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Azevedo J, Swales M, Carreiras D, Guiomar R, Macedo A, Castilho P. BI-REAL: A 12-session DBT skills group intervention adapted for bipolar disorder - A feasibility randomised pilot trial. J Affect Disord 2024; 356:394-404. [PMID: 38615843 DOI: 10.1016/j.jad.2024.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 03/21/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
International guidelines endorse psychological treatment for Bipolar Disorder (BD); however, the absence of a recognised gold-standard intervention requires further research. A Dialectical Behaviour Therapy (DBT) skills group intervention with 12 sessions was developed. This pilot randomised controlled trial (RCT) aims to evaluate the feasibility, acceptability, and outcomes variance of Bi-REAL - Respond Effectively, Assertively, and Live mindfully, tailored for individuals with BD, in preparation for a future RCT. METHODS 52 participants (female = 62.7 %; mean age = 43.2 ± 11.1) with BD were randomised by blocks to either the experimental group (EG; n = 26; Bi-REAL + Treatment as Usual, TAU) receiving 12 weekly 90-minutes sessions, or the control group (CG; n = 26, TAU). Feasibility and acceptability were assessed with a multimethod approach (qualitative interviews, semi-structured clinical interviews and a battery of self-report questionnaires - candidate main outcomes Bipolar Recovery Questionnaire (BRQ) and brief Quality of Life for Bipolar Disorder (QoL.BD)). All participants were evaluated at baseline (T0), post-intervention (T1) and 3-month follow-up (T2). RESULTS Acceptability was supported by participants' positive feedback and ratings of the sessions and programme overall, as well as the treatment attendance (86.25 % of sessions attended). The trial overall retention rate was 74.5 %, with CG having a higher dropout rate across the 3-timepoints (42.31 %). A significant Time × Group interaction effect was found for BRQ and QoL.BD favouring the intervention group (p < .05). LIMITATIONS The assessors were not blind at T1 (only at T2). Recruitment plan was impacted due to COVID-19 restrictions and replication is questionable. High attrition rates in the CG. CONCLUSIONS The acceptability of Bi-REAL was sustained, and subsequent feasibility testing will be necessary to establish whether the retention rates of the overall trial improve and if feasibility is confirmed, before progressing to a definitive trial.
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Affiliation(s)
- Julieta Azevedo
- University of Coimbra, Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Portugal; Bangor University, School of Human and Behavioural Sciences, United Kingdom; Department of Psychology, University of Exeter, Exeter, UK.
| | - Michaela Swales
- Bangor University, School of Human and Behavioural Sciences, United Kingdom
| | - Diogo Carreiras
- University of Coimbra, Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Portugal
| | - Raquel Guiomar
- University of Coimbra, Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Portugal
| | - António Macedo
- University of Coimbra, Faculty of Medicine, Institute of Psychological Medicine (IPM), Portugal; Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Portugal; Centro Hospitalar e Universitário de Coimbra, EPE (CHUC), Coimbra, Portugal
| | - Paula Castilho
- University of Coimbra, Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Portugal
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Agarwal A, Baitha U, Ranjan P, Swarnkar NK, Singh GP, Baidya DK, Garg R, Gupta N, Choudhury A, Kumar A, Roy A, Naik N, Khan MA, Wig N. Knowledge and Skills in Cardiopulmonary Resuscitation and Effect of Simulation Training on it among Healthcare Workers in a Tertiary Care Center in India. Indian J Crit Care Med 2024; 28:336-342. [PMID: 38585308 PMCID: PMC10998517 DOI: 10.5005/jp-journals-10071-24670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/02/2024] [Indexed: 04/09/2024] Open
Abstract
Aim and background High-quality cardiopulmonary resuscitation (CPR) is associated with improved patient outcomes, but healthcare workers (HCWs) may be frequently undertrained. This study aimed to assess baseline knowledge and skills among HCWs about basic and advanced life support and the effect of simulation-based training on it. Methods It was a single-center prospective quasi-interventional study among resident doctors and nurses at a Tertiary Center in New Delhi, India. A questionnaire-based assessment was done to assess baseline knowledge. The participants then underwent simulation-based training followed by questionnaire-based knowledge assessment and skill assessment. A repeat questionnaire-based assessment was done 6 months post-training to assess knowledge retention. Results A total of 82 HCWs (54 doctors and 28 nurses) were enrolled. The participants scored 22.28 ± 6.06 out of 35 (63.65%) in the pre-training knowledge assessment, with low scores in post-cardiac arrest care, advanced life support, and defibrillation. After the training, there was a significant rise in scores to 28.32 ± 4.08 out of 35 (80.9%) (p < 0.01). The retention of knowledge at 6 months was 68.87% (p < 0.01). The participants scored 92.61 ± 4.75% marks in skill assessment with lower scores in chest compressions and team leadership roles. There was a positive correlation (r = 0.35) between knowledge and skills scores (p < 0.01). Conclusion There is a progressive decrease in baseline knowledge of HCWs with the further steps in the adult chain of survival. The simulation training program had a positive impact on the knowledge of HCWs. The training programs should focus on defibrillation, advanced life support, post-cardiac arrest care, and leadership roles. How to cite this article Agarwal A, Baitha U, Ranjan P, Swarnkar NK, Singh GP, Baidya DK, et al. Knowledge and Skills in Cardiopulmonary Resuscitation and Effect of Simulation Training on it among Healthcare Workers in a Tertiary Care Center in India. Indian J Crit Care Med 2024;28(4):336-342.
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Affiliation(s)
- Ayush Agarwal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Upendra Baitha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Neeraj K Swarnkar
- Department of Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Gyaninder P Singh
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Dalim K Baidya
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Garg
- Department of Onco-Anaesthesiology and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-Anaesthesiology and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Arindam Choudhury
- Department of Cardiac Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Kumar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Nitish Naik
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Maroof Ahmed Khan
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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Cronin CJ, Lieber EMJ. The demand for skills training among Medicaid home-based caregivers. J Health Econ 2024; 95:102877. [PMID: 38581749 DOI: 10.1016/j.jhealeco.2024.102877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 12/30/2023] [Accepted: 03/15/2024] [Indexed: 04/08/2024]
Abstract
Medicaid spends nearly 100 billion dollars annually on home and community-based care for the disabled. Much of this care is provided by personal care aides, few of whom have received training related to the services they provide. We conducted a randomized controlled trial to estimate their demand for training. We find that 13 percent of these caregivers complete training without an incentive. Paying the caregivers four times their hourly wage increases training completion by roughly nine percentage points. Additional experimental variation suggests that among individuals confirmed to be aware of the training, the financial incentive increases completion from 35 to 58 percent. Demand curves based on these results suggest that while many caregivers value the opportunity to train, policies aimed at universal take up require large financial incentives.
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Affiliation(s)
| | - Ethan M J Lieber
- University of Notre Dame, United States of America; NBER, United States of America
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Biniok M, Forbrig TA, Gellert P, Gräske J. Analysis of cybersickness in virtual nursing simulation: a German longitudinal study. BMC Nurs 2024; 23:187. [PMID: 38509512 PMCID: PMC10953248 DOI: 10.1186/s12912-024-01833-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/01/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Innovative educational approaches such as simulation-based nursing education using virtual reality (VR) technologies provide new opportunities for nursing education. However, there is a lack of information on side effects, especially health-related side effects, of head-mounted displays (HMDs) on the human body when using VR devices for nursing simulation. This study aims to validate the German version of the Virtual Reality Sickness Questionnaire (VRSQ) and to evaluate its associations with sex and age, as reflected in the VRSQG scores (total score, oculomotor, and disorientation) over time. METHODS A longitudinal-sectional study was conducted. In addition to the VRSQG (pre-, post-, and 20 min post-intervention), participants (all nursing students) completed data on personal characteristics. Participants completed a VR simulation of a blood draw. Confirmatory factor analysis (CFA) was used to evaluate whether the measured construct was consistent with the original. In addition to the validity, internal consistency was analyzed and generalized linear models (GLMs) were used for data analysis. RESULTS A total of 38 nursing students (mean age 26.8 years; SD = 7.1, 79.0% female) participated. The mean time spent in the VR simulation was 21 min. All participants completed the entire simulation. The CFA indicates (CFI = 0.981, SRMR = 0.040) VRSQG structure is given. Internal consistency showed low values for the subdomain Oculomotor (Cronbach alpha 0.670). For Disorientation and the Total score values showed a sufficient internal consistency. GLMs showed significant between subject associations with age over time with VRSQG total score, oculomotor, and disorientation. Older nursing students start with higher VRSQG-Scores. Over time, an approximation occurs, so that all participants reach a similar level by the final measurement point. No associations were found between sex (male/female) and VRSQG scores. CONCLUSIONS The VRSQG is a reliable and valid self-assessment for measuring cybersickness in VR based nursing simulations, with cybersickness symptoms positively associated with age. However, in depth-evaluation regarding age-associations with cybersickness should be done. As well as studies to explore additional associations and emphasizes the importance of establishing cut-off values to assess the clinical relevance of the scores.
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Affiliation(s)
- Maria Biniok
- Department II - Health, Education and Pedagogy, Alice Salomon Hochschule Berlin University of Applied Science, Alice-Salomon-Platz 5, 12627, Berlin, Germany.
| | - Theresa A Forbrig
- Department II - Health, Education and Pedagogy, Alice Salomon Hochschule Berlin University of Applied Science, Alice-Salomon-Platz 5, 12627, Berlin, Germany
| | - Paul Gellert
- Institute of Medical Sociology and Rehabilitation Science, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Gräske
- Department II - Health, Education and Pedagogy, Alice Salomon Hochschule Berlin University of Applied Science, Alice-Salomon-Platz 5, 12627, Berlin, Germany
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Durpoix A, Lachaux E, Weiner L, Weibel S. Transdiagnostic skills training group of dialectical behavior therapy: a long-term naturalistic study. Borderline Personal Disord Emot Dysregul 2023; 10:37. [PMID: 38124187 PMCID: PMC10734074 DOI: 10.1186/s40479-023-00243-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Dialectical Behavior Therapy (DBT) has assembled a large body of evidence for the treatment of emotional dysregulation in borderline personality disorder (BPD), but also in other disorders characterized by emotional dysregulation (e.g., bipolar disorder (BD) and ADHD). Standalone skills learning groups address the problem of limited resources in several clinical settings. Furthermore, transdiagnostic skills groups facilitate the recruitment and decrease the scattering of resources in psychiatric settings. However, few studies have focused on the pertinence of transdiagnostic standalone skills groups in naturalistic settings as well as their long-term outcomes. The goal of this study is to assess the impact of participation in a transdiagnostic DBT skills group one year after its completion. METHOD Transdiagnostic DBT skills training groups were provided for BPD, BD and ADHD patients in a University Psychiatric Department (Strasbourg, France), between 2019 and 2020. They consisted of 16 group sessions of 2.5 h and 3 individual sessions. At 1-year follow-up, ad-hoc questionnaires were proposed to all participants to assess the perceived impacts, the changes in symptomatology, and the maintenance of skills learned. RESULT 22 of the 31 participants were interviewed at the one-year post-group session (64% BPD, 41% ADHD and 27% BD). 73% participants estimated that group impact was important or very important, 64% stated using the skills learned often or very often, mainly emotion regulation skills. An improvement in emotional instability, substance use, impulsivity and suicidal thoughts was reported by respectively 100%, 91%, 86% and 85% of participants. Quality of life improved according to 90% participants. All patients reported an improvement in suicidality during the post-group year, especially in suicide attempts. Psychotropic medication decreased in 59% of participants. DISCUSSION Our one-year naturalistic study suggests that transdiagnostic DBT skills training groups are promising for the treatment of emotional dysregulation in people with BPD, BD and/or ADHD. The observational design and the lack of control group are the main limitations. Randomized controlled studies are required to confirm the long-term efficacy of transdiagnostic skills learning groups in naturalistic settings.
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Affiliation(s)
- Amaury Durpoix
- Psychiatry, Mental Health and Addictology Department, University Hospitals of Strasbourg, 1 place de l'Hôpital, Strasbourg, 67000, France.
- Faculty of Medicine, Strasbourg University, Strasbourg, 67000, France.
| | - Enzo Lachaux
- Psychiatry, Mental Health and Addictology Department, University Hospitals of Strasbourg, 1 place de l'Hôpital, Strasbourg, 67000, France
- Faculty of Psychology, Strasbourg University, Strasbourg, 67000, France
| | - Luisa Weiner
- Psychiatry, Mental Health and Addictology Department, University Hospitals of Strasbourg, 1 place de l'Hôpital, Strasbourg, 67000, France
- Faculty of Psychology, Strasbourg University, Strasbourg, 67000, France
- Laboratoire de Psychologie des Cognitions, Strasbourg University, Strasbourg, 67000, France
| | - Sébastien Weibel
- Psychiatry, Mental Health and Addictology Department, University Hospitals of Strasbourg, 1 place de l'Hôpital, Strasbourg, 67000, France
- Inserm u1114, Strasbourg, 67000, France
- Faculty of Medicine, Strasbourg University, Strasbourg, 67000, France
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Avonts M, Bombeke K, Michels NR, Vanderveken OM, De Winter BY. How can peer teaching influence the development of medical students? a descriptive, longitudinal interview study. BMC Med Educ 2023; 23:861. [PMID: 37957668 PMCID: PMC10644508 DOI: 10.1186/s12909-023-04801-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/22/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Peer-assisted learning (PAL) - where students take up a teaching role at an early stage of their training-is widely used in medical curricula. Many qualitative studies have investigated the perceptions and benefits of PAL, but no studies have longitudinally explored how peer teachers experienced their development. This could allow for a better understanding of PAL. In this study, we explored the perceived impact of being a peer teacher on the development of personal and professional competencies as a medical student. METHODS We longitudinally conducted semi-structured interviews with peer teachers, during their 2-year teaching period in the skills lab at the University of Antwerp and applied descriptive thematic analysis. RESULTS In total we gathered 47 interviews in 13 peer teachers (9 female, 4 male,. 1-7 interviews each). Peer teachers reported an increase in self-confidence, which gradually transformed into self-efficacy in clinical and teaching skills., Participants told us to be inspired by the previous generation of peer teachers. Their motivation shifted from personal benefits to benefiting others while becoming a role model themselves. The peer teachers illustrated how they developed maturity by integrating different CanMEDS roles. They grew in reflection, changed/transformed an initial mark-driven study drive into more patient-centered ambitions, and started developing a personal style. CONCLUSIONS Our study suggests that being a peer teacher leads to more self-efficacy, in clinical and teaching skills, to become a role model with as motivation to benefit others and to grow towards a good doctor maturity. Although the task is to teach peers, this opportunity nurtures the practice and integration of various CanMEDS roles, not only that of scholar but also communicator, collaborator and leader, thereby positively influencing their personal and professional development and their identity as a doctor (professional role).
