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PubMed2007

Spaced education improves the retention of clinical knowledge by medical students: a randomised controlled trial.

PURPOSE: Medical knowledge learned by trainees is often quickly forgotten. How can the educational process be tailored to shift learning into longer-term memory? We investigated whether 'spaced education', consisting of weekly e-mailed case scenarios and clinical questions, could improve the retention of students' learning. METHODS: During the 2004-5 surgery clerkships, 3rd-year students completed a mandatory 1-week clinical rotation in urology and validated web-based teaching programme on 4 core urology topics. Spaced educational e-mails were constructed on all 4 topics based on a validated urology curriculum. Each consisted of a short clinically relevant question or clinical case scenario in multiple-choice question format, followed by the answer, teaching point summary and explanations of the answers. Students were randomised to receive weekly e-mailed case scenarios in only 2 of the 4 urology topics upon completion of their urology rotation. Students completed a validated 28-item test (Cronbach's alpha = 0.76) on all 4 topics prior to and after the rotation and at the end of the academic year. RESULTS: A total of 95 of 133 students (71%) completed the end-of-year test. There were no significant differences in baseline characteristics between randomised cohorts. Spaced education significantly improved composite end-of-year test scores (P < 0.001, paired t-test). The impact of the spaced educational e-mails was largest for those students who completed their urology education 6-8 and 9-11 months previously (Cohen's effect sizes of 1.01 and 0.73, respectively). CONCLUSION: Spaced education consisting of clinical scenarios and questions distributed weekly via e-mail can significantly improve students' retention of medical knowledge.

Boston↗

PubMed2006

Respiratory care manpower issues.

OBJECTIVE: Although respiratory care is a relatively new profession, its practitioners are deeply involved in providing patient care in the critical care. In preparation for writing this article, we sought to explore the respiratory therapy manpower needs and activities designed to fulfill those needs in critical care practice. MATERIALS AND METHODS: We began by delineating the historical development of respiratory care as a profession, the development of its education, and the professional credentialing system. We then conducted several literature reviews with few articles generated. We requested and received data from the American Association for Respiratory Care (AARC), The National Board for Respiratory Care (NBRC), and the Committee on Accreditation of Respiratory Care education (CoARC) relative to their membership, number of credentialed individuals, and educational program student and graduate data for 2000 through 2004. We then conducted two electronic surveys. Survey 1 was a six-item survey that examined the use of mandatory overtime in respiratory care departments. We used a convenience sample of 30 hospitals stratified by size ( or=500 beds). Survey 2 was a five-item instrument distributed by blast E-mail to the Society of Critical Care Medicine's Respiratory Care Section members and members of the RC_World list serve. This survey elicited 51 usable and non-duplicative responses from geographically and size-varied institutions. We analyzed these data in several ways from distribution analysis to one-way analysis of variance procedure and appropriate post hoc analysis techniques. Where appropriate, a matched-pairs analysis was performed and these were compared across the variables intensive care unit (ICU) beds per actual number of respiratory care practitioners (RCPs) and ICU beds per preferred number of RCPs. RESULTS: The data gathered from the professional organizations indicated a relatively stable attrition rate (35.2%+/-1.7-3.1%), even in the face of varying enrollments (6,231 in 2004 vs. 4,589 in 2002). In survey 1, we looked at the institution of mandatory overtime policies and their use in 30 size-stratified hospitals. Mandatory overtime was selected as a survey topic under the supposition that manpower shortages might lead to the development of such procedures and also to their utilization. Fourteen of the 30 hospitals responding indicated that they had a policy addressing mandatory over time. Of the 14 hospitals with policies, only ten had disciplinary actions specific to refusing the overtime. Seven of the 30 hospitals indicated that they used mandatory overtime monthly of more frequently. Survey 2 data revealed that there was a wide variation in bed size, number of ICUs, and number of RCP staff assigned to the ICU. Serendipitously, our 51 responding centers were distributed among small (16), medium (19), and large (16) hospitals in a manner that appeared to reflect the national distribution pattern. We were able to use these data to develop a closeness of fit diagram ICU beds to preferred numbers of RCPs (DF=48; p<.0001; RSq=0.77; RMSE=4.114). The number of beds per preferred number of RCPs was 9.445 to 1.0 while the actual bed to RCP ratio was 10.75 to 1. CONCLUSION: This article provides a short history of the development of respiratory care and its historical relationship with critical care. We have, perhaps for the first time, provided a unified data set of key demographic information from the three professional bodies guiding the development of the respiratory therapy profession. This data set provides time-linked data on admissions and graduations from the CoARC, membership numbers for the AARC, and the numbers of active credentialed RCP from the NBRC. By two focused surveys, we were able to show that while mandatory overtime is a common practice in respiratory care departments, it was not overwhelming utilized. We also learned that in most hospitals, regardless of bed size, there is a perceived need for 1.3 RCPs more than the actual staff and that it appears that the critical staffing level between actual to preferred RCP to beds is between 9 and 11 beds.

