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Autonomy and supervision

Evelien Van Roie, Sofie Martien, Emalie Hurkmans, Johan Pelssers, Jan Seghers, Filip Boen, Christophe Delecluse
OBJECTIVE: To evaluate the feasibility and short- and long-term effects of two 10-wk structured ergometer-cycling programs among elderly in assisted-living residences. DESIGN, SETTING, AND PARTICIPANTS: Eight assisted-living residences (N=95; age=81.2±5.9years) were randomly assigned to one of three conditions: 1) ergometer-cycling with strict coach-supervision (STRICT, N=3; n=35); 2) ergometer-cycling with autonomy-supportive minimal contact coach-supervision (AUT; N=3; n=36); or 3) control condition (CON; N=2, n=24)...
January 19, 2017: Archives of Gerontology and Geriatrics
Mark Wilberforce, Michele Abendstern, Sue Tucker, Saima Ahmed, Rowan Jasper, David Challis
AIMS: To explore the support worker functions in community mental health teams for older adults in relation to roles, boundaries, supervision and training. BACKGROUND: Support workers in community mental health teams provide important help to older people with complex mental and physical health needs in their own homes. Their numbers have grown substantially in recent years, but without professional registration there is concern that boundaries with qualified practitioners are insufficiently clear and that they do not receive the support they require...
January 25, 2017: Journal of Advanced Nursing
Olga Kantor, Andrew B Schneider, Marko Rojnica, Andrew J Benjamin, Nancy Schindler, Mitchell C Posner, Jeffrey B Matthews, Kevin K Roggin
BACKGROUND: To simulate the duties and responsibilities of an attending surgeon and allow senior residents more intraoperative and perioperative autonomy, our program created a new resident acute care surgery consult service. METHODS: We structured resident acute care surgery as a new admitting and inpatient consult service managed by chief and senior residents with attending supervision. When appropriate, the chief resident served as a teaching assistant in the operation...
December 5, 2016: Surgery
Brandon M Wojcik, Zhi Ven Fong, Madhukar S Patel, David C Chang, Emil Petrusa, John T Mullen, Roy Phitayakorn
OBJECTIVE: General surgery training has evolved to align with changes in work hour restrictions, supervision regulations, and reimbursement practices. This has culminated in a lack of operative autonomy, leaving residents feeling inadequately prepared to perform surgery independently when beginning fellowship or practice. A resident-run minor surgery clinic increases junior resident autonomy, but its effects on patient outcomes have not been formally established. This pilot study evaluated the safety of implementing a resident-run minor surgery clinic within a university-based general surgery training program...
November 2016: Journal of Surgical Education
Jane Cover, Allen Namagembe, Justine Tumusiime, Jeanette Lim, Jennifer Kidwell Drake, Anthony K Mbonye
OBJECTIVES: Evidence on contraceptive self-injection from the United States and similar settings is promising, and the practice may increase access. There are no published studies on the feasibility of contraceptive self-injection in sub-Saharan Africa to date. The purpose of this study was to assess feasibility of subcutaneous depot medroxyprogesterone acetate self-injection in Uganda, with specific objectives to (a) measure the proportion of participants who self-injected competently, (b) measure the proportion who self-injected on time 3 months after training (defined conservatively as within 7 days of their reinjection date) and (c) assess acceptability...
October 24, 2016: Contraception
Eliseu Paglioli, William Alves Martins, Ney Azambuja, Mirna Portuguez, Thomas More Frigeri, Larissa Pinos, Ricardo Saute, Cora Salles, João Rubião Hoefel, Ricardo Bernardi Soder, Jaderson Costa da Costa, Marta Hemb, Tom Theys, André Palmini
OBJECTIVE: To evaluate a novel approach to control epileptic drop attacks through a selective posterior callosotomy, sparing all prefrontal interconnectivity. METHODS: Thirty-six patients with refractory drop attacks had selective posterior callosotomy and prospective follow-up for >4 years. Falls, episodes of aggressive behavior, and IQ were quantified. Autonomy in activities of daily living, axial tonus, and speech generated a functional score ranging from 0 to 13...
November 8, 2016: Neurology
Mardelle McCuskey Shepley, Angela Watson, Francis Pitts, Anne Garrity, Elizabeth Spelman, Janhawi Kelkar, Andrea Fronsman
OBJECTIVES: The purpose of the study was to identify features in the physical environment that are believed to positively impact staff and patients in psychiatric environments and use these features as the foundation for future research regarding the design of mental and behavioral health facilities. METHODS: Pursuant to a broad literature review that produced an interview script, researchers conducted 19 interviews of psychiatric staff, facility administrators and architects...
