Attending Physician Variability: A Model of Four Supervisory Styles

Purpose: There is wide variability in how attending physician roles on teaching teams, including patient care and trainee learning, are enacted. This study sought to better understand variability by considering how different attendings configured and rationalized direct patient care, trainee oversight, and teaching activities. 

Method: Constructivist grounded theory guided iterative data collection and analyses. Data were interviews with 24 attending physicians from two academic centers in Ontario, Canada, in 2012. During interviews, participants heard a hypothetical presentation and reflected on it as though it were presented to their team during a typical admission case review. 

Results: Four supervisory styles were identified: direct care, empowerment, mixed practice, and minimalist. Driven by concerns for patient safety, direct care involves delegating minimal patient care responsibility to trainees. Focused on supporting trainees’ progressive independence, empowerment uses teaching and oversight strategies to ensure quality of care. In mixed practice, patient care is privileged over teaching and is adjusted on the basis of trainee competence and contextual features such as patient volume. Minimalist style involves a high degree of trust in senior residents, delegating most patient care, and teaching to them. Attendings rarely discussed their styles with the team. 

Conclusions: The model adds to the literature on variability in supervisory practice, showing that the four styles reflect different ways of responding to tensions in the role and context. This model could be refined through observational research exploring the impact of context on style development and enactment. Making supervisory styles explicit could support improvement of team competence.

Suicide and parasuicide: a selected review of the literature.

The increase in adolescent suicides has prompted the World Health Organization to set targets to reduce the incidence of deaths by the year 2000. In order to achieve this target further investigation into the perceptions of adolescent parasuicidal individuals is required to reduce the number of suicide attempts. Statistical evidence shows that parasuicidal individuals are commonly females who attempt suicide by taking an overdose. In the majority of cases help has been sought within the month prior to the attempt. Following an attempt many individuals feel isolated or ignored by health professionals. It appears that communication difficulties and negative attitudes by health professionals often reinforce the stigma associated with suicide. Nurses can contribute to the prevention of parasuicide/suicide by actively providing therapeutic care and counselling parasuicidal individuals to help them deal with major life events.

Management of newly diagnosed chronic myeloid leukaemia during a twin pregnancy using leucapheresis: Case report and review of the literature

A case of chronic myeloid leukaemia diagnosed as an incidental finding in a 32-year-old woman, pregnant with twins at 11 weeks gestation, is presented. Management of the patient was with leucapheresis and supportive care until spontaneous delivery of two morphologically normal infants (one male, one female) at 37 weeks gestation. Special considerations while employing leucapheresis in pregnant patients are discussed.

A practical taxonomy of methods and literature for managing uncertain spatial data in geographic information systems

Perfect information is seldom available to man or machines due to uncertainties inherent in real world problems. Uncertainties in geographic information systems (GIS) stem from either vague/ambiguous or imprecise/inaccurate/incomplete information and it is necessary for GIS to develop tools and techniques to manage these uncertainties. There is a widespread agreement in the GIS community that although GIS has the potential to support a wide range of spatial data analysis problems, this potential is often hindered by the lack of consistency and uniformity. Uncertainties come in many shapes and forms, and processing uncertain spatial data requires a practical taxonomy to aid decision makers in choosing the most suitable data modeling and analysis method. In this paper, we: (1) review important developments in handling uncertainties when working with spatial data and GIS applications; (2) propose a taxonomy of models for dealing with uncertainties in GIS; and (3) identify current challenges and future research directions in spatial data analysis and GIS for managing uncertainties.

Search filters: mapping the literature using a novel form of content analysis.

