructed to provide an ethical and scientific quality standard for trials that involve human subjects in a manner aligned with the Declaration of Helsinki. Originally designed to provide a unified standard of trial data to support submission to regulatory authorities, the principles may also be applied to other studies of human subjects. Although the application of Good Clinical Practice principles generally led to improvements in the quality and consistency of trial operations, these principles have also contributed to increasing trial complexity and costs. Alternatively, the growing availability of electronic health record data has facilitated the possibility for streamlined pragmatic clinical trials. The central tenets of Good Clinical Practice and pragmatic clinical trials represent potential tensions in trial design (stringent quality and highly efficient operations). In the present article, we highlight potential areas of discordance between Good Clinical Practice guidelines and the principles of pragmatic clinical trials and suggest strategies to streamline study conduct in an ethical manner to optimally perform clinical trials in the electronic age.

  17. [Quality assurance and quality improvement in medical practice. Part 3: Clinical audit in medical practice].

    Science.gov (United States)

    Godény, Sándor

    2012-02-01

    The first two articles in the series were about the definition of quality in healthcare, the quality approach, the importance of quality assurance, the advantages of quality management systems and the basic concepts and necessity of evidence based medicine. In the third article the importance and basic steps of clinical audit are summarised. Clinical audit is an integral part of quality assurance and quality improvement in healthcare, that is the responsibility of any practitioner involved in medical practice. Clinical audit principally measures the clinical practice against clinical guidelines, protocols and other professional standards, and sometimes induces changes to ensure that all patients receive care according to principles of the best practice. The clinical audit can be defined also as a quality improvement process that seeks to identify areas for service improvement, develop and carry out plans and actions to improve medical activity and then by re-audit to ensure that these changes have an effect. Therefore, its aims are both to stimulate quality improvement interventions and to assess their impact in order to develop clinical effectiveness. At the end of the article key points of quality assurance and improvement in medical practice are summarised.

  18. The Brave New World of clinical cancer research: Adaptive biomarker-driven trials integrating clinical practice with clinical research.

    Science.gov (United States)

    Berry, Donald A

    2015-05-01

    Clinical trials are the final links in the chains of knowledge and for determining the roles of therapeutic advances. Unfortunately, in an important sense they are the weakest links. This article describes two designs that are being explored today: platform trials and basket trials. Both are attempting to merge clinical research and clinical practice.

  19. Os saberes docentes na formação inicial do professor de física: elaborando sentidos para o estágio supervisionado Teacher knowledge in initial teacher education: elaborating meanings for supervised teaching practice activities

    Directory of Open Access Journals (Sweden)

    Ana Lúcia Pereira Baccon

    2010-01-01

    Full Text Available Neste trabalho apresentamos os resultados de uma investigação a respeito da construção dos saberes docentes, durante a realização do estágio supervisionado da licenciatura de Física. Para o levantamento das informações desta pesquisa, foram entrevistados dois grupos de estagiários e analisados seus relatórios de regência. Durante as entrevistas, semiestruturadas, o estagiário era convidado a falar sobre a sua experiência com o estágio supervisionado. Buscamos perceber as representações que cada estagiário elaborou durante o estágio, em relação aos alunos, ao professor, à escola, aos outros estagiários de seu grupo e ao próprio estágio. Com base nessas representações, procuramos verificar quais saberes os estagiários conseguiram construir durante esse período e caracterizar a singularidade de sua ação docente.In this work we present the results of research about the construction of the teacher´s knowledge, during the period of supervised teaching practice for students in a teacher education program in Physics. For the data collection, two groups of students had been interviewed; we also analyzed their reports of teaching practice. During the interviews, the students were invited to speak about their experiences on the supervised period of training. We were looking for the representations that each trainee elaborated during the period of training, related to the pupils, the teachers, the school and the other students of their groups. From these representations it was possible to verify the knowledge constructed by the trainees during the supervised teaching practice and to characterize the singularity of their practice teaching.

