Group supervision practices at psychology predoctoral internship programs: 15 years later.

This national survey was conducted to answer several questions including: how predoctoral training sites practice group supervision, how these results compared to a similar survey sent in 1991 (Riva & Cornish, 1995), and whether group process and multicultural considerations are incorporated into group supervision practices. The original survey included 157 group supervisors from sites listed in the 1991-1992 APPIC Directory, while the current study's respondents included 162 group supervisors from sites in the 2006-2007 APPIC Directory. Several important similarities and differences were found between the two time periods. The results and implications related to how group supervision is conducted are presented. Recommendations based on these results are outlined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A university-based predoctoral practicum in pediatric psychology.

Discusses the development of the clinical practicum in terms of its history and function. The practicum has become a year-long option within a Boulder-model training program in clinical psychology. The source and nature of the referrals, the intervention strategies, and the development of community relationships are presented. It is concluded that pediatric psychology at a practicum level can be a valuable clinical training and research experience within a clinical psychology training program. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using health care outcomes to improve patient care in the NICU

The authors describe their use of outcomes research in improving the care of infants in a ten-hospital network of neonatal intensive care units. Improvements in the processes of care for infants born with very low birth weights, and those suffering from chronic lung disease and nosocomial infections, are among the issues discussed.     

Correction and update: interest in pediatric dentistry

Correcting and updating the data on senior dental student plans for pediatric dentistry training indicates that there is a continuing and increasing interest in pediatric dentistry specialty training. Except for 1993, compared to the earlier period, this increase was at a slower rate, however, than that reported previously in the Journal.     

Factors affecting the mobility of pediatric dentistry faculty

A 66-year-old female underwent uneventful removal of parasagittal meningioma. At surgery, a piece of Biobond-soaked oxycellulose was applied to the lateral wall of the superior sagittal sinus for hemostasis. Her early postoperative course was complicated by focal but severe brain edema, which was adjacent to the hemostatic agent. Unlike foreign body granuloma previously reported, this complication was considered to be attributed to inflammatory reaction of Biobond, because of the early onset and fulminant edema despite of small volume of the mass lesion. Although there have been no previous reports of this complication, it should be kept in mind that intracranial application of Biobond may induce fulminant inflammatory reaction as seen in this patient.     

An unusual skin lesion in a pediatric patient with Wegener's granulomatosis

Cutaneous manifestations occur in a significant number of patients with Wegener's granulomatosis (WG); however, the presentation and histopathology of these lesions are highly variable and may present problems in diagnosis. We report the presentation of a single large skin lesion in a pediatric patient with a history of WG and the characterization of this lesion by magnetic resonance imaging (MRI) and histopathology. MRI was helpful in delineating the extent of the lesion, although a skin biopsy was necessary to confirm the diagnosis of the vasculitic nature of the lesion.     

Tonsillectomy and adenoidectomy pathway plan of care for the pediatric patient in day surgery

The care of children undergoing tonsillectomy and adenoidectomy (T&A) in the day surgery setting can be costly, due in a large part to the length of stay after surgery. A clinical pathway standardizes the length of stay and, therefore, directly controls costs associated with outpatient T&A. A T&A pathway plan of care was developed at one institution to (1) decrease the cost of the procedure, (2) improve parent/patient satisfaction, and (3) maintain or improve the quality of care.     

Costs of predoctoral clinical psychology internship training in a Canadian health care setting.

Financial pressures on institutional health care in Canada in recent years have led to substantial pressures on institutional psychological services. These pressures have resulted in the elimination or substantial diminution of psychological services in some of these institutions, including the discontinuation of many longstanding psychology internship programs. It is therefore important for psychologists to demonstrate their cost-efficiency in delivering services. However, evidence for this efficiency in the current Canadian context is lacking. This investigation examines the costs and clinical activities of the interns and staff at a major Canadian teaching hospital in order to determine the degree to which the internship is a cost-efficient method of delivering services. The results indicate that there is a small increased cost to having the services delivered through an internship program. The results are viewed as part of a balanced scorecard approach to the evaluation of an internship program. From such a perspective, other factors can be seen as balancing out the slightly increased cost. Also, a number of strategies are outlined for increasing internship cost-efficiency. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Port-wine stains. An assessment of 5 years of treatment

