A proposed framework for addressing supervisee-supervisor value conflict

Value conflicts between supervisees and supervisors can adversely affect supervisee development, service provision, and the supervision relationship. However, the role of value conflicts in supervision has been minimally considered. Building on the Farnsworth and Callahan (2013) model for addressing client-clinician value conflict, we propose a supervision-specific framework to help supervisors and supervisees navigate value conflicts that emerge during supervision. The proposed framework consists of three steps: (a) detection of value conflict in supervision; (b) identification and articulation of value conflicts; and (c) determination of appropriate recommendations for supervisees. Neither punitive nor corrective in purpose, the model is eminently exploratory and educational in nature.     

The Turkish Version of the Auditory Consonant Trigram Test as a Measure of Working Memory: A Normative Study

The following study was conducted to adapt the Auditory Consonant Trigram Test (ACT) to Turkish, acquire a new and larger set of normative data, and finally investigate the reliability and validity of the adapted version. The data were collected from a sample of 236 healthy individuals. To test the validity of the Turkish version of ACT, the normative results of ACT were first compared with those obtained from the Digit Span Test (DST) backwards section. Secondly, the ACT performance of 53 schizophrenic patients was compared with that of a matched group selected from the normative sample. Age and education variables influenced performance, whereas gender did not in the normal sample. The ACT and DST backwards scores were positively correlated. As expected, the ACT performance was worse in schizophrenic patients compared to controls. The internal consistency of the adapted version of ACT was found to be at a reliable level (a=0.8535). The Turkish version of ACT can be considered to be a reliable and valid measure of working memory.     

Programmatic Costs of the Telehealth Ostomy Self-Management Training: An Application of Time-Driven Activity-Based Costing

ObjectivesProgrammatic cost assessment of novel clinical interventions can inform their widespread dissemination and implementation. This study aimed to determine the programmatic costs of a telehealth Ostomy Self-Management Training (OSMT) intervention for cancer survivors using Time-Driven Activity-Based Costing (TDABC) methodology.MethodsWe demonstrated a step-by-step application of TDABC based on a process map with core OSMT intervention activities and associated procedures and determined resource use and costs, per unit procedure. We also assessed per-patient costs from a payer perspective and provided estimates of total hours and costs by personnel, activity, and procedure.ResultsThe per-patient cost of the OSMT was $1758. Personnel time accounted for 91% of the total cost. Site supervisor and information technology technician time were the most expensive personnel resources. Telehealth technical and communication equipment accounted for 8% of the total cost. Intervention coordination and monitoring efforts represented most of the total time cost (62%), followed by the intervention delivery (35%). The procedures with the highest cost were communication via phone or virtual meetings (24%), email exchanges (18%), and telehealth session delivery (18%).ConclusionsFuture efforts to replicate, disseminate, and implement the OSMT intervention should anticipate funding for nonclinical components of the intervention, including coordination and monitoring, and consider how these activities can be performed most efficiently. For institutions without established telemedicine programs, selection of videoconferencing platforms and adequate staffing for participant technical support should be considered. Our step-by-step application of TDABC serves as a case study demonstrating how interventionists can gather data on resource use and costs of intervention activities concurrently with their collection of trial data.     

Care following stillbirth in high-resource settings: Latest evidence,guidelines, and best practice points

Third-trimester stillbirth affects approximately 2.6 million women worldwide each year. Although most stillbirths (98%) occur in low- and middle-income countries, most of the research on the impact of stillbirth and bereavement care has come from high-income countries. The impact of stillbirth ranges from stigma to disenfranchised grief, broken relationships, clinical depression, chronic pain, substance use, increased use of health services, employment difficulties, and debt. Appropriate bereavement care following a stillbirth is essential to minimise the negative socio-economic impact on parents and their families. This article presents the best practice points in stillbirth bereavement care, including taking an individualised and flexible approach. The latest published research, guidelines, and best practice points from high-income countries will be used and will highlight the gaps in the research which urgently need to be addressed. Research and investment in appropriate, respectful aftercare is needed to minimise the negative impact for parents.     

