Combination insulin and sulfonylurea therapy in insulin-requiring type 2 diabetes mellitus

OBJECTIVES: To identify ethical dilemmas experienced by occupational and physical therapists working in the UK National Health Service (NHS). To compare ethical contexts, themes and principles across the two groups. DESIGN: A structured questionnaire was circulated to the managers of occupational and physical therapy services in England and Wales. SUBJECTS: The questionnaires were given to 238 occupational and 249 physical therapists who conformed to set criteria. RESULTS: Ethical dilemmas experienced during the previous six months were reported by 118 occupational and 107 physical therapists. The two groups were similar in age, grade, and years of experience. Fifty of the occupational therapy dilemmas occurred in mental health settings but no equivalent setting emerged for physical therapy. Different ethical themes emerged between the two groups, with the most common in occupational therapy being difficult/dangerous behaviour in patients and unprofessional staff behaviour, and for physical therapists resource limitations and treatment effectiveness. No differences were found in the ethical principles used. CONCLUSION: The ethical dilemmas reported by the therapists were primarily concerned with health care ethics, rather than the more dramatic ethics reported in much of the biomedical ethics literature. Differences were found between the two professional groups when ethical contexts and themes were compared but not when ethical principles were compared. This suggests that educators and researchers need to be aware of work settings and the interdisciplinary nature of employment as well as ethical principles held by individual therapists.     

Use of videotape in occupational therapy

The use and production of videotapes in occupational therapy are expected to increase in the future. A survey of 54 occupational therapy curricula and 59 hospital-clinics showed that 71 percent of the respondents use videotapes. Of that group, 70 percent produce videotapes for occupational therapy. Forty-six percent of the producers of occupational therapy videotapes make them available to others. Ninety-two percent of the respondents indicated a need for reviews of films and videotapes pertinent to occupational therapy, either in a directory--or a directory, with monthly reviews of new materials in the Occupational Therapy Newspaper or AJOT. A listing of subject areas most needed in a videotape format was also compiled.     

Occupational health nurses and occupational hygiene: a study of South African nurses' attitudes

The objectives of this study were to assess the current occupational hygiene practices of occupational health nurses and to assess their attitudes to the identification and initial quantification of workplace hazards. A questionnaire was mailed to all occupational health nurses registered with the South African Society of Occupational Health Nurses. Responses were obtained from 221 (53.7%). Responders and non-responders did not differ on key characteristics. Only 14 (6%) of the respondents performed occupational hygiene tasks as part of their routine work and only 31 (14%) volunteered hazard identification and quantification as tasks that would significantly improve practice. Nevertheless, when asked directly, 120 (54%) agreed that occupational hygiene fell into the ambit of occupational health nursing. Over 70% were positive about receiving theoretical and practical hygiene training. Constraints to greater hazard identification included limited time and resources and concern about intruding into the domains of other practitioners. Sufficient numbers of occupational health nurses were interested in identifying hazards in the workplace for training courses to be planned and offered now; however, restraints to practice need to be clarified and removed for these new skills to be used effectively.     

Improving peer supervisor ratings of therapist performance in dialectical behavior therapy: An Internet-based training system.

The present study involved the development of an Internet-based training system (ITS) to help train peer supervisors. The system, which was piloted with Dialectical Behavior Therapy (Linehan, 1993) using mock sessions, demonstrates how Internet-based technology can facilitate training protocols to support the ongoing training and supervision of therapists efficiently. Participant evaluation of the system was very positive, with over 90% of respondents reporting that they believed that the ITS was very useful or extremely useful for therapist training. Possible uses of the system include: (a) helping therapists to learn to discriminate more effective from less effective interventions to provide better feedback to supervisees and peers on their sessions, (b) helping therapists to improve their own ability to monitor and deliver a treatment effectively, and (c) helping to structure therapist training and supervision activities. The system could also be used to help with real-world supervision of therapists, assuming that legal and ethical issues associated with the use of the Internet for clinical supervision are addressed adequately. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Continuing medical education in marital and family therapy: a survey of South Australian psychiatrists