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Affiliation(s)
- Marijke Avonts
- Skills Lab, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Katrien Bombeke
- Skills Lab, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Nele R Michels
- Skills Lab, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Olivier M Vanderveken
- Skills Lab, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Otolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Benedicte Y De Winter
- Skills Lab, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
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Bryant MK, Sillcox R, Dort J, Schwarz E, Wright AS. Application of the acquisition of data for outcomes and procedure transfer (ADOPT) method to a hands-on course for teaching extended-view totally extraperitoneal (eTEP) hernia repair to practicing surgeons. Surg Endosc 2023; 37:8057-8063. [PMID: 37488443 DOI: 10.1007/s00464-023-10290-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/05/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND After completion of training, practicing surgeons rely on hands-on courses to expand their procedure armamentarium and improve their surgical technique. However, such courses vary in standardized teaching methods. SAGES developed the Acquisition of Data for Outcomes and Procedure Transfer (ADOPT) program as a method of longitudinal instruction utilizing standardized teaching techniques, mentorship, and webinars to cover additional techniques. This study examines the adoption of learned techniques and participant confidence before and after an ADOPT course focused on extended-view totally extraperitoneal (eTEP) hernia repair. METHODS A hands-on course focused on eTEP hernia repair was conducted with enrollment capped at 10 participants. Pre-course and post-course surveys at 3, 6, and 12 months determined implementation of the learned procedure, case volume, and confidence with eTEP skills. A 5-point Likert scale (1 = not confident at all to 5 = completely confident) assessed confidence levels. Survey responses were summarized using descriptive statistics. RESULTS Of the 10 participants, 10 (100%) completed the pre-course survey, and 7 (70%) completed at least one post-course survey. Median age was 48.5 years (36,56) with a median of 16 years (2,23) in practice, mostly in the community setting (70%). After the course, 50% had performed an eTEP procedure, and 100% reported considering this technique during surgical planning. Participants reported higher confidence in eTEP-specific skills at three months post-course from pre-course levels. The highest change in confidence was seen for the following skills: accessing the retromuscular/extraperitoneal space for ventral hernia and recognizing when the linea alba has been violated, p < 0.05. CONCLUSION This study shows that rapid incorporation of learned techniques can be achieved through the ADOPT format. Furthermore, through longitudinal mentorship and a structured hands-on course, the ADOPT course supports practicing surgeons to attain autonomy and confidence even when teaching a relatively technically challenging procedure, such as eTEP.
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Affiliation(s)
- Mary K Bryant
- Department of Surgery, University of Washington, 1959 NE Pacific St., Box 3564101, Seattle, WA, 98195, USA
| | - Rachel Sillcox
- Department of Surgery, University of Washington, 1959 NE Pacific St., Box 3564101, Seattle, WA, 98195, USA
| | - Jonathan Dort
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA
| | | | - Andrew S Wright
- Department of Surgery, University of Washington, 1959 NE Pacific St., Box 3564101, Seattle, WA, 98195, USA.
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Røed RK, Powell MB, Riegler MA, Baugerud GA. A field assessment of child abuse investigators' engagement with a child-avatar to develop interviewing skills. Child Abuse Negl 2023; 143:106324. [PMID: 37390589 DOI: 10.1016/j.chiabu.2023.106324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 06/05/2023] [Accepted: 06/19/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Child investigative interviewing is a complex skill requiring specialised training. A critical training element is practice. Simulations with digital avatars are cost-effective options for delivering training. This study of real-world data provides novel insights evaluating a large number of trainees' engagement with LiveSimulation (LiveSim), an online child-avatar that involves a trainee selecting a question (i.e., an option-tree) and the avatar responding with the level of detail appropriate for the question type. While LiveSim has been shown to facilitate learning of open-ended questions, its utility (from a user engagement perspective) remains to be examined. OBJECTIVE We evaluated trainees' engagement with LiveSim, focusing on patterns of interaction (e.g., amount), appropriateness of the prompt structure, and the programme's technical compatibility. PARTICIPANTS AND SETTING Professionals (N = 606, mainly child protection workers and police) being offered the avatar as part of an intensive course on how to interview a child conducted between 2009 and 2018. METHODS For descriptive analysis, Visual Basic for Applications coding in Excel was applied to evaluate engagement and internal attributes of LiveSim. A compatibility study of the programme was run testing different hardware focusing on access and function. RESULTS The trainees demonstrated good engagement with the programme across a variety of measures, including number and timing of activity completions. Overall, knowing the utility of avatars, our results provide strong support for the notion that a technically simple avatar like LiveSim awake user engagement. This is important knowledge in further development of learning simulations using next-generation technology.
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Affiliation(s)
- Ragnhild Klingenberg Røed
- Department of Social Work, Child Welfare and Social Policy, Faculty of Social Sciences, Oslo Metropolitan University, Oslo, Norway.
| | - Martine B Powell
- Centre for Investigative Interviewing, Griffith Criminology Institute, Griffith University, Brisbane, Australia
| | | | - Gunn Astrid Baugerud
- Department of Social Work, Child Welfare and Social Policy, Faculty of Social Sciences, Oslo Metropolitan University, Oslo, Norway
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Decosimo K, Drake C, Coffman CJ, Sperber NR, Tucker M, Hughes JM, Zullig LL, Chadduck T, Christensen L, Kaufman B, Allen KD, Hastings SN, Van Houtven CH. Implementation intensification to disseminate a skills-based caregiver training program: protocol for a type III effectiveness-implementation hybrid trial. Implement Sci Commun 2023; 4:97. [PMID: 37587517 PMCID: PMC10428549 DOI: 10.1186/s43058-023-00475-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/24/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Family caregiver training decreases caregiver psychological burden and improves caregiver depressive symptoms and health-related quality of life. Caregivers FIRST is an evidence-based group skills training curriculum for family caregivers and was announced for national dissemination in partnership with the Veterans Health Administration (VHA) National Caregiver Support Program (CSP). Previous evaluations of Caregivers FIRST implementation highlighted that varying support was needed to successfully implement the program, ranging from minimal technical assistance to intensive assistance and support. However, we do not know the optimal level of support needed to inform cost-effective national scaling of the program. We describe a protocol for randomizing 24 non-adopting VA medical centers 1:1 to a tailored, high-touch implementation support or a standard, low-touch implementation support to test the primary hypothesis that high-touch support increases Caregivers FIRST penetration, fidelity, and adoption. Additionally, we describe the methods for evaluating the effect of Caregivers FIRST participation on Veteran outcomes using a quasi-experimental design and the methods for a business case analysis to examine cost of delivery differences among sites assigned to a low or high-touch implementation support. METHODS We use a type III hybrid implementation-effectiveness study design enrolling VA medical centers that do not meet Caregivers FIRST adoption benchmarks following the announcement of the program as mandated within the CSP. Eligible medical centers will be randomized to receive a standard low-touch implementation support based on Replicating Effective Programs (REP) only or to an enhanced REP (high-touch) implementation support consisting of facilitation and tailored technical assistance. Implementation outcomes include penetration (primary), fidelity, and adoption at 12 months. Mixed methods will explore sites' perceptions and experiences of the high-touch intensification strategy. Additional analyses will include a patient-level effectiveness outcome (Veteran days at home and not in an institution) and a business case analysis using staffing and labor cost data. DISCUSSION This pragmatic trial will lead to the development and refinement of implementation tools to support VA in spreading and sustaining Caregivers FIRST in the most efficient means possible. TRIAL REGISTRATION This study was registered on April 8, 2022, at ClinicalTrials.gov (identifier NCT05319535).
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Affiliation(s)
- Kasey Decosimo
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, 27705, USA.
| | - Connor Drake
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Cynthia J Coffman
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, 27705, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Nina R Sperber
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Matthew Tucker
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, 27705, USA
| | - Jaime M Hughes
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, 27705, USA
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Section On Gerontology and Geriatric Medicine, Division of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Leah L Zullig
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Trisha Chadduck
- Veteran's Health Administration Central Office, Washington, DC, USA
| | - Leah Christensen
- Veteran's Health Administration Central Office, Washington, DC, USA
| | - Brystana Kaufman
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Kelli D Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, 27705, USA
- Department of Medicine & Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S Nicole Hastings
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
- Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, NC, USA
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Courtney H Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
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10
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Holmqvist Larsson K, Thunberg M, Münger AC, Andersson G, Falkenström F, Zetterqvist M. "It's ok that I feel like this": a qualitative study of adolescents' and parents' experiences of facilitators, mechanisms of change and outcomes in a joint emotion regulation group skills training. BMC Psychiatry 2023; 23:591. [PMID: 37582695 PMCID: PMC10428531 DOI: 10.1186/s12888-023-05080-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 08/04/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Emotion regulation difficulties underlie several psychiatric conditions, and treatments that focus on improving emotion regulation can have an effect on a broad range of symptoms. However, participants' in-depth experiences of participating in emotion regulation treatments have not been much studied. In this qualitative study, we investigated participants' experiences of a joint emotion regulation group skills training in a child and adolescent psychiatric outpatient setting. METHODS Twenty-one participants (10 adolescents and 11 parents) were interviewed about their experiences after they had participated in a seven-session transdiagnostic emotion regulation skills training for adolescents and parents. The aim of the skills training was to decrease emotion regulation difficulties, increase emotional awareness, reduce psychiatric symptoms, and enhance quality of life. The skills training consisted of psychoeducation about emotions and skills for regulating emotions. The interviews were transcribed and analysed using reflexive thematic analysis. RESULTS The analysis resulted in three overarching themes: Parent - Child processes, Individual processes, and Group processes. The result showed that participants considered an improved parent-child relationship to be the main outcome. Increased knowledge, emotion regulation skills and behavioural change were conceptualised as both mechanisms of change and outcomes. The group format, and the fact that parents and adolescents participated together, were seen as facilitators. Furthermore, the participants experienced targeting emotions in skills training as meaningful and helpful. CONCLUSION The results highlight the potential benefits of providing emotion regulation skills training for adolescents and parents together in a group format to improve the parent-child relationship and enable the opportunity to learn skills.
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Affiliation(s)
- K Holmqvist Larsson
- Department of Child and Adolescent Psychiatry in Linköping, Region Östergötland, and Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - M Thunberg
- Department of Child and Adolescent Psychiatry in Norrköping, Region Östergötland, Norrköping, Sweden
| | - A-C Münger
- Barnafrid at Department of Biomedical and Clinical Sciences, Swedish National Center on Violence Against Children, Linköping University, Linköping University, Linköping, Sweden
| | - G Andersson
- Department of Behavioural Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - F Falkenström
- Department of Psychology, Linnaeus University, Växjö, Sweden
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - M Zetterqvist
- Department of Child and Adolescent Psychiatry in Linköping, Region Östergötland, and Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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11
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Plotzky C, Loessl B, Kuhnert B, Friedrich N, Kugler C, König P, Kunze C. My hands are running away - learning a complex nursing skill via virtual reality simulation: a randomised mixed methods study. BMC Nurs 2023; 22:222. [PMID: 37370124 DOI: 10.1186/s12912-023-01384-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Clinical skills training is an essential component of nursing education. However, sometimes education does not sufficiently prepare nurses for the real world. Virtual reality (VR) is an innovative method to complement existing learning strategies, yet few studies investigate its effectiveness. This study compared educational outcomes achieved by three groups learning with either of two different VR simulation variants, with varying technological features, or a video training on the endotracheal suctioning skill. METHODS The investigated outcomes were knowledge and skill acquisition, learner satisfaction, and technology acceptance. 131 undergraduate nursing students were randomised into three groups, based on the interventions they received. Knowledge was assessed through a pre-post-test design, skill through a post-intervention objective structured clinical examination on a manikin, learning satisfaction and technology acceptance through standardised questionnaires, and qualitative feedback through focus groups. RESULTS All interventions led to a significant knowledge acquisition, with no significant difference between the groups. The video intervention group performed significantly better than the VR groups in skill demonstration. One of the two VR intervention groups had a significantly higher learner satisfaction than the video group. Technology acceptance was high for both VR groups, with the simpler VR simulation resulting in higher technology acceptance than the one with more experimental features. Students described the VR experience as realistic, interactive, and immersive, and saw the opportunity to practise skills in a safe environment, learn from mistakes, and increase knowledge and confidence. CONCLUSIONS For the development of VR trainings, we recommend keeping them simple and targeting a specific educational outcome since trying to optimise for multiple outcomes is resource intensive and hard to achieve. Psychomotor skills were easier for participants to learn by watching a video on the procedure rather than practically learning it with the VR hardware, which is a more abstract representation of reality. We therefore recommend using VR as a complementing resource to skills labs, rather than replacing existing learning strategies. Perhaps VR is not ideal for practising practical psychomotor skills at the moment, but it can increase knowledge, satisfaction, motivation, confidence and prepare for further practical training. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Christian Plotzky
- Faculty Health, Safety, Society, Care & Technology Lab, Furtwangen University, Furtwangen, Germany.