Background: Search filters are combinations of words and phrases designed to retrieve an optimal set of records on a particular topic (subject filters) or study design (methodological filters). Information specialists are increasingly turning to reusable filters to focus their searches. However, the extent of the academic literature on search filters is unknown. We provide a broad overview to the academic literature on search filters.
Objectives: To map the academic literature on search filters from 2004 to 2015 using a novel form of content analysis.
Methods: We conducted a comprehensive search for literature between 2004 and 2015 across eight databases using a subjectively derived search strategy. We identified key words from titles, grouped them into categories, and examined their frequency and co-occurrences.
Results: The majority of records were housed in Embase (n = 178) and MEDLINE (n = 154). Over the last decade, both databases appeared to exhibit a bimodal distribution with the number of publications on search filters rising until 2006, before dipping in 2007, and steadily increasing until 2012. Few articles appeared in social science databases over the same time frame (e.g. Social Services Abstracts, n = 3).
Unsurprisingly, the term ‘search’ appeared in most titles, and quite often, was used as a noun adjunct for the word 'filter' and ‘strategy’. Across the papers, the purpose of searches as a means of 'identifying' information and gathering ‘evidence’ from 'databases' emerged quite strongly. Other terms relating to the methodological assessment of search filters, such as precision and validation, also appeared albeit less frequently.
Conclusions: Our findings show surprising commonality across the papers with regard to the literature on search filters. Much of the literature seems to be focused on developing search filters to identify and retrieve information, as opposed to testing or validating such filters. Furthermore, the literature is mostly housed in health-related databases, namely MEDLINE, CINAHL, and Embase, implying that it is medically driven. Relatively few papers focus on the use of search filters in the social sciences.

Reviewing the literature

Implementing evidence into practice requires nurses to identify, critically appraise and synthesise research. This may require a comprehensive literature review: this article aims to outline the approaches and stages required and provides a working example of a published review

Psychological interventions for children and young people affected by armed conflict or political violence: a systematic literature review.

Youths exposed to armed conflict have a higher prevalence of mental health and psychosocial difficulties. Diverse interventions exist that aim to ameliorate the effect of armed conflict on the psychological and psychosocial wellbeing of conflict affected youths. However, the evidence base for the effectiveness of these interventions is limited. Using standard review methodology, this review aims to address the effectiveness of psychological interventions employed among this population. The search was performed across four databases and grey literature. Article quality was assessed using the Downs and Black Quality Checklist (1998). Where possible, studies were subjected to meta-analyses. The remaining studies were included in a narrative synthesis. Eight studies concerned non clinical populations, while nine concerned clinical populations. Review findings conclude that Group Trauma Focused-Cognitive Behavioural Therapy is effective for reducing symptoms of posttraumatic stress disorder, anxiety, depression and improving prosocial behaviour among clinical cohorts. The evidence does not suggest that interventions aimed at non clinical groups within this population are effective. Despite high quality studies, further robust trials are required to strengthen the evidence base, as a lack of replication has resulted in a limited evidence base to inform practice.

The Virgin Father (Revival of 2009 production):The Virgin Father: A Stage Play (Revival of 2009 production)

A stage play touring Cushendall, Down Arts Centre, The Playhouse Derry/Londonderry, with a further one-week run at the Lyric Theatre, Belfast.

Project Management within an Urban Site Context: Issues considering External Stakeholders

Large construction projects create numerous hazards, making it one of the most dangerous industries in which to work. This element of risk increases in urban areas and can have a negative impact on the external stakeholders associated with the project, along with their surrounding environments. The aim of this paper is to identify and document, in an urban context, the numerous issues encountered by on-site project managers from external stakeholders and how they affect a construction project. In addressing this aim, the core objective is to identify what issues are involved in the management of these stakeholders. In order to meet this requirement, a qualitative methodology encompassing an informative literature review followed by five individual case study interviews. The data gathered is assessed qualitatively using mind mapping software. A number of issues are identified which have an impact on the external stakeholders involved, and also how they affected proceedings on site. Collectively the most commonly occurring issues are environmental, legal, health and safety and communication issues. These ranged from road closures and traffic disruption to noise, dust and vibrations from site works. It is anticipated that the results of this study will assist and aid project managers in identifying issues considering external stakeholders, particularly on urban construction projects. A wide range of issues can develop depending on the complexity and nature of each project, but this research will illustrate and reinforce to project managers, that identifying issues early, effective communication and appropriate liaising can be used to manage the issues considering external stakeholders.