耳内镜外科技术教学与培训的思考

随着内镜显像技术的飞速发展,内镜在耳科手术中的使用得到不断的深入,同时给耳科手术带来了新的理念。近年来,国内也出现了一股耳内镜手术的热潮,涌现了一批从事耳内镜手术的专家,但关于耳内镜手术医生的标准化培训流程仍未形成。我中心是国内较早开展耳内镜手术的单位之一,经过长期的探索,不仅在耳内镜外科领域进行了广泛和深入的研究,在耳科医师耳内镜外科的教学培训方面也积累了一定的经验。     

Programme sentinelle : exemple de prévention du suicide auprès d’une population agricole en Suisse

ObjectivesIn the field of suicide prevention, the identification of risk groups is important, as is the training of front-line workers, to raise awareness of suicide issues. Agricultural workers represent a group at high risk of suicidal behavior due to various factors (low income of farmers, work related to climatic conditions, social isolation, poor access to primary care). The main objective of this article is to present the implementation of prevention training in suicide prevention for a population of agricultural workers in two cantons of French-speaking Switzerland (Vaud and Neuchâtel) which represent a population of about 980,000 inhabitants. The second objective is to identify the experiences of the participants in this training and their expectations.MethodsSuicide prevention training sessions are organized in collaboration with public health departments, agriculture departments and suicide prevention professionals. Each session is led by four trainers experienced in suicide prevention and belonging to the “Groupement Romand Prévention du Suicide” (GRPS) which manages the training and other training modules on this topic in French-speaking Switzerland. The GRPS guarantees the content of the training as well as the updating of scientific knowledge. The training model is based on a concept that alternates between brief theoretical contributions, exchanges between participants in plenary sessions and role playing in small groups. The training has two main objectives: on the one hand to work on the participants’ representations of suicide and to modify their posture by training “sentinels”, i.e. “peers” who can establish a link between suffering individuals and the available support resources. On the other hand, to give key messages: dare to talk about the suicidal question and to not remain alone with this.ResultsBetween December 2016 and May 2018, nine sessions were held in the two cantons of Vaud and Neuchâtel with a total of 220 participants. The sessions took place in agricultural schools or buildings related to agriculture. Invited to express themselves on the theme of suicide as well as on the concept of training, agricultural workers all verbalized the importance of this issue and were often very moved when the subject was discussed. The topics addressed by the participants were the taboo aspect of the subject, the difficulty of talking about it and the need to be able to address the subject (breaking the isolation). Participants also highlighted the need for peers to act as relays for help.ConclusionsThe sessions were highly appreciated by the organizers concerned, particularly by the public health and agricultural departments. Participants expressed their satisfaction at the opportunity to express their views on this subject, regretting that such initiatives are all too rare. Although studies highlight the difficulty of emotional expression in the agricultural field, we observed on the contrary a great facility of the participants to express their emotions in relation to the suicidal theme. We have highlighted that the issue of suicide in this population is linked to several causal factors, as is the suicidal issue more broadly. Factors specific to this population emerged from the sessions, including working conditions and difficulties related to the family environment of farmers. There is a need to strengthen suicide prevention with training programs among the agricultural population. We also note the major importance of improving access to mental health care which is often very deficient in rural areas.     

全科医师人文素质教育现状的探讨及反思

全科医师立足于基层医疗，旨在提高、满足基层居民卫生服务的全面需求。正是由于全科医师的定位及服务人群的特殊性，相对于专科医师来说，人文素质教育在全科医师培养中占据着更为重要的地位。如今，国内外越来越重视全科医师的人文素质培养，但我国相对于发达国家仍有不足。本文进一步强调了全科医师培养中人文素质教育的重要性，同时通过对比国内外全科医师人文素质教育的现状，进一步反思我国人文素质教育的改进方法。     

单纯胸外按压课程在高校人群心肺复苏培训中的应用

目的分析单纯胸外按压(chest compression cardiopulmonary resuscitation,CC-CPR)课程对高校人群胸外按压培训效果,探索心肺复苏公众培训新形式。方法招募120名高校人群随机分为CC-CPR课程组、Heart-saver CPR&AED First Aid(HS)课程组。两组分别进行不同课程培训,通过SUNLIFE Palm CPR胸腔按压反馈仪收集培训后按压数据,比较两组平均按压深度、平均按压频率、正确按压率、按压深度达标率、按压频率达标率、不良按压率。结果CC-CPR课程组在按压平均深度、频率上达到与HS课程组相同的培训效果,但在胸外按压达标率上比较,CC-CPR课程组比HS课程组在按压正确率、按压深度达标率、按压频率达标率上都有显著提升(P<0.05)。从不良胸外按压上比较,两组在滞留按压率、过深按压率、过慢按压率上都控制良好;但在过浅按压和过快按压发生率比较,CC-CPR课程组明显少于HS课程组,差异有统计学意义(P<0.05)。结论CC-CPR课程可使高校人群获得较HS课程更优的按压质量,且效率更高,是普及高校人群CPR培训方式的一种尝试与创新。     

Future ophthalmology practice pattern: A survey of Saudi Board of Ophthalmology residents

Purpose

The main purpose of the study was to examine and identify factors that influence the future practice pattern of Saudi Board of Ophthalmology residents as well as their academic goals. This study also aimed to compare the plans and career goals of the current Saudi ophthalmology residents with a former cohort of Saudi ophthalmology residents.