Attitude of Health Personnel↗

PubMed1999

Recruitment and baseline characteristics of participants in the Dietary Approaches to Stop Hypertension trial. DASH Collaborative Research Group.

Dietary Approaches to Stop Hypertension (DASH) was a randomized, multicenter feeding study designed to assess the effects of modifying dietary patterns on blood pressure. Among the most challenging aspects of conducting the DASH trial was the recruitment of participants at the 4 clinical centers. As part of the recruitment drive, 347,500 brochures were mailed, 250,500 coupons were distributed in coupon packs, 114 advertisements were published in newspapers or bulletins, 140 radio and 74 television advertisements were broadcast, and 68 screening events and presentations were conducted. These efforts yielded a total of 459 enrolled participants, ahead of schedule. The most common source of participants was mass mailing of individual brochures (n = 194, 42.3%), followed by word-of-mouth (n = 82, 17.8%), and then other types of mass mailing (n = 44, 9.6%). Recruitment of minority participants followed a similar pattern. Among the 3,192 persons attending the first in-person screening visit, the major reason for nonenrollment was low blood pressure (56%) rather than a diet-related factor. The study population was demographically heterogeneous (49% women, 60% African American, 48% married, and 77% employed full-time). On average, the diet of participants before the DASH feeding study was more similar to the trial control diet than to the combination diet, which reduced blood pressure more effectively. In summary, recruitment of a heterogeneous study population that includes a substantial number of minority participants is a feasible undertaking. However, the effort is considerable and requires a major commitment of resources.

Adult↗

PubMed1997

Implementing the Dutch College of General Practitioner's guidelines for influenza vaccination: an intervention study.

BACKGROUND: Influenza is a major health problem in most Western countries. In September 1993, the Dutch College of General Practitioners (NHG) issued guidelines for influenza vaccination. Although most general practitioners (GPs) are well acquainted with NHG standards, knowledge does not invariably lead to application. AIM: To evaluate a regional intervention promoting the implementation of NHG's influenza vaccination guidelines. METHOD: In a non-equivalent control group design (pre-test 1992, post-test 1993), two general practice regions were studied. In the intervention region, Amersfoort, there were 82 practices (118 GPs, 250,000 patients) and in the control region, Arnhem, 97 practices (124 GPs, 300,000 patients). In the intervention region, all professionals involved in influenza vaccination were approached at educational meetings and by mail. Postcard material and vaccines were distributed. The main outcome measures were five organizational aspects measured by a questionnaire (registration of high-risk patients, mail prompt, vaccine in stock, special vaccination hours and vaccination by practice assistant), and the vaccination rate (number of vaccines delivered divided by the total number of regional health insurance patients). RESULTS: All practices in the intervention region were involved; 78% responded to the pre-test and post-test questionnaires compared with 76% in the control region. Three of the five organizational aspects improved more in the intervention region: mail prompt by 25% (95% CI 11-38%), vaccine in stock by 29% (95% CI 16-44%), and special vaccination hours by 16% (95% CI 2-27%). Multivariate analyses failed to reveal any modifying factors. The vaccination rate increased by 21% (from 7.7% to 9.3%) in the intervention region, and by 6% (from 8.5% to 9.0%) in the control region. The mean increase in the intervention region exceeded that in the control region by 1.1 per 100 patients (95% CI 0.6-1.6). Multiple regression analysis revealed that this was an independent effect. CONCLUSIONS: This complex intervention was considered to be effective. The same strategy might be appropriate for other regions and other guidelines.