  20. The clinical practice of interventional radiology: a European perspective.

    LENUS (Irish Health Repository)

    Keeling, Aoife N

    2009-05-01

    The purpose of this study was to determine the current clinical environment in which interventional radiology (IR) is practiced throughout Europe. A survey, comprising 12 questions on IR clinical practice, was sent to 1800 CIRSE members. Members were asked to return one survey per department. Two hundred seventy-four departments returned completed questionnaires, 22% from the United Kingdom (n = 60), 11% from Germany (n = 30), 8% from Austria (n = 23), and the remainder spread over Europe. Experts, with more than 10 years of IR experience, comprised 74% of the survey group. Almost one-third of the radiologists dedicated more than 80% of their clinical sessions to IR alone (27%; n = 75), with two-thirds practicing in a university teaching hospital setting (66%; n = 179). Few institutions have dedicated IR inpatient hospital beds (17%; n = 46), however, to compensate, day case beds are available (31%), IR admitting rights are in place (64% overall, 86% for in-patients, and 89% for day cases), and elective IR admissions can be made through other clinicians (87%). IR outpatient clinics are run at 26% of departments, with an average of two sessions per week. Dedicated nurses staff the majority of IR suites (82%), but clinical junior doctors are lacking (46%). Hospital management\\'s refusing access to beds was the most commonly cited reason for not developing a clinical IR service (41%). In conclusion, there is marked variation across European centers in the current practice of IR. Half do not have dedicated junior doctors and only a small minority have inpatient hospital beds. If IR is to be maintained as a dedicated clinical specialty, these issues need to be addressed urgently.

  1. Impact of the Pharmacy Practice Model Initiative on Clinical Pharmacy Specialist Practice.

    Science.gov (United States)

    Jacobi, Judith; Ray, Shaunta'; Danelich, Ilya; Dodds Ashley, Elizabeth; Eckel, Stephen; Guharoy, Roy; Militello, Michael; O'Donnell, Paul; Sam, Teena; Crist, Stephanie M; Smidt, Danielle

    2016-05-01

    This paper describes the goals of the American Society of Health-System Pharmacists' Pharmacy Practice Model Initiative (PPMI) and its recommendations for health-system pharmacy practice transformation to meet future patient care needs and elevate the role of pharmacists as patient care providers. PPMI envisions a future in which pharmacists have greater responsibility for medication-related outcomes and technicians assume greater responsibility for product-related activities. Although the PPMI recommendations have elevated the level of practice in many settings, they also potentially affect existing clinical pharmacists, in general, and clinical pharmacy specialists, in particular. Moreover, although more consistent patient care can be achieved with an expanded team of pharmacist providers, the role of clinical pharmacy specialists must not be diminished, especially in the care of complex patients and populations. Specialist practitioners with advanced training and credentials must be available to model and train pharmacists in generalist positions, residents, and students. Indeed, specialist practitioners are often the innovators and practice leaders. Negotiation between hospitals and pharmacy schools is needed to ensure a continuing role for academic clinical pharmacists and their contributions as educators and researchers. Lessons can be applied from disciplines such as nursing and medicine, which have developed new models of care involving effective collaboration between generalists and specialists. Several different pharmacy practice models have been described to meet the PPMI goals, based on available personnel and local goals. Studies measuring the impact of these new practice models are needed.

  2. Normal Personality Assessment in Clinical Practice: The NEO Personality Inventory.

    Science.gov (United States)

    Costa, Paul T.; McCrae, Robert R.

    1992-01-01

    The NEO Personality Inventory (NEO-PI) is described as a measure of five factors of personality and its use in clinical assessment and treatment practice is reviewed. Data from 17 adult men and women show links between NEO-PI scales and other measures of psychopathology. (SLD)

  3. Diagnostic value of urinary dysmorphic erythrocytes in clinical practice

    NARCIS (Netherlands)

    M.J. Crop (Meindert); Y.B. de Rijke (Yolanda); P.C.M.S. Verhagen (Paul); K. Cransberg (Karlien); R. Zietse (Bob)

    2010-01-01

    textabstractBackground: In clinical practice, discriminating between glomerular and nonglomerular causes of hematuria is often difficult. Dysmorphic red blood cells (dRBC) in the urinary sediment are claimed to be effective, but the cutoff points in the literature vary. This follow-up study aimed to

  4. Measuring Effects on the Clinical Practice from a Configured EHR

    DEFF Research Database (Denmark)

    Møller-Jensen, John; Simonsen, Jesper; K. Iversen, Rikke

    2006-01-01

    during a series of workshops with the clinicians after which the XML configuration files were written and deployed. In parallel with this, the participants from the University specified a number of effects related to the clinical practice to be measured. Measurements were focused on the requested effects...