OBJECTIVE: To assess objectively the results of flashlamp-pumped dye laser treatment of port-wine stains (PWS). DESIGN: Pretreatment and posttreatment photographs were compared with the appearance of the lesion at follow-up examination. Clinical response was determined by assigning a percentage of lesional lightening score by 2 physicians and the patient, and by reflectance spectrophotometric measurements. SETTING: University and university-affiliated health center. PATIENTS: One hundred two patients (118 PWS) aged 1 month to 66 years (mean, 20 years; median, 16 years) treated from July 1, 1989, to June 30, 1994. RESULTS: Eighteen (15.3%) of the 118 PWS had more than 90% lesional lightening (complete or almost complete response), 77 (65.3%) had lightening from 50% to 90% (good response), 21 (17.8%) had lightening from 11% to 49% (poor response), and 2 (1.7%) had lightening less than 10% (no response). Clinical response did not vary among age groups, but showed statistically significant differences between anatomical locations. A return of PWS after initial response was observed in patients who were seen more than 1 year following completion of treatment. CONCLUSIONS: Treatment of PWS by flashlamp-pumped dye laser results in a good to complete response in most patients. Anatomical location of the lesion is a valuable prognostic indicator of response to treatment. The initially impressive results of flashlamp-pumped dye laser treatment of PWS may be tempered by the gradual return of the vascular lesion as time elapses after completion of therapy. Our experience indicates that PWS show a tendency to recur at a rate approaching 50% between 3 and 4 years after completion of treatment.     

An exploratory assessment of APA internships with legal/forensic experiences.

Surveyed all American Psychological Association-approved internship programs to request information on training experiences in their programs that expose the intern to the interface between psychology and law. A listing of the various types of legal/forensic experiences available for specific sites is presented. The scope of the experiences and the need for qualitative assessment of them is discussed. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Superior outcomes in pediatric renal transplantation

BACKGROUND: Nationally, results of renal transplantation in children, particularly in small children, are inferior to those obtained in adults. OBJECTIVE: To determine factors important for success in renal transplantation in children. DESIGN: Results of 108 consecutive renal transplantations performed in patients aged 7 months to 18 years were reviewed and compared with those reported by the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS), the national registry. RESULTS: One-, 2-, and 3-year graft survival rates (+/-SE) were 99% +/- 1%, 95% +/- 3%, and 93% +/- 4%, respectively, for living donor grafts and 97% +/- 3%, 92% +/- 6%, and 92% +/- 6%, respectively, for cadaver grafts. Incidence of acute rejection was half that reported by NAPRTCS. There were no graft losses for technical reasons (19% in NAPRTCS). Twelve percent of patients were younger than 2 years (6% in NAPRTCS); 17% were 2 to 5 years old (16% in NAPRTCS). Most small children received an adult-sized kidney. Ninety-three percent of recipients weighing 15 kg or less received postoperative mechanical ventilation assistance to optimize fluid resuscitation and perfusion of adult-sized kidneys. Structural abnormalities of the urinary tract were present in 53.7% of the patients (48.5% in NAPRTCS; adults, 5.3%). Nephroureterectomy was required in 38 children; in 27 (71%) of them, it was performed at the time of transplant surgery. CONCLUSIONS: Excellent results can be obtained in pediatric renal transplantation by strict adherence to surgical detail, tight immunosuppressive management, aggressive fluid management in the small child, and careful integration of urologic and transplant surgery.     

The long-term mechanically ventilated patient. An outcomes management approach

We have studied whether there is natural genetic variation for mutation frequencies, and whether any such variation is environment-related. Mutation frequencies differed significantly between wild strains of the fungus Sordaria fimicola isolated from a harsher or a milder microscale environment in "Evolution Canyon," Israel. Strains from the harsher, drier, south-facing slope had higher frequencies of new spontaneous mutations and of accumulated mutations than strains from the milder, lusher, north-facing slope. Collective total mutation frequencies over many loci for ascospore pigmentation were 2.3, 3.5 and 4.4% for three strains from the south-facing slope, and 0.9, 1.1, 1.2, 1.3 and 1.3% for five strains from the north-facing slope. Some of this between-slope difference was inherited through two generations of selfing, with average spontaneous mutation frequencies of 1.9% for south-facing slope strains and 0.8% for north-facing slope strains. The remainder was caused by different frequencies of mutations arising in the original environments. There was also significant heritable genetic variation in mutation frequencies within slopes. Similar between-slope differences were found for ascospore germination-resistance to acriflavine, with much higher frequencies in strains from the south-facing slope. Such inherited variation provides a basis for natural selection for optimum mutation rates in each environment.     