Aged↗

PubMed2000

Distribution of pharmaceuticals--a Norwegian logistic perspective.

There is a general concern about rising costs of pharmaceutical expenses. One political measure is a more efficient distribution system, which can take the form of new channels for retailing. In Norway mail-order pharmacy (MOP) has been brought to the agenda due to the recently proposed law regulating pharmacies ("Apoteklov"), market developments abroad, demand for self-medication, the increase in OTC-products and advances in information technology. Mail-order pharmacy involves direct delivery of medications through postal mail to patients or those responsible for dispensing medication. With reference to the USA, mail-order pharmacy has filled a niche in the market and several other countries are following. We are convinced that it is possible to maintain a high level of service quality in the sense of safety, counselling and compliance, and that there is a potential to develop a model for this distribution form in Norway. We believe that the actors in the Norwegian pharmaceutical market are better served in taking a more active role in this area and where possible initiating pilot projects in mail-order distribution. The pharmacists will continue to play an important role as a retail outlet and should, with their influence over patients, their knowledge and experience, contribute towards developing MOP to be a safe and complementary sales outlet. Developing such a solution demands the right balance between performance and quality on the one hand and efficiency on the other; two criteria, which we believe, do not contradict each other.

Humans↗

PubMed2004

Crossing the digital divide: evaluating online communication between patients and their providers.

OBJECTIVE: To address provider, payer, and patient concerns about the use of online communication in healthcare settings by performing a randomized controlled trial of a Web-based patient-provider communication tool in primary care. SUBJECTS AND METHODS: Forty-one staff physicians and 91 residents in 4 primary care centers were randomized to a Web-based online communication system. Patients of intervention physicians were encouraged to communicate via the system about health issues, scheduling, prescription renewals, referrals, and billing. Data collected included patient Web use, e-mail use, telephone calls, visit distribution, and physician and patient attitudes toward and satisfaction with communication. RESULTS: One thousand thirty-eight patients sent 2238 messages during the 40-week study. Half of the messages were directly related to a patient's health; half were administrative. Patient Web use peaked at 8.5 weekly messages per 100 scheduled visits. Patient e-mail and telephone volume remained similar across groups. Intervention physicians reported more positive attitudes toward Web-based communication than control physicians (mean Web benefits scale score, 4.0 vs 1.1; P = .008), but there were no between-group differences in attitudes toward communication in general. Patients and physicians reported differential preferences for the use of online communication based on problem complexity and sensitivity. CONCLUSIONS: Web-based messaging was lower than expected because of patient-related factors and limitations of the technology. Patients, physicians, and staff had positive attitudes toward online communication. There was no detectable difference in communication volume between study groups, but more sensitive measures of work burden need to be developed and evaluated.

Data Collection↗

PubMed2003

Effect of a triage-based E-mail system on clinic resource use and patient and physician satisfaction in primary care: a randomized controlled trial.

OBJECTIVES: E-mail communication between patients and their providers has diffused slowly in clinical practice. To address concerns about the use of this technology, we performed a randomized controlled trial of a triage-based e-mail system in primary care. DESIGN AND PATIENTS/PARTICIPANTS: Physicians in 2 university-affiliated primary care centers were randomized to a triage-based e-mail system promoted to their patients. E-mails from patients of intervention physicians were routed to a central account and parsed to the appropriate staff for response. Control group physicians and their patients did not have access to the system. We collected information on patient e-mail use, phone calls, and visit distribution by physician over the 10 months and performed physician and patient surveys to examine attitudes about communication. RESULTS: E-mail volume was greater for intervention versus control physicians (46 weekly e-mails per 100 scheduled visits vs 9 in the control group at the study midpoint; P <.01) but there were no between-group differences in phone volume (67 weekly phone calls per 100 scheduled visits vs 55 in the control group; P =.45) or rates of patient no-shows (5% in both groups; P =.77). Intervention physicians reported more favorable attitudes toward electronic communication than did control physicians but there were no differences in attitudes toward patient or staff communication in general. There were few between-group differences in patient attitudes toward electronic communication or communication in general. CONCLUSIONS: E-mail generated through a triage-based system did not appear to substitute for phone communication or to reduce visit no-shows in a primary care setting. Physicians' attitudes toward electronic communication were improved, but physicians' and patients' attitudes toward general communication did not change. Growth of e-mail communication in primary care settings may not improve the efficiency of clinical care.