| | - Barbara Loessl
- Faculty Health, Safety, Society, Care & Technology Lab, Furtwangen University, Furtwangen, Germany
- College of Science, Health, Engineering and Education (SHEE), Discipline of Nursing, Murdoch University, Perth, Australia
| | - Barbara Kuhnert
- Faculty of Medicine, Institute of Nursing Science, University of Freiburg, Freiburg, Germany
| | - Nina Friedrich
- Faculty of Medicine, Institute of Nursing Science, University of Freiburg, Freiburg, Germany
| | - Christiane Kugler
- Faculty of Medicine, Institute of Nursing Science, University of Freiburg, Freiburg, Germany
| | - Peter König
- Faculty Health, Safety, Society, Care & Technology Lab, Furtwangen University, Furtwangen, Germany
| | - Christophe Kunze
- Faculty Health, Safety, Society, Care & Technology Lab, Furtwangen University, Furtwangen, Germany
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12
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Van Houtven CH, Drake C, Malo TL, Decosimo K, Tucker M, Sullivan C, D'Adolf J, Hughes JM, Christensen L, Grubber JM, Coffman CJ, Sperber NR, Wang V, Allen KD, Hastings SN, Shea CM, Zullig LL. Ready, set, go! The role of organizational readiness to predict adoption of a family caregiver training program using the Rogers' diffusion of innovation theory. Implement Sci Commun 2023; 4:69. [PMID: 37337208 DOI: 10.1186/s43058-023-00447-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 05/30/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Caregivers FIRST is an evidence-based program addressing gaps in caregivers' skills. In 2020, the Veterans Health Administration Caregiver Support Program (CSP) nationally endorsed Caregivers FIRST, offering credit in leadership performance plans to encourage all VA medical centers (VAMCs) to implement locally. This study examines the association of organizational readiness with VAMC adoption of Caregivers FIRST. METHODS In a cohort observational study, we surveyed CSP managers about their facilities' readiness to implement using the Organizational Readiness for Implementing Change (ORIC) instrument and compared change commitment and change efficacy domains among VAMCs "adopters" defined as delivering Caregivers FIRST within 1 year of the national announcement to those that did not ("non-adopters"). Within "adopters," we categorized time to adoption based on Rogers' diffusion of innovation theory including "innovators," "early adopters," "early majority," "late adopters," and "laggards." Organizational readiness and site characteristics (facility complexity, staffing levels, volume of applications for caregiver assistance services) were compared between "adopters," "non-adopters," and between time to adoption subcategories. Separate logistic regression models were used to assess whether ORIC and site characteristics were associated with early adoption among "adopters." RESULTS Fifty-one of 63 (81%) VAMCs with CSP manager survey respondents adopted Caregivers FIRST during the first year. ORIC change commitment and efficacy were similar for "adopters" and "non-adopters." However, sites that adopted earlier (innovators and early adopters) had higher ORIC change commitment and efficacy scores than the rest of the "adopters." Logistic regression results indicated that higher ORIC change commitment (odds ratio [OR] = 2.57; 95% confidence interval [CI], 1.11-5.95) and ORIC change efficacy (OR = 2.60; 95% CI, 1.12-6.03) scores were associated with increased odds that a VAMC was an early adopter (categorized as an "innovator," "early adopter", or "early majority"). Site-level characteristics were not associated with Caregivers FIRST early adoption. CONCLUSIONS To our knowledge, this study is the first to prospectively assess organizational readiness and the timing of subsequent program adoption. Early adoption was associated with higher ORIC change commitment and change efficacy and not site-level characteristics. These findings yield insights into the role of organizational readiness to accelerate program adoption. TRIAL REGISTRATION ClinicalTrials.gov, NCT03474380. Registered on March 22, 2018.
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Affiliation(s)
- Courtney H Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Connor Drake
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Teri L Malo
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
| | - Kasey Decosimo
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA.
| | - Matthew Tucker
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
| | - Caitlin Sullivan
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
| | - Josh D'Adolf
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
| | - Jaime M Hughes
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Section on Gerontology and Geriatric Medicine, Division of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Leah Christensen
- Veteran's Health Administration Central Office, Washington, DC, USA
| | - Janet M Grubber
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Cooperative Studies Program Coordinating Center, Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Cynthia J Coffman
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Nina R Sperber
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Virginia Wang
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Kelli D Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Medicine & Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S Nicole Hastings
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
- Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, NC, USA
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Christopher M Shea
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leah L Zullig
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
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13
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Plett O, Flasbeck V, Brüne M. Effects of human and animal-assisted skills training on oxytocin und cortisol levels in patients with borderline personality disorder. J Psychiatr Res 2023; 162:156-160. [PMID: 37156130 DOI: 10.1016/j.jpsychires.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Borderline Personality Disorder (BPD) is characterised, among other symptoms, by emotional instability and difficulties in regulating proximity to significant others. Many with BPD have difficulties in establishing a trustful therapeutic relationship, which often develop before a background of adverse childhood experiences with caregivers. One way to facilitate therapeutic interaction in psychotherapy incorporates pet animals as "door openers". No study exists, however, that has examined the effect of animal-assisted versus human-guided skills training on neurobiological correlates of affiliation and stress regulation, i.e. oxytocin and cortisol. METHODS Twenty in-patients diagnosed with BPD were recruited to participate in an animal-assisted skills-training. Another 20 in-patients participated in a human-guided skills-training. Salivary samples of both groups were taken for determining oxytocin and cortisol before and immediately after 3 therapeutic sessions at least one week apart from one another. In addition, borderline symptom severity (BSL-23), impulsivity (BIS-15), alexithymia (TAS-20), and fear of compassion (FOCS) were determined by self-rating questionnaires before and after the 6-week interventions. RESULTS Both therapeutic interventions led to a significant reduction in cortisol and an (non-significant) increase in oxytocin, respectively. Importantly, there was a statistically significant interaction between changes in cortisol and oxytocin, independent of group. Both groups further showed clinical improvement as measured using the above-listed questionnaires. CONCLUSION Our findings suggest that both animal-assisted and human-guided interventions have measurable short-term effects on affiliative and stress hormones, with no approach being superior to the other in this regard.
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Affiliation(s)
- Olivia Plett
- LWL University Hospital Bochum, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr University, 44791, Bochum, NRW, Germany
| | - Vera Flasbeck
- LWL University Hospital Bochum, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr University, 44791, Bochum, NRW, Germany
| | - Martin Brüne
- LWL University Hospital Bochum, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr University, 44791, Bochum, NRW, Germany.
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14
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Hannula O, Hällberg V, Meuronen A, Suominen O, Rautiainen S, Palomäki A, Hyppölä H, Vanninen R, Mattila K. Self-reported skills and self-confidence in point-of-care ultrasound: a cross-sectional nationwide survey amongst Finnish emergency physicians. BMC Emerg Med 2023; 23:23. [PMID: 36859177 PMCID: PMC9979460 DOI: 10.1186/s12873-023-00795-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 02/21/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND The use of point-of-care ultrasound (POCUS) is increasing. Numerous investigators have evaluated the learning curves in POCUS, but there are no published studies on how emergency physicians perceive their own competence level with this skill. METHODS A nationwide survey amongst Finnish emergency physicians was conducted. The respondents reported their use of POCUS and how it has affected their clinical decision-making. The number of POCUS examinations performed was compared to the self-assessed skill level with different applications. Cut-off values were determined for the number of examinations required to acquire a good self-assessed skill level in each POCUS application. The correlation between self-confidence and the self-estimated skill level was analyzed. Several different statistical methods were used, such as Student's t-test, Pearson's correlation test, Loess method and ROC curve analysis. RESULTS A total of 134 out of 253 Finnish emergency medicine specialists and residents (52%) responded to the survey. The most commonly used POCUS applications were POCUS-assisted procedures, pleural effusion and pneumothorax, inferior vena cava and lower extremity deep venous thrombosis. The initial rate of perceived skill acquisition was very steep with the curve flattening with greater skill and more experience. The number of examinations performed to reach a self-assessed good competence varied from seven to 75 with different applications. The lowest cut-off point for self-assessed good competence was obtained for rapid ultrasound for the shock and hypotension-protocol and the highest for focused cardiac examinations. There was an excellent correlation between self-confidence and the self-assessed skill level. CONCLUSIONS The Finnish emergency practitioners' self-assessed development of POCUS skills parallels the previously published learning curves of POCUS. The correlation of self-confidence and the self-assessed skill level was found to be excellent. These findings add information on the development of perceived POCUS skills amongst emergency physicians and could complement a formal performance assessment.
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Affiliation(s)
- Ossi Hannula
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland. .,Emergency Department, Päijät-Häme Social and Health Care District, Lahti, Finland.
| | - Ville Hällberg
- Emergency Department, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Anna Meuronen
- Emergency Department, Helsinki University Hospital, Porvoo, Finland
| | - Olli Suominen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Suvi Rautiainen
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Pihlajalinna Medical Centre Eastern Finland, Kuopio, Finland
| | - Ari Palomäki
- Emergency Department, Kanta-Häme Central Hospital, Hämeenlinna, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Harri Hyppölä
- Emergency Department, South Savo Central Hospital, Mikkeli, Finland
| | - Ritva Vanninen
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Kalle Mattila
- Emergency Department, Turku University Hospital, Turku, Finland.,Faculty of Medicine, University of Turku, Turku, Finland
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15
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Muramatsu K, Niimi N, Ikutomo M, Shimo S, Tamaki T, Niwa M, Sango K. Motor skills training-induced activation of descending pathways mediating cortical command to hindlimb motoneurons in experimental diabetic rats. Exp Neurol 2023; 363:114357. [PMID: 36849002 DOI: 10.1016/j.expneurol.2023.114357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/29/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023]
Abstract
Diabetes disrupts the corticospinal tract (CST) system components that control hindlimb and trunk movement, resulting in weakness of the lower extremities. However, there is no information about a method to improve these disorders. This study aimed to investigate the rehabilitative effects of 2 weeks of aerobic training (AT) and complex motor skills training (ST) on motor disorders in streptozotocin-induced type 1 diabetic rats. In this study, electrophysiological mapping of the motor cortex showed that the diabetes mellitus (DM)-ST group had a larger motor cortical area compared to the DM-AT group and sedentary diabetic animals. Moreover, hand grip strength and rotarod latency increased in the DM-ST group; however, these two parameters did not change in the DM-AT group, as well as in control and sedentary diabetic rats. Furthermore, in the DM-ST group, cortical stimulation-induced and motor-evoked potentials were preserved after the interception of the CST; however, this potential disappeared after additional lesions were made on lateral funiculus, suggesting that their function extends to activating motor descending pathways other than the CST locating lateral funiculus. According to immunohistochemical analysis, the larger fibers present on the dorsal part of the lateral funiculus, which corresponds to the rubrospinal tract of the DM-ST group, expressed the phosphorylated growth-associated protein, 43 kD, which is a specific marker of axons with plastic changes. Additionally, electrical stimulation of the red nucleus revealed expansion of the hindlimb-responsible area and increased motor-evoked potentials of the hindlimb in the DM-ST group, suggesting a strengthening of synaptic connections between the red nucleus and spinal interneurons driving motoneurons. These results reveal that ST induces plastic changes in the rubrospinal tract in a diabetic model, which can compensate for diabetes by disrupting the CST system components that control the hindlimb. This finding suggests that ST can be a novel rehabilitation strategy to improve motor dysfunctions in diabetic patients.
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16
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Arráez-Aybar LA, Biasutto S, Amer MAR, García-Mata R, Bueno-López JL. Latin American Anatomists' views on human body dissection and donation. Ann Anat 2023; 246:152037. [PMID: 36436719 DOI: 10.1016/j.aanat.2022.152037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Studies abound regarding the medical students' views on the importance of anatomy and the dissection of human bodies, but little is known about the views of Latin American Anatomists. METHODS A survey was carried out to test several hypotheses among anatomists of the Americas about how they perceive their professional identity, the use and role of dissection in their undergraduate courses, and the approval degree of bequeathing their body for anatomical teaching/research; another goal was ascertaining to what extent their attitude on these topics depended on gender, length of teaching experience and belief in the afterlife. RESULTS One hundred and forty-five anatomists from thirteen Latin American and Caribbean Countries took the survey; 79% stated the main role of an anatomist is teaching; 34% recorded their undergraduate students dissected human cadavers as part of their anatomy lab course-undergraduates dissecting less in the less experienced anatomists' courses (p = 0.0002). Most anatomists said dissection was a training tool for undergraduate students, a tool for developing professional skills, and a tool to help control emotions-most experienced anatomists stood out from the rest saying dissection is only to teach anatomy (p < 0.001), even if such response was the least valued by them among all replies. Men differed from women in valuing dissection as a tool to help control emotions (p = 0.006); less experienced anatomists held the opposite (p < 0.0001). Approval of a close doctor-patient relationship diverged, being different between the most and the least experienced anatomists (p = 0.01). Anatomists said they would donate only their organs (44%), whole body (9%) and both organs and body (46%). Undecided anatomists about the belief in life after death were the least in favor of donation (p = 0.05).
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Affiliation(s)
- Luis-A Arráez-Aybar
- Department of Anatomy & Embryology, Faculty of Medicine, University Complutense of Madrid (UCM), Madrid, Spain.
| | - Susana Biasutto
- Chair of Normal Anatomy. Faculty of Medical Sciences, National University of Cordoba, Argentina
| | - Mariano A R Amer
- Chair of Anatomy, School of Dentistry, University of Buenos Aires, Argentina
| | | | - José L Bueno-López
- Department of Neurosciences, School of Medicine and Nursing, The University of the Basque Country (UPV/EHU), Leioa, Biscay, Spain
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17
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Soler J, Casellas-Pujol E, Pascual JC, Schmidt C, Domínguez-Clavé E, Cebolla A, Alvear D, Muro A, Elices M. Advancing the treatment of long-lasting borderline personality disorder: a feasibility and acceptability study of an expanded DBT-based skills intervention. Borderline Personal Disord Emot Dysregul 2022; 9:34. [PMID: 36503564 PMCID: PMC9743724 DOI: 10.1186/s40479-022-00204-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/12/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Long-term follow-up studies in patients with borderline personality disorder (BPD) consistently show persistent impairment in psychosocial adjustment, although symptoms tend to decrease over time. Consequently, it might be better to deemphasize symptom-oriented interventions and instead promote interventions that incorporate patient perspectives on recovery. In this study we aimed to examine the feasibility and acceptability of a novel intervention (dialectical behavioral therapy combined with positive psychology and contextual-based skills) in the clinical treatment of long-lasting BPD difficulties. METHODS This was a qualitative study. We developed an initial 8-week group intervention for long-lasting BPD. Upon completion of the 8-week program, the participants were asked to participate in a group discussion to provide feedback. Based on that feedback, the intervention protocol was modified and then offered to a second group of patients, who also provided feedback. The protocol was revised again and administered to a third group. A total of 32 patients participated in the group interventions; of these, 20 provided feedback in the qualitative study. The main outcome measure was acceptability. RESULTS The following overarching themes emerged from the group interviews: helpful, unhelpful and neutral practices; internal/external barriers; facilitators; and effects. Participants reported difficulties in imagining an optimal future and self-compassion. By contrast, positive skills were associated with an increase in positive emotions. The main internal barrier was facing difficult emotions. The main external barriers were language-related issues. The group format was perceived as a facilitator to success. Dropout rates, which were assessed as an additional measure of acceptability, decreased substantially in each successive group, from 60 to 40% and finally 20%. CONCLUSIONS The intervention was feasible to implement in the clinical setting and participants rated the final set of skills highly. Most of the skills were considered useful. Participant feedback was invaluable to improve the intervention, as evidenced by the large increase in the retention rate from 40 to 80%. Randomized clinical trials are needed to test the efficacy of this intervention in promoting well-being in participants with long-lasting BPD.