  5. Clinical Practice Guidelines for Transfusion of Patients in Critical Condition.

    Directory of Open Access Journals (Sweden)

    Rafael Alejandro Gómez Baute

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Transfusion of Patients in Critical Condition. We stress transfusion criteria (blood cells, platelets, granulocyte concentrations, plasma and cryoprecipitate, doses, diagnosis and treatment of post-transfusion reactions. It includes assessment guidelines focused on the most important aspects to be accomplished.

  6. Supporting Clinical Practice Candidates in Learning Community Development

    Science.gov (United States)

    DeJarnette, Nancy K.; Sudeck, Maria

    2015-01-01

    The purpose of this qualitative research study was to monitor pre-service teacher candidates' progression and implementation of the learning community philosophy along with classroom management strategies. The study took place during their final semester of clinical practice. Data were collected from self-reports, surveys, university supervisor…

  7. Multifunction laser systems in clinical and resort practice

    OpenAIRE

    ZABULONOV, Yuriy; Vladimirov, Alexander; Chukhraiev, Nikolay; Elmehsenawi, Yousry; Zukow, Walery

    2016-01-01

    SHUPYKNATIONALMEDICALACADEMY OF POSTGRADUATE EDUCATION UKRAINIANSOCIETY OFPHYSICAL AND REHABILITATION MEDICINE RADOM UNIVERSITY       Yuriy Zabulonov, Alexander Vladimirov, Nikolay Chukhraiev, Yousry Elmehsenawi, Walery Zukow       MULTIFUNCTION LASER SYSTEMS IN CLINICAL AND RESORT PRACTICE   Edited by Yuriy Zabulonov, Alexander Vladimirov, Nikolay Chukhraiev, Yousry Elmehsenawi, Walery Zukow  ...

  8. Semi-Spontaneous Oral Text Production: Measurements in Clinical Practice

    Science.gov (United States)

    Lind, Marianne; Kristoffersen, Kristian Emil; Moen, Inger; Simonsen, Hanne Gram

    2009-01-01

    Functionally relevant assessment of the language production of speakers with aphasia should include assessment of connected speech production. Despite the ecological validity of everyday conversations, more controlled and monological types of texts may be easier to obtain and analyse in clinical practice. This article discusses some simple…

  9. Terminal sedation and euthanasia: A comparison of clinical practices

    NARCIS (Netherlands)

    J.A.C. Rietjens (Judith); J.J.M. van Delden (Johannes); A. van der Heide (Agnes); A.M. Vrakking (Astrid); B.D. Onwuteaka-Philipsen (Bregje); P.J. van der Maas (Paul); G. van der Wal (Gerrit)

    2006-01-01

    textabstractBackground: An important issue in the debate about terminal sedation is the extent to which it differs from euthanasia. We studied clinical differences and similarities between both practices in the Netherlands. Methods: Personal interviews were held with a nationwide stratified sample

  10. The Use of Bone Age in Clinical Practice - Part 1

    NARCIS (Netherlands)

    D.D. Martin; J.M. Wit; Z.E. Hochberg; L. Sävendahl; R.R. van Rijn; O. Fricke; N. Cameron; J. Caliebe; T. Hertel; D. Kiepe; K. Albertsson-Wikland; H.H. Thodberg; G. Binder; M.B. Ranke

    2011-01-01

    This review examines the role of skeletal maturity ('bone age', BA) assessment in clinical practice. BA is mainly used in children with the following conditions: short stature (addressed in part 1 of this review), tall stature, early or late puberty, and congenital adrenal hyperplasia (all addressed

  11. Multiple sclerosis brain lesion measurements in clinical practice

    OpenAIRE

    2014-01-01

    Jain S., Smeets D., Sima D., Van Hecke W., Loeckx D., Van Huffel S., Maes F., ''Multiple sclerosis brain lesion measurements in clinical practice'', European journal of neurology, vol. 21 suppl. s1, pp. 345, 2014 (Joint congress of European neurology, May 31 - June 3, 2014, Istanbul, Turkey).