Adult↗

PubMed2006

Major advances in genetic evaluation techniques.

The past quarter-century in genetic evaluation of dairy cattle has been marked by evolution in methodology and computer capacity, expansion in the array of evaluated traits, and globalization. Animal models replaced sire and sire-maternal grandsire models and, more recently, application of Bayesian theory has become standard. Individual test-day observations have been used more effectively in estimation of lactation yield or directly as input to evaluation models. Computer speed and storage are less limiting in choosing procedures. The increased capabilities have supported evaluation of additional traits that affect the net profitability of dairy cows. The importance of traits other than yield has increased, in a few cases due to an antagonistic relationship with yield. National evaluations combined internationally provide evaluations for bulls from all participating countries on each of the national scales, facilitating choices from among many more bulls. Selection within countries has increased inbreeding and the use of similar genetics across countries reduces the previously available outcross population. Concern about inbreeding has prompted changes in evaluation methodology and mating practices, and has promoted interest in crossbreeding. In just the past decade, distribution of genetic evaluations has gone from mailed paper or computer tapes for a limited audience to publicly accessible, request-driven distribution via the Internet. Among the distributed information is a choice of economic indices that combine an increasing array of traits into numbers reflecting breeding goals under different milk-pricing conditions. Considerable progress in genomics and the mapping of the bovine genome have identified markers for some deleterious recessive genes, but broader benefits of marker-assisted selection are still in the future. A possible exception is the proprietary use of DNA testing by semen producers to select among potential progeny test bulls. The collection and analysis of industry-wide data to evaluate genetic merit will continue to be the most important tool for genetic progress into the foreseeable future.

Animals↗

PubMed2005

Toward secure distribution of electronic health records: quantitative feasibility study on secure E-mail systems for sharing patient records.

If the quality and efficiency of medical services are to be ensured, electronic health records (EHR) and EHR-supporting infrastructure must be prevalent. Many hospitals, however, have EHR systems for their internal use only, and the standardization process for the exchange of medical information is still in process. This standardization process addresses information security and is considering public key infrastructure (PKI) as one security measure, but PKI is rarely used by medical practioners because of its poor user-friendliness. Here we propose an effective use of the identity-based encryption (IBE) system as a security measure. This system enables us to send encrypted and signed messages without requiring the receiver to get a public key, and it enables us to deliver secured messages to ambiguous receivers like those to whom letters of reference are sent. We evaluated the feasibility of this technology by using the analytic hierarchy process, which is an effective analysis tool when selection and judgment depend on nonquantitative psychological factors, to analyze the results of an experiment in which medical workers used E-mail agents with and without PKI and IBE. We found that medical practioners and researchers avoid using PKI because of its poor user-friendliness and instead use IBE even though it is harder to install. We therefore think IBE would encourage medical institutions to share patient records.

Algorithms↗

PubMedDate not supplied

[The study of the impact of the consensus conference "Strategies for long-term therapy of patients with schizophrenia"].