September 2016: General Hospital Psychiatry
April Catlett
PURPOSE: The purpose of this cross-sectional, quantitative research was to examine if registered dental hygienists feel competent to work independently based on regulations of dental supervision. METHODS: A stratified sample of 360 dental hygienists from 8 states completed the Dempster Practice Behaviors Scale survey. ANOVA and MANOVA analyses revealed how state dentist supervision level, age, degree of education, employment status, gender and years of clinical experience affect the perceived autonomy of professional dental hygienists...
August 2016: Journal of Dental Hygiene: JDH
Fauziah Rabbani, Leah Shipton, Wafa Aftab, Kashif Sangrasi, Shagufta Perveen, Aysha Zahidie
BACKGROUND: Community health worker motivation is an important consideration for improving performance and addressing maternal, newborn, and child health in low and middle-income countries. Therefore, identifying health system interventions that address motivating factors in resource-strained settings is essential. This study is part of a larger implementation research project called Nigraan, which is intervening on supportive supervision in the Lady Health Worker Programme to improve community case management of pneumonia and diarrhea in rural Pakistan...
2016: BMC Health Services Research
Njoki Ng'ang'a, Mary Woods Byrne, Margaret E Kruk, Aloisia Shemdoe, Helen de Pinho
BACKGROUND: In sub-Saharan Africa, the capacity of human resources for health (HRH) managers to create positive practice environments that enable motivated, productive, and high-performing HRH is weak. We implemented a unique approach to examining HRH management practices by comparing perspectives offered by mid-level providers (MLPs) of emergency obstetric care (EmOC) in Tanzania to those presented by local health authorities, known as council health management teams (CHMTs). METHODS: This study was guided by the basic strategic human resources management (SHRM) component model...
2016: Human Resources for Health
Rune Svanström, Susanne Andersson, Helena Rosén, Mia Berglund
BACKGROUND: In implementing new programs of care, such as person-centered care, there is a risk that the focus will be at an organizational level, instead of a level that describes what happens in the personal development among staff. The aim of this study was to describe experiences of the implementation process of a learning supporting model designed to increase patient involvement and autonomy in care. The project, which lasted 2 years, involved training sessions, supervision and reflective meetings...
July 23, 2016: BMC Research Notes
Marit Hitzert, Marieke A A Hermus, Marisja Scheerhagen, Inge C Boesveld, Therese A Wiegers, M Elske van den Akker-van Marle, Paula van Dommelen, Karin M van der Pal-de Bruin, Johanna P de Graaf
OBJECTIVE: to assess the experiences with maternity care of women who planned birth in a birth centre and to compare them to alternative planned places of birth, by using the responsiveness concept of the World Health Organization. DESIGN: this study is a cross-sectional study using the ReproQ questionnaire filled out eight to ten weeks after birth. The primary outcome was responsiveness of birth care. Secondary outcomes included overall grades for birth care and experiences with the birth centre services...
September 2016: Midwifery
Emily Reeve, Petra Denig, Sarah N Hilmer, Ruud Ter Meulen
Deprescribing is the term used to describe the process of withdrawal of an inappropriate medication supervised by a clinician. This article presents a discussion of how the Four Principles of biomedical ethics (beneficence, non-maleficence, autonomy, and justice) that may guide medical practitioners' prescribing practices apply to deprescribing medications in older adults. The view of deprescribing as an act creates stronger moral duties than if viewed as an omission. This may explain the fear of negative outcomes which has been reported by prescribers as a barrier to deprescribing...
December 2016: Journal of Bioethical Inquiry
Cécile Bolly
A long-distance training course was implemented to the academic program which teaches ethics to future doctors. Its main objective was to develop students' individual patient care skills to carry out an analysis on ethically problematic situations. Such procedures may seem paradoxical in a training course which aims to develop one's sensitivity to others; it does however help to accommodate the geographical constraints linked to students accessing their practical training (in a country's different hospitals or abroad) and provides students with a introductory course on e-learning organised by their university's learning centre...
March 2016: Journal International de Bioéthique, International Journal of Bioethics
Andrea L Shugar, Nada Quercia, Christopher Trevors, Marina M Rabideau, Sohnee Ahmed
With the increasing awareness of genetic contributions to disease in Canada, the availability of and demand for genetic testing has soared. Genetic counseling is becoming a recognized and rapidly growing (yet unregulated) health profession in Canada. We hypothesized that the potential risk for harm to the public posed by genetic counseling practice in the province of Ontario is sufficient to consider regulation. The Ontario Ministry of Health and Long-Term Care (MOHTLC) sets criteria (both primary and secondary) to identify health professional bodies that meet the threshold for regulation in the province...