The effect of magnification on student performance in pediatric operative dentistry

Previous research has shown that accurate student self-evaluation is related to higher quality dental products. Variance in student performance still remains. Enhancement of visual perception could contribute to product improvement. Only one study has evaluated the effects of magnification on simulated dental patient care. The present study sought to determine if magnification had a positive effect on student-generated products in pediatric amalgam preparations. Fifty-two third-year students were randomly assigned to experimental (magnification) or control (no magnification) groups. Members of the experimental group used magnification in their daily work in the pediatric dentistry clinic. No significant differences between the groups' preparations or evaluations of standard preparations were found. Further study should address these issues: 1) possible effects of specific training in the use of magnification devices; 2) whether the tolerance for error in dental preparations is so great that finer vision contributes little to product improvement; 3) the role of tactile sensation in evaluation and preparation; and 4) the possible benefits of magnification for effect of age. Based on this study, it seems that requiring students to purchase magnification devices may not be justified.     

Veterinary dentistry (15). Apex resection in the horse

Periapical disorders in horses can be treated by resection of the apex. The indications, contraindications, diagnosis, treatment and complications of the intervention are discussed. Four case reports of horses in which apicoectomy with retrograde endodontic treatment was performed are reviewed.     

A family practice education system based on patient care outcomes in family practice settings

The philosophy, goals, objectives, methodology, and results of a family practice faculty development program are described. Developing family practice educators who will create an education system based on patient care outcomes in family practice settings is the central philosophical purpose of this faculty development program. On completion of the program all participants recognized the essential nature of this philosophical goal and were more comfortable and confident in their ability to: (1) determine resident learning needs; (2) organize curriculum units; (3) use different teaching techniques; and (4) understand their own personal teaching needs and interests. The implications of these changes for developing a family practice curriculum based on patient needs are described.     

Antibiotic optimization. An evaluation of patient safety and economic outcomes

BACKGROUND: Although numerous reports have described interventions designed to influence antibiotic utilization, to our knowledge none have been evaluated in a randomized study. METHODS: Adult inpatients receiving 1 or more of 10 designated parenteral antibiotics for 3 or more days during a 3-month period were randomized to an intervention (n = 141) and a control (n = 111) group using an unblocked, computer-generated random number table. Obstetric patients and those seen in infectious disease consultation were excluded. The intervention group received antibiotic-related suggestions from a team consisting of an infectious disease fellow and a clinical pharmacist. Both groups were evaluated for clinical and microbiological outcomes as well as antibiotic utilization via prospective chart reviews and analysis of the hospital's administrative database. RESULTS: Sixty-two (49%) of the intervention group patients received a total of 74 suggestions. Sixty-three (84%) of these suggestions were implemented; the majority involved changes in antibiotic choice, dosing regimen, or route of administration. Per patient antibiotic charges were nearly $400 less in the intervention group vs controls (P = .05). Almost all the savings were related to lower intravenous antibiotic charges. Clinical and microbiological response, antibiotic-associated toxic effects, in-hospital mortality, and readmission rates were similar for both groups. Multiple linear regression analysis identified randomization to the intervention group and female sex as the sole predictors of lower antibiotic charges. There was a trend toward a shorter length of stay for the intervention group (20 vs 24.7 days, P = .11). CONCLUSIONS: This is the first randomized study to evaluate whether antibiotic choices can be influenced in a cost-effective fashion without sacrificing patient safety. We demonstrate that 50% of patients initially treated with expensive parenteral antibiotics can have their regimens refined after 3 days of therapy and that these modifications result in good clinical outcomes with a substantial reduction in antibiotic expense.