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Autonomy and supervision

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...
October 12, 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...
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...
July 14, 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...
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...
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)
Oluwasomi Festus Meshe, Leica Sarah Claydon, Hilary Bungay, Sharon Andrew
AIM: To investigate the relationship between physical activity (PA) and measures of health-related quality of life (HRQoL) and hospital admissions in people with chronic obstructive pulmonary disease (COPD) following pulmonary rehabilitation (PR). METHOD: CINAHL, Medline, PubMed, AMED, PsycINFO and Cochrane Library (database inception to July 2014) were searched. Relevant outcomes included relationships between PA and HRQoL, lung function (forced expiratory volume in one second, FEV1) and/or hospital admission...
April 6, 2016: Disability and Rehabilitation
Javier Jiménez Benito, Sonia Ester Rodríguez García
In this paper we analyze some of the major difficulties of informed consent (IC). We consider insufficient to base IC on the principle of autonomy. We must not forget that the patient may be in a situation of extreme vulnerability and the good doctor should assume a degree of commitment and responsibility with his/her decisions. Our aim is to introduce the ethics of responsibility of Levinas in practice and theory of IC in order to generate a beneficent medical practice in which the supervision and overseeing of the patient do not undermine his/her autonomy...
September 2016: Medicine, Health Care, and Philosophy
Meghan O'Connell, Chizoba Wonodi
BACKGROUND: Since 2002, the Nigerian government has deployed consultants to states to provide technical assistance for routine immunization (RI). RI consultants are expected to play a role in supportive supervision of health facility staff, capacity building, advocacy, and monitoring and evaluation. METHODS: We conducted a retrospective review of the RI consultant program's strengths and weaknesses in 7 states and at the national level from June to September 2014 using semi-structured interviews and online surveys...
March 2016: Global Health, Science and Practice
Hilary Bungay, Jo Jackson, Sue Lord
AIM: To examine the views of assistant practitioners and trainee assistant practitioners regarding experiences of practice in relation to the autonomy of the role and level of supervision, the training involved and support experienced in undertaking the foundation degree, and the effects of the assistant practitioner role in the workplace. METHOD: A service evaluation was undertaken in which a small cross-sectional quantitative survey was distributed to trainee assistant practitioners undertaking the foundation degree, and assistant practitioners who had previously completed the foundation degree or who had qualified via another route...
March 23, 2016: Nursing Standard
Susan Camille van Schalkwyk, Deborah Murdoch-Eaton, Ara Tekian, Cees van der Vleuten, Francois Cilliers
Doctoral studies represent a complex undertaking for students and supervisors. Some research describes the experience of students while there are volumes of advice for students considering a doctorate. Yet the terrain for supervisors is less well-trodden and the concept of a pedagogy of supervision is only really starting to emerge. Texts on the doctoral journey from the supervisor's perspective are uncommon and less yet has been written in the context of health professions education. The aim of this Guide, therefore, is to provide guidance for the supervisor's journey, drawing on our collective experience and such literature as there is...
May 2016: Medical Teacher
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