June 7, 2016: Journal of Genetic Counseling
Isabel Del Cura-González, Juan A López-Rodríguez, Teresa Sanz-Cuesta, Ricardo Rodríguez-Barrientos, Jesús Martín-Fernández, Gloria Ariza-Cardiel, Elena Polentinos-Castro, Begoña Román-Crespo, Esperanza Escortell-Mayor, Milagros Rico-Blázquez, Virginia Hernández-Santiago, Amaya Azcoaga-Lorenzo, Elena Ojeda-Ruiz, Ana I González-González, José F Ávila-Tomas, Jaime Barrio-Cortés, José M Molero-García, Raul Ferrer-Peña, María Eugenia Tello-Bernabé, Mar Trujillo-Martín
BACKGROUND: Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce...
May 17, 2016: Implementation Science: IS
Gurjit Sandhu, Christopher P Magas, Adina B Robinson, Christopher P Scally, Rebecca M Minter
OBJECTIVE: The purpose of this study was to identify behaviors that faculty and residents exhibit during intraoperative interactions, which support or inhibit progressive entrustment leading to operative autonomy. BACKGROUND: In the operating room, a critical balance is sought between direct faculty supervision and appropriate increase in resident autonomy with indirect faculty supervision. Little is known regarding perspectives of faculty and residents about how attendings increasingly step back and safely delegate autonomy to trainees...
May 9, 2016: Annals of Surgery
Soter Ameh, Eme Owoaje, Angela Oyo-Ita, Caroline W Kabiru, Obaji E O Akpet, Aniekan Etokidem, Okokon Enembe, Nnette Ekpenyong
BACKGROUND: Malaria in pregnancy (MIP) has serious consequences for the woman, unborn child and newborn. The use of sulfadoxine-pyrimethamine for the intermittent preventive treatment of malaria in pregnancy (SP-IPTp) is low in malaria endemic areas, including some regions of Nigeria. However, little is known about pregnant women's compliance with the SP-IPTp national guidelines in primary health care (PHC) facilities in the south-south region of Nigeria. The aim of this study was to identify the barriers to and determinants of the use of SP-IPTp among pregnant women attending ANC in PHC facilities in Cross River State, south-south region of Nigeria...
May 4, 2016: BMC Pregnancy and Childbirth
Aspasia Karageorge, Anthony Llewellyn, Louise Nash, Claire Maddocks, Dimitra Kaldelis, Harsimrat Sandhu, James Edwards, Brian Kelly
OBJECTIVE: In Australia and internationally, psychiatry has struggled to fill training places to keep up with demand for service. The objective of this study was to review the components of psychiatry terms and placements that determine a positive experience and potentially influence interest in vocational training in psychiatry. METHOD: A literature review and narrative synthesis was undertaken on 20 papers identified as meeting inclusion criteria. RESULTS: The top themes contributing to positive experiences during the psychiatry term were: receiving high quality supervision; supported autonomy; and witnessing patient recovery...
June 2016: Australasian Psychiatry: Bulletin of Royal Australian and New Zealand College of Psychiatrists
Angela Gurrado, Rocco Bellantone, Giuseppe Cavallaro, Marilisa Citton, Vasilis Constantinides, Giovanni Conzo, Giovanna Di Meo, Giovanni Docimo, Ilaria Fabiola Franco, Maurizio Iacobone, Celestino Pio Lombardi, Gabriele Materazzi, Michele Minuto, Fausto Palazzo, Alessandro Pasculli, Marco Raffaelli, Frederic Sebag, Salvatore Tolone, Paolo Miccoli, Mario Testini
This retrospective comparative multicenter study aims to analyze the impact on patient outcomes of total thyroidectomy (TT) performed by resident surgeons (RS) with close supervision and assistance of attending surgeons (AS).All patients who underwent TT between 2009 and 2013 in 10 Units of endocrine surgery (8 in Italy, 1 in France, and 1 in UK) were evaluated. Demographic data, preoperative diagnosis, extension of goiter, type of surgical access, surgical approach, operative time, use and duration of drain, length of hospitalization, histology, and postoperative complications were recorded...
April 2016: Medicine (Baltimore)
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