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Affiliation(s)
- Joaquim Soler
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret 167, 08025, Barcelona, Spain.,Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Institut d'Investigació Biomèdica-Sant Pau (IIB-NTPAU), Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Barcelona, Spain
| | - Elisabet Casellas-Pujol
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret 167, 08025, Barcelona, Spain.,Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Institut d'Investigació Biomèdica-Sant Pau (IIB-NTPAU), Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Barcelona, Spain
| | - Juan Carlos Pascual
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret 167, 08025, Barcelona, Spain. .,Universitat Autònoma de Barcelona (UAB), Barcelona, Spain. .,Institut d'Investigació Biomèdica-Sant Pau (IIB-NTPAU), Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Barcelona, Spain.
| | - Carlos Schmidt
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret 167, 08025, Barcelona, Spain
| | - Elisabet Domínguez-Clavé
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret 167, 08025, Barcelona, Spain.,Institut d'Investigació Biomèdica-Sant Pau (IIB-NTPAU), Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Barcelona, Spain
| | - Ausias Cebolla
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, University of Valencia UV, Valencia, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain
| | - David Alvear
- Universidad del País Vasco/Euskal Herriko Unibertsitatea, leioa, Spain
| | - Anna Muro
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Department of Basic, Developmental and Educational Psychology, Universitat Autònoma de Barcelona Serra Húnter Programme, Generalitat de Catalunya, Barcelona, Spain
| | - Matilde Elices
- Institut d'Investigació Biomèdica-Sant Pau (IIB-NTPAU), Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Barcelona, Spain.,Institute Mar of Medical Research, IMIM, Barcelona, Spain
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18
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Goto Y, Miura H, Yamaguchi Y, Onishi J. Evaluation of an advance care planning training program for practice professionals in Japan incorporating shared decision making skills training: a prospective study of a curricular intervention. Palliat Care 2022; 21:135. [PMID: 35883081 PMCID: PMC9315089 DOI: 10.1186/s12904-022-01019-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 07/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We developed a novel training program for health care professionals that incorporated shared decision making (SDM) skills training into an advance care planning (ACP) training course, the first in Japan. This study aimed to assess the training program's impact on health care professionals' knowledge, skill, attitudes, and confidence to initiate ACP. METHODS Using the novel Japanese educational program, we evaluated the effect of 8-month programs conducted eight community training sites of professionals who can practice ACP in a local area in Aichi Prefecture (the Aichi ACP Project). SDM skills training was provided during the workshops conducted in the ACP training course, and the participants' satisfaction and understanding of the training were assessed. After the completion of two workshops, information on SDM skill results from the training and submitted assignments were collected anonymously from the training sites. RESULT A total of 404 participants completed all education programs. After the first workshop, at least 95% of trainees stated that they were satisfied with the training and that it was useful for ACP practice. The evaluation of the results between the first and second workshops indicated improvement in SDM skills on some items of the SDM measures. In the second workshop, at least 90% of participants submitted implementation reports, and after the second workshop, a survey of confidence in ACP practice was administered, with responses indicating improvement. There were high levels of interest in education related to the ACP practices of oneself and others. CONCLUSIONS This educational program can be an effective for developing professionals who can practice ACP with SDM skills.
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Affiliation(s)
- Yuko Goto
- Department of Home Care and Regional Liaison Promotion, National Center for Geriatrics and Gerontology, Nagoya, Japan.
| | - Hisayuki Miura
- Department of Home Care and Regional Liaison Promotion, National Center for Geriatrics and Gerontology, Nagoya, Japan
| | - Yasuhiro Yamaguchi
- Department of Respiratory Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Joji Onishi
- Department of Community Health Care and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
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19
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Kowalski C, Boulesteix AL, Harendza S. Effective methods to enhance medical students' cardioversion and transcutaneous cardiac pacing skills retention - a prospective controlled study. BMC Med Educ 2022; 22:417. [PMID: 35650577 PMCID: PMC9158220 DOI: 10.1186/s12909-022-03495-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Guideline-based therapy of cardiac arrhythmias is important for many physicians from the beginning of their training. Practical training of the required skills to treat cardiac arrhythmias is useful for acquiring these skills but does not seem sufficient for skill retention. The aim of this study was to compare different retention methods for skills required to treat cardiac arrhythmias with respect to the performance of these skills in an assessment. METHODS Seventy-one final-year medical students participated in a newly designed workshop to train synchronized cardioversion (SC) and transcutaneous cardiac pacing (TCP) skills in 2020. All participants completed an objective structured clinical examination (OSCE 1) one week after the training. Afterwards, the participants were stratified and randomized into three groups. Nine weeks later, one group received a standard operating procedure (SOP) for the skills, one group participated in a second workshop (SW), and one group received no further intervention (control). Ten weeks after the first training, all groups participated in OSCE 2. RESULTS The average score of all students in OSCE 1 was 15.6 ± 0.8 points with no significant differences between the three groups. Students in the control group reached a significantly (p < 0.001) lower score in OSCE 2 (-2.0 points, CI: [-2.9;-1.1]) than in OSCE 1. Students in the SOP-group achieved on average the same result in OSCE 2 as in OSCE 1 (0 points, CI: [-0.63;+0.63]). Students who completed a second skills training (SW-group) scored not significantly higher in OSCE 2 compared to OSCE 1 (+0.4 points, CI: [-0.29;+1.12]). The OSCE 2 scores in groups SOP and SW were neither significantly different nor statistically equivalent. CONCLUSIONS Partial loss of SC and TCP skills acquired in a workshop can be prevented after 10 weeks by reading an SOP as well as by a second workshop one week before the second assessment. Refreshing practical skills with an SOP could provide an effective and inexpensive method for skills retention compared to repeating a training. Further studies need to show whether this effect also exists for other skills and how frequently an SOP should be re-read for appropriate long-term retention of complex skills.
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Affiliation(s)
- Christian Kowalski
- Department of Anesthesiology, Ludwig-Maximilians-University, Munich, Germany
| | - Anne-Laure Boulesteix
- Department of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University, Munich, Germany
| | - Sigrid Harendza
- Department of Internal Medicine, University Medical, Center Hamburg-Eppendorf, Hamburg, Germany
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20
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Cherrier MM, Higano CS, Gray HJ. Cognitive skill training improves memory, function, and use of cognitive strategies in cancer survivors. Support Care Cancer 2022; 30:711-720. [PMID: 34368888 PMCID: PMC8639759 DOI: 10.1007/s00520-021-06453-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/19/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Cancer survivors commonly report symptoms of impaired cognition. This project examined effectiveness of a behavioral skills training intervention to improve cognition and reduce cognitive dysfunction symptoms in cancer survivors. METHODS Participants were randomly assigned to group-based workshops focused on learning new cognitive skills (skills treatment-TX) or an active control of education workshops (education control-EC) or a passive control of wait list (WL). Participants were evaluated pre- and post intervention with subjective mood and symptom questionnaires and objective neurocognitive tests. RESULTS One hundred twenty-eight participants (mean age 59 years), average 4.6 years (+ / - 5.5 years) post cancer treatment with various cancer types (breast, bladder, prostate, colon, uterine), were enrolled. Analysis of all participants who attended workshop(s) revealed improvement in the TX workshop completers on all objective cognitive measures (attention, concentration, declarative, and working memory) save one test of selective attention, and improvement on a single measure (verbal memory) and decline (selective attention) in the EC group. TX workshop completers also improved on all symptom and mood measures, in contrast to EC group which improved on a single subscale of a symptom measure, but increased on an anxiety measure. TX group alone improved on a quantified measure of each participants' unique, "top three," self-described cognitive symptoms. CONCLUSION Improvement from behavioral skills training was evident from objective cognitive tests, subjective symptom measures, and quantified, individual patient-specific symptoms. Behavioral skill training is an effective treatment for cognitive dysfunction in cancer survivors, and should be considered as a treatment option by health care providers.
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Affiliation(s)
- Monique M. Cherrier
- Department of Psychiatry and Behavioral Sciences, University of Washington, Box 356560, Seattle, WA 98195, USA,Fred Hutchinson Cancer Consortium, Seattle, WA 98195, USA,Corresponding author
| | - Celestia S. Higano
- Department of Medicine, Division of Oncology, University of Washington, Seattle, WA 98195, USA,Fred Hutchinson Cancer Research Center, Seattle, WA 98195, USA
| | - Heidi J. Gray
- Fred Hutchinson Cancer Consortium, Seattle, WA 98195, USA,Department of Medicine, Division of Oncology, University of Washington, Seattle, WA 98195, USA,Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, USA
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21
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Egede LE, Davidson TM, Knapp RG, Walker RJ, Williams JS, Dismuke CE, Dawson AZ. HOME DM-BAT: home-based diabetes-modified behavioral activation treatment for low-income seniors with type 2 diabetes-study protocol for a randomized controlled trial. Trials 2021; 22:787. [PMID: 34749788 PMCID: PMC8574935 DOI: 10.1186/s13063-021-05744-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/20/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND About 13% of African Americans and 13% of Hispanics have diabetes, compared to 8% of non-Hispanic Whites (NHWs). This is more pronounced in the elderly where about 25-30% of those aged 65 and older have diabetes. Studies have found associations between social determinants of health (SDoH) and increased incidence, prevalence, and burden of diabetes; however, few interventions have accounted for the context in which the elderly live by addressing SDoH. Specifically, psychosocial factors (such as cognitive dysfunction, functional impairment, and social isolation) impacting this population may be under-addressed due to numerous medical concerns addressed during the clinical visit. The long-term goal of the project is to identify strategies to improve glycemic control and reduce diabetes complications and mortality in African Americans and Hispanics/Latinos with type 2 diabetes. METHODS This is a 5-year prospective, randomized clinical trial, which will test the effectiveness of a home-based diabetes-modified behavioral activation treatment for low-income, minority seniors with type 2 diabetes mellitus (T2DM) (HOME DM-BAT). Two hundred, aged 65 and older and with an HbA1c ≥8%, will be randomized into one of two groups: (1) an intervention using in-home, nurse telephone-delivered diabetes education, and behavioral activation or (2) a usual care group using in-home, nurse telephone-delivered, health education/supportive therapy. Participants will be followed for 12 months to ascertain the effect of the intervention on glycemic control, blood pressure, and low-density lipoprotein (LDL) cholesterol. The primary hypothesis is low-income, minority seniors with poorly controlled type 2 diabetes randomized to HOME DM-BAT will have significantly greater improvements in clinical outcomes at 12 months of follow-up compared to usual care. DISCUSSION Results from this study will provide important insight into the effectiveness of a home-based diabetes-modified behavioral activation treatment for low-income, minority seniors with uncontrolled type 2 diabetes mellitus and inform strategies to improve glycemic control and reduce diabetes complications in minority elderly with T2DM. TRIAL REGISTRATION ClinicalTrials.gov NCT04203147 ). Registered on December 18, 2019, with the National Institutes of Health Clinical Trials Registry.
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Affiliation(s)
- Leonard E Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.
| | - Tatiana M Davidson
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St, MSC 160, Charleston, SC, 29425, USA
| | - Rebecca G Knapp
- Department of Public Health Services, College of Medicine, Medical University of South Carolina, 135 Cannon St., Charleston, SC, 29425, USA
| | - Rebekah J Walker
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Joni S Williams
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Clara E Dismuke
- Health Economics Resource Center, VA Palo Alto Healthcare System, 795 Willow Road (152 MPD), Menlo Park, CA, 94025, USA
| | - Aprill Z Dawson
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
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22
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Taussig HN, Dmitrieva J, Garrido EF, Cooley JL, Crites E. Fostering Healthy Futures Preventive Intervention for Children in Foster Care: Long-term Delinquency Outcomes from a Randomized Controlled Trial. Prev Sci 2021; 22:1120-1133. [PMID: 33905053 PMCID: PMC8541930 DOI: 10.1007/s11121-021-01235-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
Child maltreatment and foster care placement are strong risk factors for delinquency and juvenile justice involvement, and there is substantial crossover between youth in the child welfare and juvenile justice systems. This study examines the long-term impact of the Fostering Healthy Futures (FHF) program, a 30-week mentoring and skills group preventive intervention for preadolescent maltreated children in foster care. Participants included 426 children recently placed in out-of-home care who were randomized to intervention or control conditions. Outcomes included both self-reported delinquency, measured at multiple time points between 6 months and 12 years post-intervention, as well as court records of delinquency charges, which were measured for 7 consecutive years beginning 3 months after the intervention began. Results from multilevel models indicated that the intervention group self-reported 30-82% less total and non-violent delinquency than the control group between ages 14 and 18. Court charges for total and violent delinquency in mid-adolescence were also 15-30% lower for the intervention group. These findings indicate that a mentoring and skills training program in preadolescence can reduce delinquency and justice involvement for children who are at high risk for these outcomes.
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Affiliation(s)
- Heather N Taussig
- Graduate School of Social Work, University of Denver, 2148 S. High Street, Denver, CO, 80208, USA.
- Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO, 80045, USA.
| | - Julia Dmitrieva
- Department of Psychology , Frontier Hall, 2155 S. Race St, CO, 80208, Denver, USA
| | - Edward F Garrido
- Department of Psychology , Frontier Hall, 2155 S. Race St, CO, 80208, Denver, USA
| | - John L Cooley
- Department of Psychological Sciences, Texas Tech University, 2500 Broadway, Lubbock, TX, 79409, USA
| | - Erin Crites
- Colorado State Court Administrator's Office, 1300 Broadway UNIT 1200, Denver, CO, 80203, USA
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23
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Tan XH, Foo MA, Lim SLH, Lim MBXY, Chin AMC, Zhou J, Chiam M, Krishna LKR. Teaching and assessing communication skills in the postgraduate medical setting: a systematic scoping review. BMC Med Educ 2021; 21:483. [PMID: 34503497 PMCID: PMC8431930 DOI: 10.1186/s12909-021-02892-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 08/17/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND Poor communication skills can potentially compromise patient care. However, as communication skills training (CST) programs are not seen as a priority to many clinical departments, there is a discernible absence of a standardised, recommended framework for these programs to be built upon. This systematic scoping review (SSR) aims to gather prevailing data on existing CSTs to identify key factors in teaching and assessing communication skills in the postgraduate medical setting. METHODS Independent searches across seven bibliographic databases (PubMed, PsycINFO, EMBASE, ERIC, CINAHL, Scopus and Google Scholar) were carried out. Krishna's Systematic Evidence-Based Approach (SEBA) was used to guide concurrent thematic and content analysis of the data. The themes and categories identified were compared and combined where possible in keeping with this approach and then compared with the tabulated summaries of the included articles. RESULTS Twenty-five thousand eight hundred ninety-four abstracts were identified, and 151 articles were included and analysed. The Split Approach revealed similar categories and themes: curriculum design, teaching methods, curriculum content, assessment methods, integration into curriculum, and facilitators and barriers to CST. Amidst a wide variety of curricula designs, efforts to develop the requisite knowledge, skills and attitudes set out by the ACGME current teaching and assessment methods in CST maybe categorised into didactic and interactive methods and assessed along Kirkpatrick's Four Levels of Learning Evaluation. CONCLUSIONS A major flaw in existing CSTs is a lack of curriculum structure, focus and standardisation. Based upon the findings and current design principles identified in this SSR in SEBA, we forward a stepwise approach to designing CST programs. These involve 1) defining goals and learning objectives, 2) identifying target population and ideal characteristics, 3) determining curriculum structure, 4) ensuring adequate resources and mitigating barriers, 5) determining curriculum content, and 6) assessing learners and adopting quality improvement processes.
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Affiliation(s)
- Xiu Hui Tan
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Malia Alexandra Foo
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Shaun Li He Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Marie Bernadette Xin Yi Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, Block MD 6, 14 Medical Drive, #05-01, Singapore, 117599, Singapore
| | - Jamie Zhou
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Lien Centre of Palliative Care, Duke-NUS Graduate Medical School, 8College Road, Singapore, 169857, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- Centre of Biomedical Ethics, National University of Singapore, Block MD 11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
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24
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Chainey J, Elomaa AP, O'Kelly CJ, Kim MJ, Bednarik R, Zheng B. Eye-Hand Coordination of Neurosurgeons: Evidence of Action-Related Fixation in Microsuturing. World Neurosurg 2021; 155:e196-e202. [PMID: 34400325 DOI: 10.1016/j.wneu.2021.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We examined performance differences between expert and novice neurosurgeons under a surgical microscope with the goal to evaluate surgical expertise. METHODS The Tobii eye-tracker was used to record surgeons' eye movements while they performed a microsuturing task. A total of 19 expert and 18 novice trials were recorded under the microscope. Surgical videos were annotated to label subtasks and critical actions. Total suturing time and subtask times were also compared between novice and expert surgeons. At 3 critical and discrete surgical actions (needle piercing into tissue, exiting, and thread cutting) we examined eye fixation that was directly coupled to each of these actions. RESULTS Compared with novices, expert surgeons completed the suture with shorter total time (258.52 ± 102.14 seconds vs. 330.02 ± 96.52 seconds, P = 0.038), penetration time (17.15 ± 3.50 seconds vs. 26.26 ± 18.58 seconds, P = 0.043), and knot-tying time (194.63 ± 94.55 seconds vs. 262.52 ± 79.05 seconds, P = 0.025). On average, experts displayed longer fixation (1.62 seconds) and preaction fixation time (1.3 seconds) than novices (fixation time = 1.24 seconds, P = 0.048; preaction fixation = 0.82 seconds, P = 0.005)). Experts maintained their visual engagement constantly over the 3 levels of subtasks while novices required a longer fixation time for the challenging piercing action than for the exiting and cutting action. CONCLUSIONS The action-related fixation can be used to evaluate microsurgeons' level of expertise and in surgical education for gaze training.
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Affiliation(s)
- Jonathan Chainey
- Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Antti-Pekka Elomaa
- Department of Neurosurgery, University of Eastern Finland, Kuopio, Finland
| | - Cian J O'Kelly
- Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Michael J Kim
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Roman Bednarik
- School of Computing, University of Eastern Finland, Joensuu, Finland
| | - Bin Zheng
- Department of Surgery, University of Alberta, Edmonton, Canada.
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25
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Tiderington E, Goodwin J. Moving On From Supportive Housing (MOSH): Development and evaluation of a transitional skill-building curriculum for providers helping residents exit homeless services. Eval Program Plann 2021; 85:101913. [PMID: 33548902 DOI: 10.1016/j.evalprogplan.2021.101913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/17/2020] [Accepted: 01/17/2021] [Indexed: 06/12/2023]
Abstract
This article describes the development and evaluation of MOSH (Moving On From Supportive Housing), a transitional skill-building curriculum for providers helping residents exit homeless services to mainstream housing without embedded supports. In this evaluation, we assess the feasibility, acceptability, fit, and potential efficacy of the MOSH curriculum to improve proximal provider-level outcomes, including self-efficacy to provide MOSH-related independent living skills and supports. Homeless-services providers (N = 49) from a range of programs and settings participated in the training. Findings from focus groups and pre- and posttest surveys indicate high levels of overall satisfaction with the training. The majority of trainees perceived the training to be useful to their work and potentially useful for service recipients, felt the training would fit well within their existing day-to-day work, and said they were very likely to use MOSH skills in such work. Statistically significant improvements in self-efficacy regarding all skills but one were also found. MOSH holds promise as an intervention that can enhance provider practice and promotion of independent living skills in homeless services. Although these initial findings on MOSH are encouraging, further research will be needed to evaluate provider knowledge gains and effective use of these skills in practice.
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Affiliation(s)
- Emmy Tiderington
- Rutgers, The State University of New Jersey, School of Social Work, 360 Martin Luther King Jr. Boulevard, Newark, NJ, 07102, United States.
| | - Jordan Goodwin
- Rutgers, The State University of New Jersey, School of Social Work, United States
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26
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Ramirez-Hernandez D, Stolwyk RJ, Chapman J, Wong D. The experience and acceptability of smartphone reminder app training for people with acquired brain injury: a mixed methods study. Neuropsychol Rehabil 2021; 32:1263-1290. [PMID: 33563100 DOI: 10.1080/09602011.2021.1879875] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Smartphones are useful compensatory memory aids, yet training on how to use them is seldom offered as part of rehabilitation for acquired brain injuries (ABIs). We aimed to explore the experience and acceptability of a smartphone training intervention in 26 people with ABI who participated in a pilot randomized controlled trial comparing three skills training approaches. Participants completed questionnaire ratings and a semi-structured interview, six weeks post-training. Most participants rated the training as enjoyable (80.8%) and reasonable in duration (88.5%). Others reported that more than one training session was needed to learn the app (34.6%). Five themes were identified from qualitative data through thematic analysis: (1) Attitudes and pre-existing factors, (2) Experiencing the intervention, (3) Tailoring the intervention to the individual, (4) Facilitators and barriers to implementation and (5) Enhancing smartphone use in everyday life. These themes were juxtaposed with a theoretical framework of acceptability, which indicated that some elements (e.g., having a structured session and a supportive trainer) contributed to the acceptability of the intervention by minimizing training burden and increasing self-efficacy. Tailoring the training to the individual's technological skills and lifestyle, providing post-training resources and involving family members were identified as factors that could improve intervention acceptability.
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Affiliation(s)
- Diana Ramirez-Hernandez
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Renerus J Stolwyk
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Jodie Chapman
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia.,School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Dana Wong
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia.,School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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27
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Sepehri A, von Roth P, Stoffel K, Acklin Y, Oussedik S, Wijburg B, Wada A, Cunningham M, Masri BA. Surgical Skills Training Using Simulation for Basic and Complex Hip and Knee Arthroplasty. Orthop Clin North Am 2021; 52:1-13. [PMID: 33222980 DOI: 10.1016/j.ocl.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Skills training is important in an arthroplasty curriculum and can focus either on "part tasks" or on full procedures. The most commonly used simulations in orthopedics including arthroplasty are anatomic specimens, dry bone models, and virtual or other technology-enhanced systems. A course curriculum planning committee must identify the gaps to address, define what learners need to be able to do, and select the most appropriate simulation modality and assessment for delivery. Each simulation must have a clear structure with learning objectives, steps, and take-home messages. Feedback from learners and faculty must be integrated to improve processes and models for future learning.
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Affiliation(s)
- Aresh Sepehri
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada; Department of Orthopaedics, Diamond Health Care Centre, 11th Floor - 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada
| | | | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, Basel 4031, Switzerland
| | - Yves Acklin
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, Basel 4031, Switzerland
| | - Sam Oussedik
- University College Hospital London, 235 Euston Road, Bloomsbury, London NW1 2BU, UK
| | - Bas Wijburg
- AO Recon, Clavadelerstrasse 8, Davos Platz 7270, Switzerland
| | - Arisa Wada
- Education, AO Recon, Clavadelerstrasse 8, Davos Platz 7270, Switzerland
| | - Michael Cunningham
- Curriculum Development, AO Foundation - AO Education Institute, Stettbachstrasse 6, Dübendorf 8600, Switzerland
| | - Bassam A Masri
- Department of Orthopaedics, Complex Joint Reconstruction Clinic, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, 3rd Floor, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada.
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Higgins M, Madan C, Patel R. Development and decay of procedural skills in surgery: A systematic review of the effectiveness of simulation-based medical education interventions. Surgeon 2020; 19:e67-e77. [PMID: 32868158 DOI: 10.1016/j.surge.2020.07.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/31/2020] [Indexed: 01/10/2023]
Abstract
CONTEXT Changes to surgical training programmes in the UK has led to a reduction in theatre time for trainees, and an increasing reliance on simulation to provide procedural experience. Whilst simulation offers opportunity for repetitive practice, the effectiveness of simulation as an educational intervention for developing procedural surgical skills is unclear. METHODS A systematic literature review was undertaken to retrieve all studies describing simulation-based medical education (SBME) interventions for the development of procedural surgical skills using the MEDLINE, PsycINFO, CINAHL, EMBASE and PUBMED databases. Studies measuring skill retention or demonstrating transferability of skills for improving patient outcomes were included in the review. RESULTS SBME is superior to no training and can lead to improvement in procedural surgical skills, such that skills transfer from simulated environments into theatre. SBME results in minimal skill degradation after 2 weeks, although more significant decay results after >90 days. Many studies recruited <10 participants, used a variety of methods and were restricted to endoscopic surgical techniques. All studies did not compare interventions with non-SBME teaching methods for developing procedural surgical skills. No studies compared the curriculum design of different surgical training programmes. CONCLUSIONS SBME interventions are effective for developing procedural skills in surgery. SBME interventions are also effective for preventing the decay of procedural surgical skills. Although no studies demonstrate non-inferiority of SBME interventions compared to time in theatre developing skills, SBME interventions do enable the transfer of skills into theatre, and the potential for improving patient outcomes.
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Van Rossem I, Devroey D, De Paepe K, Puttemans F, Petit P, Schol S, Deridder S, Vandevoorde J. A Training Game for Students Considering Family Medicine: an Educational Project Report. J Med Life 2020; 12:411-418. [PMID: 32025260 PMCID: PMC6993303 DOI: 10.25122/jml-2019-0056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The Groningen Institute Model for Management in Care Services aims to prepare medical students for their complex tasks as family physicians, based on the CanMEDS framework. Although initially developed for pharmacy students, the present paper reports on the eight-year experience with GIMMICS for family physician students at the Vrije Universiteit Brussel. The Groningen Institute Model for Management in Care Services is a training game that simulates real-life situations in a structured and supervised setting. It offers students the possibility to practice clinical, practical, and communicational skills. Students install and manage their group practices, hold consultations with simulated patients, participate in several assignments and collaborate with pharmacy students. Feedback sessions showed that the training game is well-received by the students. A self-assessment questionnaire comprised of 23 questions on significant aspects of the seven CanMEDS roles showed significantly higher scores at the end of the game for 17 questions (p<0.05, Wilcoxon signed-rank test ). GIMMICS is a valuable linking pin between the different learning methods in medical education and clinical practice, helping students to improve themselves in the CanMEDS roles. However, simulation-based medical education requires significant time and resource investment.
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Affiliation(s)
- Inès Van Rossem
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
| | - Dirk Devroey
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kristien De Paepe
- Department of Pharmaceutical Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Francis Puttemans
- Department of Pharmaceutical Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Pascale Petit
- Study Guidance Centre, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sandrina Schol
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sander Deridder
- Department of Chemical Engineering, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jan Vandevoorde
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
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Baby B, Singh R, Singh R, Suri A, Arora C, Kumar S, Kalra PK, Banerjee S. A Review of Physical Simulators for Neuroendoscopy Skills Training. World Neurosurg 2020; 137:398-407. [PMID: 32014545 DOI: 10.1016/j.wneu.2020.01.183] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Minimally invasive neurosurgical approaches reduce patient morbidity by providing the surgeon with better visualization and access to complex lesions, with minimal disruption to normal anatomy. The use of rigid or flexible neuroendoscopes, supplemented with a conventional stereoscopic operating microscope, has been integral to the adoption of these techniques. Neurosurgeons commonly use neuroendoscopes to perform the ventricular and endonasal approaches. It is challenging to learn neuroendoscopy skills from the existing apprenticeship model of surgical education. The training methods, which use simulation-based systems, have achieved wide acceptance. Physical simulators provide anatomic orientation and hands-on experience with repeatability. Our aim is to review the existing physical simulators on the basis of the skills training of neuroendoscopic procedures. METHODS We searched Scopus, Google Scholar, PubMed, IEEE Xplore, and dblp. We used the following keywords "neuroendoscopy," "training," "simulators," "physical," and "skills evaluation." A total of 351 articles were screened based on development methods, evaluation criteria, and validation studies on physical simulators for skills training in neuroendoscopy. RESULTS The screening of the articles resulted in classifying the physical training methods developed for neuroendoscopy surgical skills into synthetic simulators and box trainers. The existing simulators were compared based on their design, fidelity, trainee evaluation methods, and validation studies. CONCLUSIONS The state of simulation systems demands collaborative initiatives among translational research institutes. They need improved fidelity and validation studies for inclusion in the surgical educational curriculum. Learning should be imparted in stages with standardization of performance metrics for skills evaluation.