  12. A practical clinical approach to management of the difficult airway

    NARCIS (Netherlands)

    Eindhoven, GB; Dercksen, B; Regtien, JG; Borg, PAJ; Wierda, JMKH

    2001-01-01

    Difficult airway management represents a challenge in anaesthesia. In the last decades airway difficulty awareness has improved as a result of better anticipation and decision-making. Airway algorithms and protocols have a more prominent role in training and in clinical anaesthesia practice. In

  13. 《食品安全监督管理》课程教学改革与实践探索%Reform and educational practice in the course of food safety supervision and administration

    Institute of Scientific and Technical Information of China (English)

    相启森; 马云芳; 董吉林; 申瑞玲

    2015-01-01

    The course of food safety supervision and administration is an important professional basic course in food quality and safety disciplines, which is characterized by the comprehensiveness, applicability, and practicality. In order to improve the quality of teaching, a serious reform and practice on the course of food safety supervision and a dminis-tration was performed, such as the course content, instructional methods, and assessment methods. These reform and e-ducational practice stimulated students' enthusiasm for learning and improved the effectiveness and efficiency of teach-ing and engineering practice ability.%《食品安全监督管理》是食品质量与安全专业的重要专业基础课程,具有综合性、应用性和实践性等特点。为了提高教学质量,在教学内容、教学方法和课程考核方法等方面对《食品安全监督管理》进行了课程教学的改革与实践。结果表明,上述教学改革与实践激发了学生学习的积极性,提高了课堂教学的效率和效果。

  14. Barriers and Enablers to Clinical Fieldwork Education in Rural Public and Private Allied Health Practice

    Science.gov (United States)

    Maloney, Phoebe; Stagnitti, Karen; Schoo, Adrian

    2013-01-01

    There is a need to maximise rural clinical fieldwork placement to build health workforce capacity. This study investigated allied health professionals' (AHPs) experience of supervising students as part of work-integrated learning in public and private rural health settings. An anonymous postal questionnaire with 30 questions was used to collect…

  15. On psychoanalytic supervision as signature pedagogy.

    Science.gov (United States)

    Watkins, C Edward

    2014-04-01

    What is signature pedagogy in psychoanalytic education? This paper examines that question, considering why psychoanalytic supervision best deserves that designation. In focusing on supervision as signature pedagogy, I accentuate its role in building psychoanalytic habits of mind, habits of hand, and habits of heart, and transforming theory and self-knowledge into practical product. Other facets of supervision as signature pedagogy addressed in this paper include its features of engagement, uncertainty, formation, and pervasiveness, as well as levels of surface, deep, and implicit structure. Epistemological, ontological, and axiological in nature, psychoanalytic supervision engages trainees in learning to do, think, and value what psychoanalytic practitioners in the field do, think, and value: It is, most fundamentally, professional preparation for competent, "good work." In this paper, effort is made to shine a light on and celebrate the pivotal role of supervision in "making" or developing budding psychoanalysts and psychoanalytic psychotherapists. Now over a century old, psychoanalytic supervision remains unparalleled in (1) connecting and integrating conceptualization and practice, (2) transforming psychoanalytic theory and self-knowledge into an informed analyzing instrument, and (3) teaching, transmitting, and perpetuating the traditions, practice, and culture of psychoanalytic treatment.

  16. Best practices for clinical pathology testing in carcinogenicity studies.

    Science.gov (United States)

    Young, Jamie K; Hall, Robert L; O'Brien, Peter; Strauss, Volker; Vahle, John L

    2011-02-01

    The Society of Toxicologic Pathology (STP) and American Society for Veterinary Clinical Pathology (ASCVP) convened a Clinical Pathology in Carcinogenicity Studies Working Group to recommend best practices for inclusion of clinical pathology testing in carcinogenicity studies. Regulatory guidance documents and literature were reviewed, and veterinary pathologists from North America, Japan, and Europe were surveyed regarding current practices, perceived value, and recommendations for clinical pathology testing in carcinogenicity studies. For two-year rodent carcinogenicity studies, the Working Group recommends that clinical pathology testing be limited to collection of blood smears at scheduled and unscheduled sacrifices to be examined only if indicated to aid in the diagnosis of possible hematopoietic neoplasia following histopathologic evaluation. Additional clinical pathology testing is most appropriately used to address specific issues from prior toxicity studies or known test article-related class effects. Inadequate data were available to make a recommendation concerning clinical pathology testing for alternative six-month carcinogenicity assays using genetically modified mice, although the Working Group suggests that it may be appropriate to use the same approach as for two-year carcinogenicity studies since the study goal is the same.