UNLABELLED: The case management, treatment and psychosocial rehabilitation of schizophrenic patients is an important part of the activity of the psychiatric sector and takes up many human, scientific, organizational and financial resources. The best way to reach satisfactory results for the individual patient is still uncertain and current practice in France shows noticeable variations that have been rarely investigated in terms of outcome. A consensus conference (CC) on "Strategies for long-term therapy of patients with schizophrenia" was therefore held in Paris in 1994 to produce accurate guidelines designed to help both clinicians and patients and to improve practice. It was organized by the French Federation of Psychiatry, the National Union of Friends and Relatives of Mental Patients, and the National Agency for the Development of Health Evaluation. The conclusions of the CC were mailed, in the form of a booklet, to members of these associations (psychiatrists and relatives) and were reported in the medical and general press. METHODS: The impact of the CC was judged by (a) the psychiatrists'awareness of the existence of the CC, (b) their knowledge of its conclusions, and (c) changes in practice. The following were analyzed: press coverage; requests for the booklet; the results of a survey of a representative sample of 396 psychiatrists two years after the CC; prescription changes in the public sector in a cohort of 2,407 schizophrenic patients under treatment at the time of the CC; prescriptions to psychotic patients by a representative sample of psychiatrists in private practice. RESULTS: Awareness: Articles on the CC were published in 27 journals and newspapers, 30,000 booklets were distributed and 8,348 were mailed in response to 1,121 spontaneous requests; 78% of the psychiatrists interviewed said they were aware of the existence of the CC and 70% said they were aware of the conclusions. Knowledge: The psychiatrists' declared practice conformed with CC conclusions 41%-85% of the time depending on the recommendation. No difference in practice was noted between the psychiatrists who said they knew of the recommendations and those who said they did not. Changes in practice: A significant but small improvement in prescription habits was noted for a principal recommendation ("just one neuroleptic is enough"). One-neuroleptic prescriptions increased from 51.1% the year before the CC to 56.4% two years after the CC. The increase mainly concerned the most recently treated patients. However, during the same time-span, prescriptions of anti-cholinergics plus neuroleptics rose from 48.2% to 54.3%. CONCLUSION: It is difficult to attribute changes in practice to a CC. However, the impact of the CC seemed real even if inconstant and not great enough. Clearly, to enhance impact an action plan is needed. It should include corrective measures and focus on additional dissemination efforts, teaching and training programs, and updating of guidelines if necessary.

Adult↗

PubMed2002

[Development and application of an Internet-based educational system to share pharmaceutical case reports between pharmacists].

For pharmacists to enhance skill of pharmaceutical cares, it is necessary to learn many instructive clinical cases, which include drug-related incidences and checks of medication errors by pharmacists. However, these cases tend to be kept in each facility and there is no access to the cases for outside pharmacists. Therefore, we aimed to develop an internet-based educational system to gather such cases, append educational commentaries by university staffs, and share them between pharmacists. An exclusive site was set up on the world wide web (WWW) homepage of the Section of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kyushu University (http://seizai.phar.kyushu-u.ac.jp) on November 2000. Browsing was limited to registered pharmacists. Any pharmacist can be freely registered. Cases were collected via WWW-forms in the site. After educational commentaries and elucidation were appended, the cases were distributed to the registered pharmacists by e-mails and WWW pages. Many applications for membership have been sent from around Japan to have more than 50 members per month, and many cases have been contributed. These cases were distributed weekly by e-mail magazines. The developed system enabled us to share many educational cases of drug-related problems all over the country. This system could contribute to pharmacists to enhance their skills of pharmaceutical cares.

Education, Pharmacy, Continuing↗

PubMed2005

The FOCIS international survey on psychiatrists' opinions on cognition in schizophrenia.

BACKGROUND: The goal of this project was to develop an interview to evaluate psychiatrists' views on the nature of cognitive dysfunction in schizophrenia, its importance as a potential treatment target, and its relative importance as a treatment target across different phases of schizophrenia. MATERIALS AND METHODS: A survey (available in paper or on-line) consisting of 27 questions, was developed by the Focus on Cognition in Schizophrenia (FOCIS) group, and distributed in a single wave mailing to 63,295 psychiatrists in 21 countries worldwide. RESULTS: The overall response rate was 4.7% (n=2975). The surveyed psychiatrists perceived cognition as a high treatment priority in stabilized schizophrenia patients, but less so for first episode or acute schizophrenia patients. The potential of atypical antipsychotics to improve cognitive dysfunction in schizophrenia was identified by 81% of the respondent psychiatrists. CONCLUSIONS: Cognitive deficits in people with schizophrenia are seen by clinical psychiatrists as relevant to treatment and rehabilitation plans. They were, however, regarded as a higher treatment priority in stabilized chronic rather than in first episode patients. The results suggest clinical psychiatrists need additional education regarding the nature of cognitive dysfunction in schizophrenia and its importance for psychosocial rehabilitation and community re-entry.