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Affiliation(s)
- Britty Baby
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India; Amar Nath and Shashi Khosla School of Information Technology, Indian Institute of Technology-Delhi, New Delhi, India
| | - Ramandeep Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rajdeep Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Suri
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India; Amar Nath and Shashi Khosla School of Information Technology, Indian Institute of Technology-Delhi, New Delhi, India.
| | - Chetan Arora
- Department of Computer Science Engineering, Indian Institute of Technology-Delhi, New Delhi, India
| | - Subodh Kumar
- Department of Computer Science Engineering, Indian Institute of Technology-Delhi, New Delhi, India
| | - Prem Kumar Kalra
- Department of Computer Science Engineering, Indian Institute of Technology-Delhi, New Delhi, India
| | - Subhashis Banerjee
- Department of Computer Science Engineering, Indian Institute of Technology-Delhi, New Delhi, India
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Kells M, Joyce M, Flynn D, Spillane A, Hayes A. Dialectical behaviour therapy skills reconsidered: applying skills training to emotionally dysregulated individuals who do not engage in suicidal and self-harming behaviours. Borderline Personal Disord Emot Dysregul 2020; 7:3. [PMID: 32021690 PMCID: PMC6993331 DOI: 10.1186/s40479-020-0119-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 01/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dialectical behaviour therapy (DBT) is an evidence-based intervention for borderline personality disorder (BPD) but is an intensive treatment with significant health service costs. Access to DBT can sometimes be restricted due to limited resources. Positive results have been reported for the use of DBT skills training (DBT-ST), one of the four modes of standard DBT, in the treatment of individuals with BPD who self-harm. This study evaluates DBT-ST for a subgroup of individuals attending community mental health services who may have a diagnosis of BPD (or emerging BPD traits) but who are not actively self-harming. METHODS Participants in this study were 100 adults attending community mental health services with a diagnosis of BPD, emerging BPD traits or emotion dysregulation who were not actively self-harming. The majority of participants were female (71%), aged 25-34 years (32%), single (48%) and unemployed (34%). Participants partook in a 24-week DBT-ST intervention delivered by DBT therapists. Outcome measures included the Difficulties in Emotion Regulation Scale (DERS), the DBT Ways of Coping Checklist (DBT-WCCL) and the Five Facet Mindfulness Questionnaire (FFMQ). Measures were administered at pre-intervention, at the end of each skills module, and at post-intervention. RESULTS Significant reductions in emotion dysregulation (DERS) and dysfunctional coping (DBT-WCCL) scores were reported from pre- to post-intervention (p < .001). A significant increase in mindfulness scores (FFMQ) and DBT skill use (DBT-WCCL) was also observed (p < .001). However, the drop-out rate was high (49% at post-intervention). DISCUSSION The results of this uncontrolled study suggest that a standalone 24-week DBT-ST intervention may have a beneficial impact in terms of a reduction in emotion dysregulation and dysfunctional coping, and an increase in mindfulness and DBT skills use in patients with BPD/ emerging BPD traits who are not currently engaging in self-harm. Adequately powered randomised controlled trials are required to determine treatment efficacy in comparison to standard DBT for this population.
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Affiliation(s)
- Mary Kells
- 1Cork Mental Health Services, Cork Kerry Community Healthcare, Health Service Executive, Inniscarraig House, Western Road, Cork, Ireland
| | - Mary Joyce
- 2National Suicide Research Foundation, Western Gateway Building, University College Cork, Cork, Ireland
| | - Daniel Flynn
- 3Mental Health Services, Cork Kerry Community Healthcare, Health Service Executive, St Finbarr's Hospital, Cork, Ireland
| | - Ailbhe Spillane
- 2National Suicide Research Foundation, Western Gateway Building, University College Cork, Cork, Ireland
| | - Aoife Hayes
- 2National Suicide Research Foundation, Western Gateway Building, University College Cork, Cork, Ireland
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Santarém Semedo C, Moreira Diniz A, Herédia V. Training health professionals in patient-centered communication during magnetic resonance imaging to reduce patients' perceived anxiety. Patient Educ Couns 2020; 103:152-158. [PMID: 31402071 DOI: 10.1016/j.pec.2019.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 06/26/2019] [Accepted: 08/01/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE We examined how a patient-centered communication training program for magnetic resonance imaging (MRI) affected health professional (HP) practice and patients' perceived anxiety (PA). METHODS We implemented an intervention program. Six of the 17 eligible HPs completed the study. The proportion of observed desired behaviors (PODBs), including MRI procedure explanation (MRI-PE), communication, and MRI checking procedures was measured using an observation grid. We tested 182 patients (85 pre-, 58 post-, and 39 at follow-up) for PA pre- and post-MRI. RESULTS The Bayesian ANOVA effect size suggested moderate evidence of improvement in HP PODBs, pre- to post-intervention. Use of MRI-PE declined between post-intervention and follow-up (6 months later). Observed changes in PA, pre- to post-MRI, could be related to time constraints and perceived pressure to explain the exam in detail once institutional routines are reestablished. CONCLUSION In MRI units, time constraints condition the performance of HPs who address patients' PA. PRACTICE IMPLICATIONS "Real workplace" interventions that promote better patient-centered communication and provide each patient with a comprehensive explanation of MRI procedures also appear to improve HP PODBs.
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Affiliation(s)
- Carla Santarém Semedo
- Research Centre in Education and Psychology, Department of Psychology, School of Social Sciences, University of Évora, Évora, Portugal.
| | - António Moreira Diniz
- Research Centre in Education and Psychology, Department of Psychology, School of Social Sciences, University of Évora, Évora, Portugal
| | - Vasco Herédia
- Radiology Department, Hospital do Espírito Santo, EPE, Évora, Portugal and Affidea-Évora, Évora, Portugal
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Brouwers M, van Weel C, Laan R, van Weel-Baumgarten E. Training Undergraduates Skills in Breaking Bad News: How Students Value Educators' Feedback. J Cancer Educ 2019; 34:1103-1106. [PMID: 30128954 PMCID: PMC6882760 DOI: 10.1007/s13187-018-1415-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Feedback is a key factor in acquiring breaking bad news (BBN) communication skills and its' acceptance depends on the perceived credibility of the provider. Our aim was to investigate students' opinions on the provided feedback by different educators (surgeons, psychologists, and simulated patient (SP)) during BBN skills training. We developed a questionnaire investigating provided feedback by the surgeon, psychologist, and SP (yes or no statements), regarding (1) perceived safety of the atmosphere, (2) perceived positive feedback, (3) perceived specific feedback, and (4) perceived usefulness for improvement during BBN skills training. Five hundred twenty students returned the questionnaire after BBN skills training. Most students rated the feedback as positive, specific, and useful. Also, the atmosphere was considered safe. Feedback ratings of the SP were the same as for the surgeon and valued higher than for the psychologist. An unsafe atmosphere, or not receiving positive, specific, or useful feedback was mostly related to the psychologist's feedback. Feedback on BBN skills training by surgeons and SPs is rated equally helpful by students and is regarded specific, useful, and positive. When designing a BBN training, it is worth to consider involving SP's as well as clinicians.
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Affiliation(s)
- Marianne Brouwers
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Chris van Weel
- Department of Health Services Research and Policy, Australian National University, Canberra, Australia
| | - Roland Laan
- Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Evelyn van Weel-Baumgarten
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Taussig HN, Weiler LM, Garrido EF, Rhodes T, Boat A, Fadell M. A Positive Youth Development Approach to Improving Mental Health Outcomes for Maltreated Children in Foster Care: Replication and Extension of an RCT of the Fostering Healthy Futures Program. Am J Community Psychol 2019; 64:405-417. [PMID: 31468553 PMCID: PMC6917986 DOI: 10.1002/ajcp.12385] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Preventing the negative impact of maltreatment on children's mental health requires interventions to be contextually sensitive, grounded in theory and research, and effective in reaching and retaining children and families. This study replicates and extends previous findings of the Fostering Healthy Futures (FHF) program, a 30-week mentoring and skills group intervention for preadolescent maltreated children in foster care. Participants included 426 children recently placed in out-of-home care who were randomized to intervention or control conditions. Outcomes measured 6-10 months postintervention included a multi-informant (child, caregiver, teacher) index of mental health problems as well as measures of posttraumatic stress symptoms, dissociative symptoms, quality of life, and use of mental health services and psychotropic medications. There were high rates of program initiation, retention, and engagement; 95% of those randomized to FHF started the program, 92% completed it, and over 85% of the mentoring visits and skills groups were attended. The FHF program demonstrated significant impact in reducing mental health symptomatology, especially trauma symptoms, and mental health service utilization. These program effects were consistent across almost all subgroups, suggesting that FHF confers benefit for diverse children. Results indicate that positive youth development programming is highly acceptable to children and families and that it can positively impact trauma and its sequelae.
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Affiliation(s)
- Heather N Taussig
- University of Denver, Denver, CO, USA
- Kempe Center, University of Colorado School of Medicine, Aurora, CO, USA
| | | | | | - Tara Rhodes
- Colorado Department of Education, Denver, CO, USA
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Joseph-Williams N, Williams D, Wood F, Lloyd A, Brain K, Thomas N, Prichard A, Goodland A, McGarrigle H, Sweetland H, Edwards A. A descriptive model of shared decision making derived from routine implementation in clinical practice ('Implement-SDM'): Qualitative study. Patient Educ Couns 2019; 102:1774-1785. [PMID: 31351787 DOI: 10.1016/j.pec.2019.07.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/09/2019] [Accepted: 07/13/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Research is needed to understand how Shared Decision-Making (SDM) is enacted in routine clinical settings. We aimed to 1) describe the process of SDM between clinicians and patients; 2) examine how well the SDM process compares to a prescriptive model of SDM, and 3) propose a descriptive model based on observed SDM in routine practice. METHODS Patients with chronic kidney disease and early stage breast cancer were recruited consecutively via Cardiff and Vale University Health Board (UK) teams. Consultations were audio-recorded, transcribed and thematically analysed. RESULTS Seventy-six consultations were observed: 26 pre-dialysis consultations and two consultations each for 25 breast cancer patients. Key stages of the 'Three Talk Model' were observed. However, we also observed more elements and greater complexity: a distinct preparation phase; tailored and evolving integrative option conversation; patients and clinicians developing 'informed preferences'; distributed and multi-stage decisions; and a more open-ended planning discussion. Use of decision aids was limited. CONCLUSION A more complex picture was observed compared with previous portrayals in current theoretical models. PRACTICE IIMPLICATIONS The model can provide a basis for future training and initiatives to promote SDM, and tackle the gap between what is advocated in policy, but rarely achieved in practice.
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Affiliation(s)
- Natalie Joseph-Williams
- Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK.
| | - Denitza Williams
- Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK
| | - Fiona Wood
- Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK
| | - Amy Lloyd
- Cardiff University, College of Biomedical and Life Sciences, Centre for Trials Research, Cardiff, UK
| | - Katherine Brain
- Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK
| | - Nerys Thomas
- Pre dialysis Team, Cardiff and Vale University Health Board, Nephrology and Transplant Directorate, University Hospital of Wales, Cardiff, UK
| | - Alison Prichard
- Pre dialysis Team, Cardiff and Vale University Health Board, Nephrology and Transplant Directorate, University Hospital of Wales, Cardiff, UK
| | - Annwen Goodland
- Pre dialysis Team, Cardiff and Vale University Health Board, Nephrology and Transplant Directorate, University Hospital of Wales, Cardiff, UK
| | - Helen McGarrigle
- Cardiff Breast Centre, Cardiff and Vale University Health Board, University Hospital Llandough, Cardiff, UK
| | - Helen Sweetland
- Cardiff Breast Centre, Cardiff and Vale University Health Board, University Hospital Llandough, Cardiff, UK
| | - Adrian Edwards
- Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK
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Michels NR, Vanhomwegen E. An educational study to investigate the efficacy of three training methods for infiltration techniques on self-efficacy and skills of trainees in general practice. BMC Fam Pract 2019; 20:133. [PMID: 31521131 PMCID: PMC6744665 DOI: 10.1186/s12875-019-1023-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/03/2019] [Indexed: 11/13/2022]
Abstract
Background Research shows that few general practitioners perform intra- and periarticular infiltrations. Lack of good training strategies to teach these skills would be an important reason for this observation. In this study, we investigated and compared three different training strategies for infiltrations of the glenohumeral joint, subacromial space, lateral epicondyle, carpal tunnel and knee joint. Methods Trainees in general practice were randomized into three teaching groups: a theoretical lecture (n = 18), or a theoretical lecture with training on anatomical models (n = 19) or with a training on cadavers (n = 11). The study period was 3 months. Before and after the training, the self-efficacy (questionnaire) and skills (Objective Structured Clinical Examination or OSCE, test on anatomical models) were evaluated. The self-efficacy was assessed again 3 months later. A Kruskal-Wallis test was used to compare the results before versus after training and between groups (p < 0.05). Results All three training strategies had a significantly positive effect on the self-efficacy concerning knowledge and skills. This benefit remained 3 months after training. However, some participants still felt uncomfortable to perform infiltrations. Best scores for self-efficacy concerning skills and best scores on the OSCE were observed after training on cadavers, followed by training on anatomical models. Conclusions Based on this study we suggest the combination of a theoretical lecture with a training on cadavers to teach infiltration techniques. To achieve an optimal long-term effect, additional refresher trainings may be necessary.