  17. Section 25 aftercare under supervision: the first eighteen months' experience.

    Science.gov (United States)

    Davies, S; Bruce, J; Fallows, S

    1999-07-01

    Supervised discharge was introduced, against much professional opposition, in the Mental Health (Patients in the Community) Act 1995. All patients subject to supervised discharge (SD) in a large health district were identified by medical records departments, and the outcome of their SD on 1 October 1997, eighteen months after the legislation came into effect, was assessed. In that first eighteen months, half of the general, rehabilitation and forensic psychiatrists in the trust used SD for 22 patients. Of the 12 orders in effect for over six months, six were renewed at six months and three at one year. In spite of professional hostility and scepticism about the clinical practicalities of SD, the use of the new power has gradually increased with experience. Outcomes to date seem generally positive, but further definitive research is needed.

  18. The frontline clinical manager identifying direct reports' level of practice.

    Science.gov (United States)

    Longo, M Anne; Roussel, Linda; Pennington, Sandra L; Hoying, Cheryl

    2013-01-01

    Patricia Benner applied the Dreyfus Model of Skill Acquisition to describe and interpret skill acquisition and clinical judgment in nursing practice. Operational definitions for the 5 levels of her original Novice to Expert Theory were used by the study participants in a large Midwestern pediatric hospital to self-identify their level of practice. The frontline clinical managers of these direct care registered nurses (RNs) used the same tool to rate their direct reports. The aim of this portion of a larger study was to determine if the clinical manager's perception of their direct reports was the same as that of the RNs. The results of this study are being used by one study unit's clinical managers as the basis for implementing the Hersey and Blanchard Situational Leadership Model. The clinical managers work with their direct reports depending on the level of practice and the details of the task to be performed. One example is creating therapeutic relationships with each other and with families to ensure a safe environment for all.

  19. Grading journals in clinical practice: a delicate issue.

    Science.gov (United States)

    Holmes, V

    1997-12-01

    Offering students opportunities to gain a strong sense of self, a positive professional image, and a chance to articulate their clinical practice is a challenge for nurse educators. Writing journals in clinical placements is one way in which students can create a dialogue with their teacher and reflect upon and explore their clinical experiences in the context in which these experiences occur. However, grading journals according to numerous predetermined criteria can sabotage the benefits and opportunities of writing journals. Judgment and control are two aspects of evaluation and subsequent grading that can sabotage the benefits. Limiting predetermined criteria and not assigning grades to students' journals are two answers to this delicate issue. To function as competent practitioners, nursing students must be able to meet standards of practice; they must achieve a strong sense of self and a positive professional image. Clinical placements offer students the opportunity to explore the experience of clinical nursing and the context in which these experiences unfold. As students acquire skills and explore the practice of nursing, they also face the reality that their instructors will award a judgment of worth to their efforts. This evaluation is necessary to determine whether students have met the required standards. Evaluation and subsequent grades, therefore, must be an integral part of the students' clinical experience. Writing journals is often used as a method of exploring experiences in clinical nursing. Journals are also used as a method of clinical evaluation. Assigning a grade to student journals has a detrimental effect on the purpose of the assignment. An emphasis on exploring the purpose of writing journals and an analysis of the impact that grading has on this exercise will expose the incompatibility between writing and grading journals.

  20. An overview of clinical governance policies, practices and initiatives.

    Science.gov (United States)

    Braithwaite, Jeffrey; Travaglia, Joanne F

    2008-02-01

    To map the emergence of, and define, clinical governance; to discuss current best practices, and to explore the implications of these for boards of directors and executives wishing to promote a clinical governance approach in their health services. Review and analysis of the published and grey literature on clinical governance from 1966 to 2006. Medline and CINAHL databases, key journals and websites were systematically searched. Central issues were identified in the literature as key to effective clinical governance. These include: ensuring that links are made between health services' clinical and corporate governance; the use of clinical governance to promote quality and safety through a focus on quality assurance and continuous improvement; the creation of clinical governance structures to improve safety and quality and manage risk and performance; the development of strategies to ensure the effective exchange of data, knowledge and expertise; and the sponsoring of a patient-centred approach to service delivery. A comprehensive approach to clinical governance necessarily includes the active participation of boards and executives in sponsoring and promoting clinical governance as a quality and safety strategy. Although this is still a relatively recent development, the signs are promising.