Attitude of Health Personnel↗

PubMedDate not supplied

Comparing breast cancer risk between lesbians and their heterosexual sisters.

PURPOSE: The purpose of this study was to explore the similarities and differences between lesbians and their heterosexual sisters in the established risks for developing breast cancer. METHODS: The design for this study was a matched (lesbian with heterosexual sister) cross-sectional, mail-back, anonymous survey. We distributed the surveys throughout the state of California to English-speaking women who identified themselves as lesbians, age 40 and older, and their sisters. Using the modified Gail Breast Cancer Risk model as well as other well-established factors associated with the development of breast cancer, we compared the breast cancer risk potential for 324 sister pairs (N = 648). Data were analyzed using paired t-tests, analysis of covariance (ANCOVA), McNemar's chi(2), or the Bowker statistic, as appropriate for the level of data. MAIN FINDINGS: The lesbians had significantly higher 5-year (p <.0001) and lifetime (p =.001) risk for developing breast cancer. The reasons for lesbians' predicted rate of breast cancer were most likely their higher scores on all pregnancy-related variables and the relatively high number of breast biopsies they reported. The lesbians had used birth control pills less (p <. 0001), had significantly fewer pregnancies (p <.0001), children (p <.0001), abortions (p <.0001), and miscarriages (p <.0001) as well as significantly more breast biopsies (p =.02) than did their heterosexual sisters. CONCLUSIONS: A lesbian who comes out to her clinician is relying on the clinician to be informed and be open to discuss her life. When a lesbian has a lump or a suspicious mammogram, she needs her clinician to advocate for her within the health care system because she is at higher risk for having cancer than a heterosexual woman.

Adult↗

PubMed1998

A criterion-referenced measure of latex allergy knowledge.

The exponential use of latex products has increased patients' and health care workers' sensitization to natural rubber latex. The purpose of this research study was to develop and test a set of items designed to measure professional nurses' knowledge about natural rubber latex reactions and interventions appropriate for latex precautions. The items were developed from research reports in the literature and changed to reflect the suggestions offered by experienced perioperative nurses (pilot = 8) and three nationally known experts in latex allergy responses. The revised form was mailed to the home or distributed at the workplace of perioperative nurses (n = 158). Criteria for item retention were < .90 difficulty index and clinical relevance. Certified nurses (i.e., CNORs) scored significantly higher than other nurses who took the test at the same time (t-test = 2.00, P = .05). A pretest and posttest evaluation of the revised 20 items was conducted before and after a latex allergy continuing education program during the spring of 1998. The current knowledge test (i.e., version 1.1) has reliability (alpha = .80); content validity (CVI = .92); and accumulated evidence of construct validity (preinstruction mean = 14.16, postinstruction mean = 17.15, t-paired = 10.54, df = 70, P = < .001). An empirically developed professional nurse latex allergy competency test suitable for clinical use was the outcome of this research study.

Clinical Competence↗

PubMed2005

The effectiveness of nutrition counselling by Australian General Practitioners.

OBJECTIVE: To determine whether General Practitioners (GPs) consider or provide nutrition counselling for hypertension, diabetes, lipid disorders, ischaemic heart disease (IHD), overweight or obesity, and whether GPs include assessment of the patient's usual diet, assessment of the patient's readiness to change their diet, provision and discussion of nutrition leaflets when counselling. DESIGN: A self-completed questionnaire. SETTING: New South Wales, Australia. SUBJECTS: A total of 399 GPs were surveyed using a division mailing list. METHODS: Questionnaires were distributed in May 2004 with two reminders provided at four-weekly intervals. RESULTS: Of the 399 GPs, 28 no longer practiced at the address while nine were on extended leave. Of the remaining 362, 50% responded, 5% declining to participate, while 163 (45%) completed the questionnaire. GPs were less likely to strongly agree to consider nutrition for hypertension (37%), IHD (61%) and overweight (68%), than diabetes (86%), lipid disorders (82%) and obesity (83%). They were also less likely to strongly agree to provide nutrition for hypertension (22%), IHD (46%) and overweight (45%), than diabetes (79%), lipid disorders (71%) and obesity (68%). In total, 97% of GPs provided some nutrition counselling, with 66% 'often' assessing the patients diet and 59% 'often' assessing the patient's readiness to change their diet. In total, 45% were unaware of stage of change behaviour theory. A total of 85% used nutrition leaflets and 59% 'often' discussed these with their patients. CONCLUSIONS: Determining what are the barriers to nutrition counselling for hypertension, IHD and overweight is urgently needed. Educating GPs on stage of change behaviour theory could increase the efficacy of the counselling provided.