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Affiliation(s)
- Nele R Michels
- Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Doornstraat 331, 2610, Antwerp, Belgium.
| | - Els Vanhomwegen
- Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Doornstraat 331, 2610, Antwerp, Belgium
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Mosson R, Augustsson H, Bäck A, Åhström M, von Thiele Schwarz U, Richter A, Gunnarsson M, Hasson H. Building implementation capacity (BIC): a longitudinal mixed methods evaluation of a team intervention. BMC Health Serv Res 2019; 19:287. [PMID: 31064362 DOI: 10.1186/s12913-019-4086-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/09/2019] [Indexed: 11/29/2022] Open
Abstract
Background Managers and professionals in health and social care are required to implement evidence-based methods. Despite this, they generally lack training in implementation. In clinical settings, implementation is often a team effort, so it calls for team training. The aim of this study was to evaluate the effects of the Building Implementation Capacity (BIC) intervention that targets teams of professionals, including their managers. Methods A non-randomized design was used, with two intervention cases (each consisting of two groups). The longitudinal, mixed-methods evaluation included pre–post and workshop-evaluation questionnaires, and interviews following Kirkpatrick’s four-level evaluation framework. The intervention was delivered in five workshops, using a systematic implementation method with exercises and practical working materials. To improve transfer of training, the teams’ managers were included. Practical experiences were combined with theoretical knowledge, social interactions, reflections, and peer support. Results Overall, the participants were satisfied with the intervention (first level), and all groups increased their self-rated implementation knowledge (second level). The qualitative results indicated that most participants applied what they had learned by enacting new implementation behaviors (third level). However, they only partially applied the implementation method, as they did not use the planned systematic approach. A few changes in organizational results occurred (fourth level). Conclusions The intervention had positive effects with regard to the first two levels of the evaluation model; that is, the participants were satisfied with the intervention and improved their knowledge and skills. Some positive changes also occurred on the third level (behaviors) and fourth level (organizational results), but these were not as clear as the results for the first two levels. This highlights the fact that further optimization is needed to improve transfer of training when building teams’ implementation capacity. In addition to considering the design of such interventions, the organizational context and the participants’ characteristics may also need to be considered to maximize the chances that the learned skills will be successfully transferred to behaviors. Electronic supplementary material The online version of this article (10.1186/s12913-019-4086-1) contains supplementary material, which is available to authorized users.
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Hansen MC, Jones BD, Eack SM, Glenthøj LB, Ikezawa S, Iwane T, Kidd SA, Lepage M, Lindenmayer JP, Ljuri I, Maida K, Matsuda Y, Nakagome K, Nordentoft M, Ozog V, Penney D, Saperstein AM, Sunaga A, Vinogradov S, Virdee G, Wojtalik JA, Medalia A. Validation of the MUSIC Model of Motivation Inventory for use with cognitive training for schizophrenia spectrum disorders: A multinational study. Schizophr Res 2019; 206:142-8. [PMID: 30580895 DOI: 10.1016/j.schres.2018.11.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 08/26/2018] [Accepted: 11/30/2018] [Indexed: 11/21/2022]
Abstract
AIM Low motivation is a core symptom of schizophrenia which significantly impacts successful engagement in and benefit from psychosocial treatments. Therefore, it is important for clinicians to design psychosocial treatments to effectively motivate and engage patients during the treatment. The MUSIC® Model of Academic Motivation Inventory (MMI) is an 18-item instrument with five scales that assess students' motivation during academic tasks. The objective of the current study was to validate the MMI for use with schizophrenia-spectrum patients undergoing cognitive training. METHODS Participants included 181 people with schizophrenia spectrum disorders enrolled in cognitive training in four countries. A confirmatory factor analysis (CFA) assessed construct validity. Quality of fit was determined using the Comparative Fit Index (CFI), the Standardized Root Mean Square Residual (SRMR), and the Root Mean Square Error of Approximation (RMSEA). Pearson's correlation coefficients assessed construct validity and Cronbach's alphas assessed reliability. Furthermore, we examined factor loadings for each inventory item and assessed predictive validity by analyzing MMI scales with attendance outcomes. RESULTS Consistent with the original MMI validation studies used in academic settings, we found CFI values indicated a good fit, as did the SRMR and RMSEA values. The scales were correlated yet distinct. Cronbach's alpha values ranged from good to excellent and factor loadings showed that all items loaded very well onto their intended factors. The MMI had a positive relationship to treatment intensity. CONCLUSION The MMI is a valid and reliable tool to use with individuals with schizophrenia spectrum disorders undergoing a cognitive training intervention.
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Beidel DC, Frueh BC, Neer SM, Bowers CA, Trachik B, Uhde TW, Grubaugh A. Trauma management therapy with virtual-reality augmented exposure therapy for combat-related PTSD: A randomized controlled trial. J Anxiety Disord 2019; 61:64-74. [PMID: 28865911 DOI: 10.1016/j.janxdis.2017.08.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 08/03/2017] [Accepted: 08/17/2017] [Indexed: 11/21/2022]
Abstract
Virtual reality exposure therapy (VRET) realistically incorporates traumatic cues into exposure therapy and holds promise in the treatment of combat-related posttraumatic stress disorder (PTSD). In a randomized controlled trial of 92 Iraq and Afghanistan veterans and active duty military personnel with combat-related PTSD, we compared the efficacy of Trauma Management Therapy (TMT; VRET plus a group treatment for anger, depression, and social isolation) to VRET plus a psychoeducation control condition. Efficacy was evaluated at mid- and post-treatment, and at 3- and 6-month follow-up. Consistent with our hypothesis, VRET resulted in significant decreases on the Clinician Administered PTSD Scale and the PTSD Checklist-Military version for both groups. Also consistent with our hypothesis, significant decreases in social isolation occurred only for those participants who received the TMT group component. There were significant decreases for depression and anger for both groups, although these occurred after VRET and before group treatment. All treatment gains were maintained six-months later. Although not part of the original hypotheses, sleep was not improved by either intervention and remained problematic. The results support the use of VRET as an efficacious treatment for combat-related PTSD, but suggest that VRET alone does not result in optimal treatment outcomes across domains associated with PTSD.
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Carrion C, Folkvord F, Anastasiadou D, Aymerich M. Cognitive Therapy for Dementia Patients: A Systematic Review. Dement Geriatr Cogn Disord 2018; 46:1-26. [PMID: 30092585 DOI: 10.1159/000490851] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/12/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cognitive therapy is a well-established intervention for treating elderly suffering from dementia. In particular, reality orientation and skills training seem to be effective interventions for reversing cognitive impairment among elderly, although findings are inconclusive. Therefore, a systematic update of the existing evidence of cognitive therapy for people suffering from dementia is needed. AIM To review existing scientific evidence regarding the efficacy of cognitive therapies for elderly suffering from dementia. METHODS Studies were retrieved from several bibliographic databases (January 2009 to December 2017) with prespecified selection criteria, data extraction, and methodological quality assessment. RESULTS In total, 10 reality orientation, 25 skills training, and 12 mixed trials were identified as meeting the inclusion criteria and were systematically reviewed. Results from reality orientation trials showed minor effects for cognitive assessments, while skills training trials and mixed trials showed contradicting effects on cognition. Effects on other outcomes (e.g., daily functioning, depression, language) were limited or not found. CONCLUSIONS Skills training trials and mixed trials seem to affect cognitive impairment in a positive way, although the results are inconclusive. Comparison between studies was difficult due to differences in form of intervention. Because findings are inconclusive, more structuralized and comparable randomized controlled trials are needed.
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Affiliation(s)
- Carme Carrion
- UOC eHealth Center (eHC), Universitat Oberta de Catalunya (UOC), Barcelona, Spain.,eHealth Lab Research Group, Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - Frans Folkvord
- Open Evidence Research, Universitat Oberta de Catalunya, Barcelona, Spain.,Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands.,Communication Science, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Marta Aymerich
- UOC eHealth Center (eHC), Universitat Oberta de Catalunya (UOC), Barcelona, Spain
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Gupta SJ, Kemper KJ, Lynn J. Interest in online interprofessional elective mind-body skills (MBS) training. Complement Ther Med 2018; 36:137-141. [PMID: 29458920 DOI: 10.1016/j.ctim.2017.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION There is growing interest in mind-body skills (MBS) education and online interprofessional elective MBS training for health professionals. We conducted this study to understand a) the demand among different health professionals for an online MBS course; b) engagement with different MBS topics; and c) planned behavior changes. METHODS We examined registrations from May 1 through August 31, 2014 for a new online MBS elective, analyzing the percentage of registrants who engaged with one or more of 12 modules by September 30, 2014. We also reviewed written comments about planned behavior change. RESULTS The 693 registrants included physicians, nurses, social workers, dietitians, psychologists, and others. The two most popular topics were "Introduction: to Stress, Resilience, and Relaxation Response" and "Autogenic Training". Half of registrants (57%) engaged with at least one module and 9% completed all 12 modules within the study period. Nearly all (90%) of those who completed evaluations planned to use the technique they learned for themselves, introduce it to patients, or both. DISCUSSION Online elective MBS training attracts diverse health professionals and leads to plans for personal and professional behavior change. Additional research is necessary to understand the impact of different amounts and kinds of MBS training on professionals' resilience, burnout, and quality of care.
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Affiliation(s)
- Suman J Gupta
- College of Medicine, The Ohio State University, Columbus, OH, USA; Center for Integrative Health and Wellness, The Ohio State University, USA; Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, NY, USA
| | - Kathi J Kemper
- College of Medicine, The Ohio State University, Columbus, OH, USA; Center for Integrative Health and Wellness, The Ohio State University, USA; Department of Pediatrics, The Ohio State University, USA.
| | - Joanne Lynn
- College of Medicine, The Ohio State University, Columbus, OH, USA; Department of Neurology and Office of the Dean for Student Affairs, The Ohio State University, USA
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Dombek M, Lopez CA, Han Z, Lungarini A, Santos N, Schwaitzberg S, Cao C, Jones DB, De S, Olasky J. FUSE certification enhances performance on a virtual computer based simulator for dispersive electrode placement. Surg Endosc 2018; 32:3640-3645. [PMID: 29442242 DOI: 10.1007/s00464-018-6095-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 02/07/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has developed the fundamental use of surgical energy (FUSE) didactic curriculum in order to further understanding of the safe use of surgical energy. The virtual electrosurgical skill trainer (VEST) is being developed as a complementary simulation-based curriculum, with several modules already existing. Subsequently, a new VEST module has been developed about dispersive electrode placement. The purpose of this study is to assess knowledge about dispersive electrode placement in surgeons and surgical trainees in addition to describing a new VEST module. METHODS Forty-six subjects (n = 46) were recruited for participation at the 2016 SAGES conference Learning Center. Subjects were asked to complete demographic surveys, a five-question pre-test, and a five-question post-test after completing the VEST dispersive electrode module. Subjects were then asked to rate different aspects of the module using a five-point Likert scale questionnaire. RESULTS Mean pre-simulator and post-simulator assessment scores were 1.5 and 3.4, respectively, with Wilcoxon signed rank analysis showing a significant difference in the means (p < 0.05). Subjects were grouped by the presence (n = 12) or absence (n = 31) of prior FUSE experience and by training level. Mann-Whitney U testing showed no significant difference in pre-simulator assessment scores between attending surgeons and trainees (p > 0.05). In those with and without FUSE exposure, a significant difference (p < 0.05) was seen in pre-simulator assessment scores, and no significant difference in Likert scale assessment scores was seen. CONCLUSIONS This study demonstrated a new VEST educational module. Consistently high Likert assessment scores showed that users felt that the VEST module helped their understanding of dispersive electrode placement. Additionally, the study reflected a potential knowledge deficit in the safe use of dispersive electrodes in the surgical community, also demonstrating that even some exposure to the FUSE curriculum developed by SAGES provides increased awareness about dispersive electrode use.
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Affiliation(s)
- Michael Dombek
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA. .,Department of Surgery, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite 9B, Boston, MA, 02215, USA.
| | - Carlos A Lopez
- Department of BioMedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Zhongqing Han
- Department of BioMedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Alyssa Lungarini
- Department of Surgery, Cambridge Health Alliance, Cambridge, MA, USA
| | - Nicole Santos
- Department of Surgery, Cambridge Health Alliance, Cambridge, MA, USA
| | | | - Caroline Cao
- College of Engineering and Computer Science, Wright State University, Dayton, OH, USA
| | - Daniel B Jones
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Suvranu De
- Department of BioMedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Jaisa Olasky
- Department of Surgery, Mount Auburn Hospital, Cambridge, MA, USA
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Henselmans I, Smets EMA, de Haes JCJM, Dijkgraaf MGW, de Vos FY, van Laarhoven HWM. A randomized controlled trial of a skills training for oncologists and a communication aid for patients to stimulate shared decision making about palliative systemic treatment (CHOICE): study protocol. BMC Cancer 2018; 18:55. [PMID: 29310605 PMCID: PMC5759304 DOI: 10.1186/s12885-017-3838-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 11/23/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Systemic treatment for advanced cancer offers uncertain and sometimes little benefit while the burden can be high. Hence, treatment decisions require Shared Decision Making (SDM). The CHOICE trial examines the separate and combined effect of oncologist training and a patient communication aid on SDM in consultations about palliative systemic treatment. METHODS A RCT design with four parallel arms will be adopted. Patients with metastatic or irresectable cancer with a median life expectancy <12 months who meet with a medical oncologist to discuss the start or continuation of palliative systemic treatment are eligible. A total of 24 oncologists (in training) and 192 patients will be recruited. The oncologist training consists of a reader, two group sessions (3.5 h; including modelling videos and role play), a booster feedback session (1 h) and a consultation room tool. The patient communication aid consists of a home-sent question prompt list and a value clarification exercise to prepare patients for SDM in the consultation. The control condition consists of care as usual. The primary outcome is observed SDM in audio-recorded consultations. Secondary outcomes include patient and oncologist evaluation of communication and decision-making, the decision made, quality of life, potential adverse outcomes such as anxiety and hopelessness, and consultation duration. Patients fill out questionnaires at baseline (T0), before (T1) and after the consultation (T2) and at 3 and 6 months (T3 and T4). All oncologists participate in two standardized patient assessments (before-after training) prior to the start of patient inclusion. They will fill out a questionnaire before and after these assessments, as well as after each of the recorded consultations in clinical practice. DISCUSSION The CHOICE trial will enable evidence-based choices regarding the investment in SDM interventions targeting either oncologists, patients or both in the advanced cancer setting. The trial takes into account the immediate effect of the interventions on observed communication, but also on more distal and potential adverse patient outcomes. Also, the trial provides evidence regarding the assumption that SDM about palliative cancer treatment results in less aggressive treatment and more quality of life in the final period of life. TRIAL REGISTRATION Netherlands Trial Registry number NTR5489 (prospective; 15 Sep 2015).