OBJECTIVE: South Australian psychiatrists were surveyed to determine their impressions of the usefulness of marital and family therapy (MFT) in the management of serious psychiatric conditions and to ascertain their previous experience with Continuing Medical Education (CME) about family therapy. It was expected that psychiatrists' preferences regarding CME would be related to their clinical experience of the usefulness of MFT. METHOD: One hundred and twenty psychiatrists returned a questionnaire about their training, clinical and research interests, with ratings of the usefulness of MFT and CME preferences. This represented 65% of those eligible for the CME programme. RESULTS: Thirteen percent of the respondents found MFT to be extremely useful and a further 47% found it moderately useful in their current practice. There was evidence of a possible training effect: respondents who had previous CME rated MFT as more useful, especially for mood disorders. Furthermore, the treatment of mood disorders seemed to have a particular relevance in family psychiatry, making a statistically unique contribution to ratings of MFT usefulness in the respondents' total practice. Sixty-nine percent of the respondents requested further CME in family therapy. This represented 45% of all South Australian psychiatrists. Respondents who rated MFT as more useful in practice were significantly more likely to be interested in CME. CONCLUSIONS: There seems to be sufficient interest and clinical experience among psychiatrists for MFT to be included in CME courses. It is recommended that further training focus on major mental disorders, especially mood disorders and schizophrenia.     

Multi-institutional survey of graduates of pediatric anesthesia fellowship: assessment of training and current professional activities

We surveyed all the graduates of four fellowship programs in pediatric anesthesia between 1985 and 1993 to assess their current professional activities, their evaluation of fellowship training, and their opinions on future directions of such training. One-hundred ninety-one (62%) of the graduates responded. Nearly all of the respondents had sought fellowship training for pediatric anesthesia and thought that the training was worthwhile. At the time of the survey, 40% worked in a children's hospital, 72% had university or affiliate positions, and 54% had a practice that was > 50% pediatric. Those with > or = 12 mo fellowship and/or board certification in pediatrics were the most likely to have a pediatric-dedicated practice. Seventy percent of the respondents thought that fellowship training should be for 12 mo, and the proportion of respondents who recommended inclusion of training in pain management and clinical research was greater than the number who had actually received such training. Fifty-eight percent of respondents supported restriction of fellowship positions in the future, but 83% did not support a mandatory 2-yr fellowship with research training. We conclude that fellowships in pediatric anesthesia seem to be successful in providing training that is not only satisfying to the trainees, but that is also followed by active involvement in the care of children and in the training of residents and fellows in anesthesia. Additional information should be gathered to assess the impact of this training on pediatric care, to formulate a standardized curriculum, and to justify support for such training in the future. Implications: We surveyed graduates of four fellowship programs in pediatric anesthesia (1985-1993) to assess current professional activities, fellowship training, and future directions of such training. Fellowships in pediatric anesthesia seem to provide training that is satisfying to trainees and that is followed by active involvement in the care of children.     

A survey of current clinical practice of permanent prostate brachytherapy in the United States

PURPOSE: To help establish standards of care for transperineal interstitial permanent prostate brachytherapy (TIPPB) by obtaining data regarding current clinical practice among the most experienced TIPPB brachytherapists in the United States. METHODS AND MATERIALS: The 70 brachytherapists who performed the greatest number of TIPPB cases in 1995 in the U.S. were surveyed. Each received a comprehensive four page questionnaire that included sections on training and experience, patient and isotope selection criteria, manpower, technique, and follow-up. Thirty-five (50%) surveys were ultimately returned after three mailings and follow-up phone calls. The cumulative experience of the 35 respondents represented approximately 45% of the total TIPPB volume in the U.S. for 1995. Respondents included 29 from the private sector and six from academic programs. RESULTS: The median physician experience with TIPPB was reported as 4.9 years. Each performed an average of 73 TIPPB procedures in 1995 (range 40-300). This represented an increase in volume for most (74%) of the respondents. Sixty-three percent of the respondents attended a formal training course, 54% had TIPPB-specific residency training, and 31% had been proctored (16 had received two or more types of training experience). The most commonly reported selection criteria for implant alone was on Gleason score < or = 7, PSA < 15, < or = Stage T2a, and gland size < or = 60 cc, although no clear consensus was found. Fifty-four percent considered a history of TURP to be a relative contraindication, while 34% considered TURP to have no impact on patient selection. Eighty-six percent of respondents combine brachytherapy with external beam radiation in an average of 32% of their patients. Boosts were given with both 125I prescribed to 120 Gy (75%) or 103Pd to 90 Gy (50%). Sixty percent reported using a Mick applicator, 46% prefer using preloaded needles, and (11%) use both techniques. Real-time imaging was usually performed with ultrasound (94%); most included fluoroscopy (60%). Definitions of PSA control varied widely. CONCLUSIONS: TIPPB clinical practice in the U.S. demonstrates similarities in technique, but differences in patient selection and definitions of biochemical control. It is, therefore, incumbent on those beginning TIPPB programs to carefully review the specific practice details of those institutions with a broad experience.     