Australia↗

PubMed2004

Clinician influences on use of portable electronic memory devices in traumatic brain injury rehabilitation.

PRIMARY OBJECTIVE: To explore the relationship between a group of clinicians' own experience, training and confidence with portable electronic memory devices and their use of the same in traumatic brain injury (TBI) rehabilitation. RESEARCH DESIGN: Survey study. METHODS AND PROCEDURES: Eighty-one TBI clinicians from various disciplines and work settings completed a survey distributed in person or by mail. MAIN OUTCOMES AND RESULTS: Twenty-nine respondents (36%) reported using portable electronic memory devices with patients with TBI. Using regression analysis, respondent device training and confidence teaching patients device use were statistically associated with respondents' use of such devices in TBI rehabilitation. CONCLUSIONS: Portable electronic memory device use with persons following TBI may be under-utilized. The importance of ongoing clinician training and of maximizing clinician confidence utilizing these devices in TBI rehabilitation is emphasized. The representativeness of the respondent sample is discussed. Specific training strategies and continued research needs are presented.

Adult↗

PubMed2004

Boundaries in psychotherapy supervision.

OBJECTIVE: This study examines the perceptions of trainees and supervisors on the boundaries of the supervisory relationship. METHOD: A 19-item questionnaire about the appropriateness of the actions of a psychotherapy supervisor was completed by 43 supervisors and 52 trainees. It was distributed at Grand Rounds and mailed out to psychotherapy supervisors in the community. RESULTS: Generally, trainees and supervisors agreed about the boundaries of supervision. Only one item indicated a significant difference between trainees and supervisors. Trainees considered the discussion of sexual fantasies as less appropriate than did supervisors. Using factor analysis, two scales accounted for 66% of the common variance. Supervisors scored higher than trainees on scale 1 (F = 5.14, df = 1.92, p = .03) and women scored lower than men on scale 2 (F = 9.88, df = 1.92, p = .002). CONCLUSION: Scale 1, a set of items related to sexual topics, revealed a significant difference in supervisor/trainee response with supervisors considering discussion of sexual items as appropriate compared to trainees. Scale 2, a set of items related to self-disclosure, revealed a significant difference with male respondents favoring looser boundaries and more self-disclosure than female respondents. The boundaries of the supervisory relationship are important concerns for our profession. This is the first study to provide an empirical evaluation of perceptions of trainees and supervisors on aspects of boundaries in the supervisory relationship. If the findings are replicated, they could contribute to future analysis of trainee/supervisor relationships. The maintenance of good boundaries between trainees and supervisors is crucial to the integrity of the supervisory relationship.

Factor Analysis, Statistical↗

PubMed1978

Comparative educational approaches to screening for colorectal cancer.

The purpose of the study was to evaluate the public's willingness to perform the do-it-yourself Hemoccult Test for colon-rectum cancer and to assess the relative effectiveness of alternative means of persuading people to do the test. American Cancer Society volunteers in four different part of the country contacted a total of 11,115 members of the American Association of Retired Persons, using five methods that differed in the extent of personal and impersonal contact involved. Other variables such as inclusion of postage and dietary restrictions were studied and cost efficiencies were estimated. The Group Meeting Method was the most effective personal distribution method. The Selective Mail-Out Method was the most effective impersonal method. The return rate was higher when postage was provided. Dietary restrictions did not markedly reduce participation. Including digital examinations did not affect the return rate. The findings suggest that the Hemoccult Test has the potential of reaching a significant proportion of the nation's older population.

Colonic Neoplasms↗