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Affiliation(s)
- I. Henselmans
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands
| | - E. M. A. Smets
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands
| | - J. C. J. M. de Haes
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands
| | - M. G. W. Dijkgraaf
- Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - F. Y. de Vos
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H. W. M. van Laarhoven
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Beidel DC, Frueh BC, Neer SM, Lejuez CW. The efficacy of Trauma Management Therapy: A controlled pilot investigation of a three-week intensive outpatient program for combat-related PTSD. J Anxiety Disord 2017; 50:23-32. [PMID: 28545005 DOI: 10.1016/j.janxdis.2017.05.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 04/25/2017] [Accepted: 05/03/2017] [Indexed: 11/16/2022]
Abstract
Despite the 8-18.5% of returning Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF) and Operation New Dawn (OND) veterans who are suffering from posttraumatic stress disorder (PTSD), few receive empirically supported treatments. Among those that do, the dropout rate is high and more than 50% retain their diagnosis after treatment. This study evaluated the efficacy of Trauma Management Therapy (TMT), delivered in a 3-week intensive outpatient (IOP) format. TMT combines virtual-reality augmented individual exposure therapy with a group intervention to address social isolation, anger, and depression. One hundred twelve (112) OIF/OEF/OND veterans and active duty personnel participated. Assessment included measures of PTSD, sleep, depression, anger, guilt, and social isolation, administered at post-treatment, 3-month, and 6-month follow-up. The effect size for TMT delivered in an IOP format was 2.06, with 65.9% no longer meeting diagnostic criteria for PTSD. There were similar positive effects in other domains and treatment gains were maintained at 6-month follow-up. The results are discussed regarding the need for efficacious, multi-component interventions that can be delivered safely and rapidly, and the potential of this approach towards that end.
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Affiliation(s)
- Deborah C Beidel
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL 32816, United States.
| | - B Christopher Frueh
- Department of Psychology, University of Hawaii at Hilo, 200 W. Kawili St., Hilo, HI, United States.
| | - Sandra M Neer
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL 32816, United States.
| | - Carl W Lejuez
- Department of Psychology, Kansas University, Strong Hall, Room 200, Lawrence, KS 66045, United States.
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Atesok K, MacDonald P, Leiter J, Dubberley J, Satava R, VanHeest A, Hurwitz S, Marsh JL. Orthopaedic education in the era of surgical simulation: Still at the crawling stage. World J Orthop 2017; 8:290-294. [PMID: 28473955 PMCID: PMC5396012 DOI: 10.5312/wjo.v8.i4.290] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 12/18/2016] [Accepted: 01/14/2017] [Indexed: 02/06/2023] Open
Abstract
Surgical skills education is in the process of a crucial transformation from a master-apprenticeship model to simulation-based training. Orthopaedic surgery is one of the surgical specialties where simulation-based skills training needs to be integrated into the curriculum efficiently and urgently. The reason for this strong and pressing need is that orthopaedic surgery covers broad human anatomy and pathologies and requires learning enormously diverse surgical procedures including basic and advanced skills. Although the need for a simulation-based curriculum in orthopaedic surgery is clear, several obstacles need to be overcome for a smooth transformation. The main issues to be addressed can be summarized as defining the skills and procedures so that simulation-based training will be most effective; choosing the right time period during the course of orthopaedic training for exposure to simulators; the right amount of such exposure; using objective, valid and reliable metrics to measure the impact of simulation-based training on the development and progress of surgical skills; and standardization of the simulation-based curriculum nationwide and internationally. In the new era of surgical education, successful integration of simulation-based surgical skills training into the orthopaedic curriculum will depend on efficacious solutions to these obstacles in moving forward.
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Stefanidis D, Anton NE, Howley LD, Bean E, Yurco A, Pimentel ME, Davis CK. Effectiveness of a comprehensive mental skills curriculum in enhancing surgical performance: Results of a randomized controlled trial. Am J Surg 2017; 213:318-324. [PMID: 27908500 PMCID: PMC5303657 DOI: 10.1016/j.amjsurg.2016.10.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 10/07/2016] [Accepted: 10/20/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION We hypothesized that the implementation of a novel mental skills curriculum (MSC) during laparoscopic simulator training would improve mental skills and performance, and decrease stress. METHODS Sixty volunteer novices were randomized into intervention and control groups. All participants received FLS training while the intervention group also participated in the MSC. Skill transfer and retention were assessed on a live porcine model after training and 2 months later, respectively. Performance was assessed using the Test of Performance Strategies-2 (TOPS-2) for mental skills, FLS metrics for laparoscopic performance, and the State Trait Anxiety Inventory (STAI-6) and heart rate (HR) for stress. RESULTS Fifty-five participants (92%) completed training and the transfer test, and 46 (77%) the retention test. There were no significant differences between groups at baseline. Compared to controls the intervention group significantly improved their mental skill use, demonstrated higher laparoscopic skill improvement during retention, and reported less stress during the transfer test. CONCLUSIONS The MSC implemented in this study effectively enhanced participants' mental skill use, reduced cognitive stress in the operating room with a small impact on laparoscopic performance.
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Affiliation(s)
- Dimitrios Stefanidis
- Department of Surgery, Indiana University, Indianapolis, IN, United States; Carolinas Simulation Center, Carolinas HealthCare System, Charlotte, NC, United States.
| | - Nicholas E Anton
- Department of Surgery, Indiana University, Indianapolis, IN, United States; Carolinas Simulation Center, Carolinas HealthCare System, Charlotte, NC, United States
| | - Lisa D Howley
- Association of American Medical Colleges, Washington, DC, United States
| | - Eric Bean
- Get A Strong Mind, Inc, San Diego, CA, United States
| | - Ashley Yurco
- Carolinas Simulation Center, Carolinas HealthCare System, Charlotte, NC, United States
| | - Manuel E Pimentel
- Carolinas Simulation Center, Carolinas HealthCare System, Charlotte, NC, United States
| | - Cameron K Davis
- Carolinas Simulation Center, Carolinas HealthCare System, Charlotte, NC, United States
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Dort J, Trickey A, Paige J, Schwarz E, Dunkin B. Hands-on 2.0: improving transfer of training via the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Acquisition of Data for Outcomes and Procedure Transfer (ADOPT) program. Surg Endosc 2016; 31:3326-3332. [PMID: 28039640 DOI: 10.1007/s00464-016-5366-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 11/16/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Practicing surgeons commonly learn new procedures and techniques by attending a "hands-on" course, though trainings are often ineffective at promoting subsequent procedure adoption in practice. We describe implementation of a new program with the SAGES All Things Hernia Hands-On Course, Acquisition of Data for Outcomes and Procedure Transfer (ADOPT), which employs standardized, proven teaching techniques, and 1-year mentorship. Attendee confidence and procedure adoption are compared between standard and ADOPT programs. METHODS For the pilot ADOPT course implementation, a hands-on course focusing on abdominal wall hernia repair was chosen. ADOPT participants were recruited among enrollees for the standard Hands-On Hernia Course. Enrollment in ADOPT was capped at 10 participants and limited to a 2:1 student-to-faculty ratio, compared to the standard course 22 participants with a 4:1 student-to-faculty ratio. ADOPT mentors interacted with participants through webinars, phone conferences, and continuous email availability throughout the year. All participants were asked to provide pre- and post-course surveys inquiring about the number of targeted hernia procedures performed and related confidence level. RESULTS Four of 10 ADOPT participants (40%) and six of 22 standard training participants (27%) returned questionnaires. Over the 3 months following the course, ADOPT participants performed more ventral hernia mesh insertion procedures than standard training participants (median 13 vs. 0.5, p = 0.010) and considerably more total combined procedures (median 26 vs. 7, p = 0.054). Compared to standard training, learners who participated in ADOPT reported greater confidence improvements in employing a components separation via an open approach (p = 0.051), and performing an open transversus abdominis release, though the difference did not achieve statistical significance (p = 0.14). DISCUSSION These results suggest that the ADOPT program, with standardized and structured teaching, telementoring, and a longitudinal educational approach, is effective and leads to better transfer of learned skills and procedures to clinical practice.
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Affiliation(s)
- Jonathan Dort
- Inova Fairfax Medical Campus, Falls Church, VA, USA.
| | | | - John Paige
- LSU Health New Orleans School of Medicine, New Orleans, LA, USA
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Kersten L, Prätzlich M, Mannstadt S, Ackermann K, Kohls G, Oldenhof H, Saure D, Krieger K, Herpertz-Dahlmann B, Popma A, Freitag CM, Trestman RL, Stadler C. START NOW - a comprehensive skills training programme for female adolescents with oppositional defiant and conduct disorders: study protocol for a cluster-randomised controlled trial. Trials 2016; 17:568. [PMID: 27903282 PMCID: PMC5131438 DOI: 10.1186/s13063-016-1705-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/14/2016] [Indexed: 11/10/2022] Open
Abstract
Background In Europe, the number of females exhibiting oppositional defiant disorder (ODD) and conduct disorder (CD) is growing. Many of these females live in youth welfare institutions. Consequently, there is a great need for evidence-based interventions within youth welfare settings. A recently developed approach targeting the specific needs of girls with ODD and CD in residential care is START NOW. The aim of this group-based behavioural skills training programme is to specifically enhance emotional regulation capacities to enable females with CD or ODD to appropriately deal with daily-life demands. It is intended to enhance psychosocial adjustment and well-being as well as reduce oppositional and aggressive behaviour. We present the study protocol (version 4.1; 10 February 2016) of the FemNAT-CD intervention trial titled ‘Group-Based Treatment of Adolescent Female Conduct Disorders: The Central Role of Emotion Regulation’. Methods/design The study is a prospective, confirmatory, cluster-randomised, parallel-group, multi-centre, randomised controlled trial with 128 institutionalised female adolescents who fulfil the diagnostic criteria of ODD and/or CD. Institutions/wards will be randomised either to provide the 12-week skills training as an add-on intervention or to provide treatment as usual. Once the first cycle is completed, each institution will run a second cycle with the opposite condition. Primary endpoints are the pre-post change in number of CD/ODD symptoms as assessed by a standardised, semi-structured psychiatric interview (Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children–Present and Lifetime, CD/ODD section) between baseline and the end of intervention, as well as between baseline and a 3-month follow-up point. Secondary objectives include pre-post change in CD/ODD-related outcome measures, most notably emotional regulation on a behavioural and neurobiological level after completion of START NOW compared with treatment as usual. Discussion To our knowledge, this study is the first to date to systematically investigate the effectiveness of an adapted integrative psychosocial intervention designed for female adolescents with ODD and CD in youth welfare settings. Trial registration German Clinical Trials Register (DRKS) identifier: DRKS00007524. Registered on 18 December 2015 and with the World Health Organisation International Clinical Trials Registry Platform. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1705-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Linda Kersten
- Department of Child and Adolescent Psychiatry/Department of Psychology, University Psychiatry Clinics Basel/University of Basel, Basel, Switzerland.
| | - Martin Prätzlich
- Department of Child and Adolescent Psychiatry/Department of Psychology, University Psychiatry Clinics Basel/University of Basel, Basel, Switzerland
| | - Sandra Mannstadt
- Department of Child and Adolescent Psychiatry/Department of Psychology, University Psychiatry Clinics Basel/University of Basel, Basel, Switzerland
| | - Katharina Ackermann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe-Universität, Frankfurt am Main, Germany
| | - Gregor Kohls
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - Helena Oldenhof
- Department of Child and Adolescent Psychiatry, de Bascule, University of Amsterdam/VUmc, Amsterdam, The Netherlands
| | - Daniel Saure
- Institute of Medical Biometry and Informatics, Department Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Katrin Krieger
- Coordination Centre for Clinical Trials, University Hospital Heidelberg, Heidelberg, Germany
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - Arne Popma
- Department of Child and Adolescent Psychiatry, de Bascule, University of Amsterdam/VUmc, Amsterdam, The Netherlands
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe-Universität, Frankfurt am Main, Germany
| | | | - Christina Stadler
- Department of Child and Adolescent Psychiatry/Department of Psychology, University Psychiatry Clinics Basel/University of Basel, Basel, Switzerland
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Design and implementation of the 2012 Canadian shoulder course for senior orthopedic residents. Orthop Traumatol Surg Res 2016; 102:885-890. [PMID: 27743999 DOI: 10.1016/j.otsr.2016.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 07/26/2016] [Accepted: 08/18/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The objective of the present paper is to analyze the first edition of a comprehensive shoulder course for senior orthopedic surgery residents and the chosen evaluation tools. HYPOTHESIS A course focusing on shoulder surgery, requested by graduating residents in orthopedic surgery, will have a strong level of satisfaction and help improve skills, knowledge, and problem solving abilities in this domain as measured by a pre and post-test. MATERIAL AND METHODS A two-day course was created with practical sessions, lectures, and case studies. Participants were given a multiple choice pre and post course test and evaluation questionnaires after each session. RESULTS Sixty residents attended the course. Nine of the fifteen sessions scored above the 90% satisfaction cut-off; none of the sessions scored below 80%. However, only one question showed a statistically significant improvement after the course. DISCUSSION Response to this course was overwhelmingly positive and the sessions received positive evaluations. However, the method to evaluate residents was not adequate; residents reported learning on their freeform evaluations but this was not represented on the multiple choice evaluation method. Evaluation tools and course duration will be modified in future iterations to improve assessment and teaching. LEVEL OF EVIDENCE IV. STUDY DESIGN Observational.
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Abstract
OBJECTIVES As communication is a central part of every interpersonal meeting within healthcare and research reveals several benefits of effective communication, we need to teach students and practitioners how to communicate with patients and with colleagues. This paper reflects on what and how to teach. METHODS In the previous century two major changes occurred: clinical relationship between doctor and patient became important and patients became partners in care. Clinicians experienced that outcome and especially compliance was influenced by the relational aspect and in particular by the communicative skills of the physician. This paper reflects on teaching and defines problems. It gives some implications for the future. RESULTS Although communication skills training is reinforced in most curricula all over the word, huge implementation problems arise; most of the time a coherent framework is lacking, training is limited in time, not integrated in the curriculum and scarcely contextualized, often no formal training nor teaching strategies are defined. Moreover evidence on communication skills training is scarce or contradictory. CONCLUSIONS Knowing when, what, how can be seen as an essential part of skills training. But students need to be taught to reflect on every behavior during every medical consultation. PRACTICE IMPLICATIONS Three major implications can be helpful to overcome the problems in communication training. First research and education on healthcare issues need to go hand in hand. Second, students as well as healthcare professionals need a toolkit of basic skills to give them the opportunity not only to tackle basic and serious problems, but to incorporate these skills and to be able to use them in a personal and creative way. Third, personal reflection on own communicative actions and dealing with interdisciplinary topics is a core business of medical communication and training.
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Affiliation(s)
- Myriam Deveugele
- Department of Family Medicine and Primary Health Care, Ghent University, Campus UZ - 6K3 De Pintelaan 185, B 9000 Gent, Belgium.
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