Training graduate students to be clinical supervisors: A survey of Canadian professional psychology programmes.

Recognising the need for training in clinical supervision, the Canadian Psychological Association (CPA) requires that accredited professional psychology programmes offer graduate students training in supervision. To fill a gap in the existing supervision literature, we surveyed training directors (or designates) of CPA accredited clinical and counselling programmes to understand how this training standard is currently being met in the area of clinical supervision. Responses were obtained from 20 of 28 programmes (71.4% response rate). Approximately 50% of respondents indicated that their programmes required some coursework related to clinical supervision, with wide variability, however, in the number of hours of coursework provided to students (range 3 to 39). Most courses included lectures and group discussion, but also often provided students with practical experience in clinical supervision provision. Only 25% of programmes required a practicum in which students gained experience in clinically supervising other students, although an additional 40% of programmes offered an elective practicum in which students gained some training in clinical supervision. Most programmes (~71%) identified strategies for improving training in clinical supervision (e.g., improving course work, requiring practical experience), but also identified challenges to offering clinical supervision training (e.g., availability of skilled supervisors, insufficient time to devote to supervision, student competency). Based on the findings, we offer some recommendations for how training in clinical supervision could be improved in Canadian professional psychology programmes as well as describe some important directions for future research in this area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethics-based training for nonclinical staff in mental health settings.

Under the Ethics Code of the American Psychological Association (2002), psychologists are responsible for ensuring that delegated tasks are performed competently. For staff members who interact with clients or who have access to confidential client information, technical competence may not suffice. Psychologists who want to provide the best protection for clients can offer staff training that fosters “ethical competence” as well. Setting-specific ethics training is important even for personnel who have previously worked in other mental health sites, because it demonstrates how the profession’s ethical standards will be upheld through specific policies in the current setting. From an ethical perspective, staff training is not an end in itself or a risk-management strategy for protecting psychologists; rather, it is a means of protecting clients and their rights. The goal is to create a culture of safety (S. J. Knapp & L. D. VandeCreek, 2006) in which upholding ethical standards becomes everyone’s shared responsibility. This ethics-based training would be appropriate for nonclinical staff, clinical staff, supervisees, and students. It can be adapted to outpatient, inpatient, research, or academic clinic settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A pilot study of the theoretical and technical competence and appropriate education for the use of nine physical agent modalities in occupational therapy practice

OBJECTIVE: This study described occupational therapy practitioners' perceptions about the content and method of training or education necessary for gaining theoretical and technical competence in the use of nine physical agent modalities (PAMs). METHOD: A survey was developed and sent to 543 members of the Physical Disabilities Special Interest Section of the American Occupational Therapy Association who had identified their primary area of practice as hand therapy. One hundred and fifty-one completed surveys (28% response rate) were returned. RESULTS: The respondents indicated that theoretical and technical expertise necessary for competent use of PAMs varied according to the type of modality being considered. Continuing education courses were identified as the best method for gaining theoretical and technical competence for the use of deep thermal agents, such as ultrasound and electrical stimulation agents, whereas entry-level professional education and one-the-job training were identified as most appropriate for superficial thermal agents, such as paraffin bath and hot and cold packs. CONCLUSION: The results suggest that considerations regarding the type and amount of education necessary for gaining theoretical and technical competence in the use of PAMs depend on the type of modality being addressed. These differences should be considered in the future development of competency objectives for the use of PAMs.     

An exploration of experiences and preferences in clinical supervision with play therapists.

Clinical supervision plays a significant role in the counseling profession. Understanding and refining the supervisory process can foster development in the training of therapists in general and play therapists in particular, ultimately resulting in better mental health services for children. This study was designed to explore the experiences and preferences of play therapists in clinical supervision. Participants (N = 559) completed a Web-hosted survey that included items related to their current and preferred supervision experiences as well as a demographic questionnaire. A subset of the respondents (N = 238) completed questions related to their current supervision experiences. Findings suggest that: (a) a substantial number of participants were not receiving supervision for their work in play therapy, (b) supervisees prefer a combination of group and individual supervision, (c) supervisor professional identity as a play therapist and credential are salient supervisee preferences, and (d) compared to current supervision experiences, supervisee preferences had a noteworthy impact on practical significance demonstrated through large, moderate, and small effect sizes. Results from the study offer an opportunity for professionals to consider changes in how supervision is provided to therapists who work with children in play settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multiskilling: a survey of occupational therapy practitioners' attitudes

OBJECTIVE: Multiskilling has been identified as one means of reducing she cost of health care. This study examined occupational therapy practitioners' knowledge of multiskilling, how it is affecting service delivery and quality of care, and how therapists believe the addition of skills should occur. METHOD: A questionnaire was constructed for the survey and mailed to a random sample of 200 occupational therapists and occupational therapy assistants, all of whom were members of the American Occupational Therapy Association. RESULTS: The 117 respondents had a moderate understanding of multiskilling. They responded that multiskilling is beneficial to both the occupational therapy profession and the clients it serves, but they were also aware of its potential risks or disadvantages. According to respondents, multiskilling occurs formally through defined protocol and; more commonly, informally, driven by necessity and the desire to treat the client most effectively. CONCLUSION: The results indicate a need for the occupational therapy profession to define multiskilling and cross training; develop ways of serving clients that respond to administrative needs and constraints while preserving the uniqueness of occupational therapy; and monitor treatment outcomes of all service delivery methods to provide information regarding efficiency, effectiveness, and client satisfaction.     

Utilizing technological innovations to enhance psychotherapy supervision, training, and outcomes.

Recent technological advances in the use of the Internet and video technologies has greatly impacted the provision of psychotherapy and other clinical services as well as how the training of psychotherapists may be conducted. When utilized appropriately these technologies may provide greater access to needed services to include treatment, consultation, supervision, and training. Specific ethical challenges and pitfalls are discussed and recommendations are made for the ethical use of these technologies. Additionally, innovative practices from the seven articles in the special section that follows are highlighted and reviewed. These articles present a number of innovations that can take psychotherapy training, research, supervision, and treatment forward toward increased effectiveness. Recommendations for integrating these innovations into ongoing practices are provided and for additional research to build on the important work of the authors in this special section are provided. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Skills training versus psychosocial occupational therapy for persons with persistent schizophrenia

OBJECTIVE: The authors compared the community functioning of outpatients with persistent forms of schizophrenia after treatment with psychosocial occupational therapy or social skills training, with the latter conducted by paraprofessionals. METHOD: Eighty outpatients with persistent forms of schizophrenia were randomly assigned to receive either psychosocial occupational therapy or skills training for 12 hours weekly for 6 months, followed by 18 months of follow-up with case management in the community. Antipsychotic medication was prescribed through "doctor's choice" by psychiatrists who were blind to the psychosocial treatment assignments. RESULTS: Patients who received skills training showed significantly greater independent living skills during a 2-year follow-up of everyday community functioning. CONCLUSIONS: Skills training can be effectively conducted by paraprofessionals, with durability and generalization of the skills greater than that achieved by occupational therapists who provide their patients with psychosocial occupational therapy.     

Intravenous cyclosporine for severe attacks of ulcerative colitis: a survey of Canadian gastroenterologists

A single randomized trial evaluated the use of intravenous cyclosporine treatment for severe attacks of ulcerative colitis. The perceived efficacy and safety of this intervention were measured through a survey of the membership of the Canadian Association of Gastroenterology (CAG). METHODS: All CAG members were mailed a survey with questions regarding their familiarity with the data supporting the use of cyclosporine, their perception of the efficacy and toxicity of the drug, and whether patients who fail conventional treatment should receive this therapy. The proportion of respondents who had used cyclosporine to treat severe ulcerative colitis was determined. RESULTS: One hundred and sixty-one responses were received (34% response rate). Sixty-four per cent of respondents were academic faculty members and 82% treated patients with severe colitis. Using multivariate analyses, positive associations were found between the respondents' age (P = 0.004) and subspecialty training in gastroenterology (P = 0.001), and whether respondents treat patients with severe ulcerative colitis. Twenty-six per cent of individuals had prescribed cyclosporine for this indication, of whom 88% were in academic practice (P = 0.007). Over 90% of respondents believe that further clinical trials are needed before cyclosporine becomes accepted as standard therapy. CONCLUSIONS: Although the use of cyclosporine is measurable among Canadian gastroenterologists, the majority believe that further clinical trials are necessary before the drug is accepted as a standard therapy.     

Dental health attitudes among dentate black and white adults

OBJECTIVES: Blacks and poor persons share a greater burden of oral disease and are less likely to seek dental care on a regular basis. The role of dental attitudes and knowledge of services on this circumstance is unclear. The authors quantified group differences in dental attitudes and knowledge of services and related them to regularity of dental care use. METHODS: As part of the baseline phase of The Florida Dental Care Study, a longitudinal study of oral health, 873 respondents who had at least one tooth and who were 45 years or older participated for an interview and a clinical dental examination. Dental care use, seven dental attitudinal constructs, and knowledge of dental services were queried. RESULTS: Forty-five percent of respondents reported going to a dentist only when they have a problem, and 17% of respondents had not seen a dentist in more than 5 years. Ten percent of respondents reported that they had at least one permanent tooth removed by someone other than a dentist (typically, the respondent himself). Blacks and poor persons had more negative attitudes toward dental care and dental health and were less knowledgeable of dental services. Multivariate analyses suggested that dental attitudes were important to understanding the use of dental care services for this diverse group of adults, and that race and poverty contributed independently to dental care use even with dental attitudes taken into account. CONCLUSIONS: Dental attitudes contribute to race and poverty differences in dental care use among adults. The persistence of race and poverty effects with attitudes taken into account suggests that additional explanatory factors contribute as well. These differences may contribute to more prevalent and severe oral health decrements among the same adults who also are more likely to suffer from other health decrements.     

Treatment of depression by obstetrician-gynecologists: a survey study

OBJECTIVE: We performed an exploratory survey of depression diagnosis, treatment, and patient referral patterns by Fellows of ACOG. We also examined obstetrician-gynecologists' professional training in the management of clinical depression. METHODS: We sent a questionnaire to a total of 1370 ACOG Fellows. Sixty percent of the surveys were returned. RESULTS: As a group, obstetrician-gynecologists reported diagnosing an average of four new cases of depression per month. Within the overall sample, the number of new diagnoses of depression made each month was significantly greater for those defining themselves as primary care physicians than for those defining themselves as specialists. When treating depression pharmacologically, obstetrician-gynecologists reported that they overwhelmingly (74% of the time) chose selective serotonin reuptake inhibitor antidepressants. Ninety-five percent of obstetrician-gynecologists reported that they referred severely depressed patients to a mental health professional. A majority of respondents neither received residency training (80%) nor completed a continuing medical education course (60%) on the treatment of clinical depression in women. CONCLUSION: Obstetrician-gynecologists who describe themselves as primary care physicians make significantly more diagnoses of depression than those considering themselves specialists. Studies further to assess obstetrician-gynecologists' management of depression and better to define needs for professional education are warranted.     

The general practitioner's role in breast cancer screening: a survey in Otago-Southland

AIMS: To study the experience of general practitioners in Otago and Southland with the existing breast cancer screening programme and the reviews on future programmes. METHODS: A questionnaire was sent to all 210 general practitioners in Otago and Southland in June 1996. RESULTS: The response rate was 71%. All the 141 respondents except one encouraged eligible women to take part in the programme; this was done mainly during individual doctor-patient consultations, by pamphlets and posters, and in the work of the practice nurse. Ten percent of practitioners had a practice-based recall system for breast cancer screening. Seventy-five percent of general practitioners currently provide a list of eligible women to the programme, and of these, 52% check the list to exclude ineligible women. Only 24% of practitioners supplying a patient list to the programme reported that a patient had ever requested that their name be excluded from the list. Twenty-five percent of general practitioners providing lists had a notice in the waiting room stating that. Of those who did not provide lists, concerns about logistics, ethical issues and cost were raised, although 40% of these general practitioners intended to provide lists in the future. In a future programme, 57% of general practitioners felt they should be paid for supplying lists defined by age only and 82% felt they should be paid for supplying a list of women eligible by both age and medical history. Most general practitioners felt that general practitioner lists were the preferred source for invitations to the breast screening programme and that general practitioners had an important part in any future programme. Screening at the ages 50-64 (as currently proposed) is supported by 95% of general practitioners; in addition, 64% supported screening at ages 65-69. Only a minority of general practitioners supported screening at ages 40-49 or ages 70-74. Most general practitioners would offer screening to women under age 50 with either a strong or a weak family history, or even with a past history of a fibroadenoma. CONCLUSIONS: These results show that almost all general practitioners support breast cancer screening programmes and feel that they have an important role in future programmes. The majority support extension of the programme to ages 65-69, but not to ages 40-49. The majority support screening women with individual risk factors at ages under 50, although their responses show that better information on the importance of different risk factors is required.