Oncology clinicians' defenses and adherence to communication skills training with simulated patients: an exploratory study.

The aim of this exploratory study was to assess the impact of clinicians' defense mechanisms-defined as self-protective psychological mechanisms triggered by the affective load of the encounter with the patient-on adherence to a communication skills training (CST). The population consisted of oncology clinicians (N = 31) who participated in a CST. An interview with simulated cancer patients was recorded prior and 6 months after CST. Defenses were measured before and after CST and correlated with a prototype of an ideally conducted interview based on the criteria of CST-teachers. Clinicians who used more adaptive defense mechanisms showed better adherence to communication skills after CST than clinicians with less adaptive defenses (F(1, 29) = 5.26, p = 0.03, d = 0.42). Improvement in communication skills after CST seems to depend on the initial levels of defenses of the clinician prior to CST. Implications for practice and training are discussed. Communication has been recognized as a central element of cancer care [1]. Ineffective communication may contribute to patients' confusion, uncertainty, and increased difficulty in asking questions, expressing feelings, and understanding information [2, 3], and may also contribute to clinicians' lack of job satisfaction and emotional burnout [4]. Therefore, communication skills trainings (CST) for oncology clinicians have been widely developed over the last decade. These trainings should increase the skills of clinicians to respond to the patient's needs, and enhance an adequate encounter with the patient with efficient exchange of information [5]. While CSTs show a great diversity with regard to their pedagogic approaches [6, 7], the main elements of CST consist of (1) role play between participants, (2) analysis of videotaped interviews with simulated patients, and (3) interactive case discussion provided by participants. As recently stated in a consensus paper [8], CSTs need to be taught in small groups (up to 10-12 participants) and have a minimal duration of at least 3 days in order to be effective. Several systematic reviews evaluated the impact of CST on clinicians' communication skills [9-11]. Effectiveness of CST can be assessed by two main approaches: participant-based and patient-based outcomes. Measures can be self-reported, but, according to Gysels et al. [10], behavioral assessment of patient-physician interviews [12] is the most objective and reliable method for measuring change after training. Based on 22 studies on participants' outcomes, Merckaert et al. [9] reported an increase of communication skills and participants' satisfaction with training and changes in attitudes and beliefs. The evaluation of CST remains a challenging task and variables mediating skills improvement remain unidentified. We recently thus conducted a study evaluating the impact of CST on clinicians' defenses by comparing the evolution of defenses of clinicians participating in CST with defenses of a control group without training [13]. Defenses are unconscious psychological processes which protect from anxiety or distress. Therefore, they contribute to the individual's adaptation to stress [14]. Perry refers to the term "defensive functioning" to indicate the degree of adaptation linked to the use of a range of specific defenses by an individual, ranging from low defensive functioning when he or she tends to use generally less adaptive defenses (such as projection, denial, or acting out) to high defensive functioning when he or she tends to use generally more adaptive defenses (such as altruism, intellectualization, or introspection) [15, 16]. Although several authors have addressed the emotional difficulties of oncology clinicians when facing patients and their need to preserve themselves [7, 17, 18], no research has yet been conducted on the defenses of clinicians. For example, repeated use of less adaptive defenses, such as denial, may allow the clinician to avoid or reduce distress, but it also diminishes his ability to respond to the patient's emotions, to identify and to respond adequately to his needs, and to foster the therapeutic alliance. Results of the above-mentioned study [13] showed two groups of clinicians: one with a higher defensive functioning and one with a lower defensive functioning prior to CST. After the training, a difference in defensive functioning between clinicians who participated in CST and clinicians of the control group was only showed for clinicians with a higher defensive functioning. Some clinicians may therefore be more responsive to CST than others. To further address this issue, the present study aimed to evaluate the relationship between the level of adherence to an "ideally conducted interview", as defined by the teachers of the CST, and the level of the clinician' defensive functioning. We hypothesized that, after CST, clinicians with a higher defensive functioning show a greater adherence to the "ideally conducted interview" than clinicians with a lower defensive functioning.

Evaluation of Virtual Reality Snowplow Simulator Training, January 2007

Each winter, Iowa Department of Transportation (Iowa DOT) maintenance operators are responsible for plowing snow off federal and state roads in Iowa. Drivers typically work long shifts under treacherous conditions. In addition to properly navigating the vehicle, drivers are required to operate several plowing mechanisms simultaneously, such as plow controls and salt spreaders. There is little opportunity for practicing these skills in real-world situations. A virtual reality training program would provide operators with the opportunity to practice these skills under realistic yet safe conditions, as well as provide basic training to novice or less-experienced operators. In order to provide such training to snowplow operators in Iowa, the Iowa DOT purchased a snowplow simulator. The Iowa DOT commissioned a study through Iowa State University designed to (1) assess the use of this simulator as a training tool and (2) examine personality and other characteristics associated with being an experienced snowplow operator. The results of this study suggest that Iowa DOT operators of all ages and levels of experience enjoyed and seemed to benefit from virtual reality snowplow simulator training. Simulator sickness ratings were relatively low, implying that the simulator is appropriate for training a wide range of Iowa DOT operators. Many reported that simulator training was the most useful aspect of training for them.

Cost-effectiveness analysis of a European primary-care physician training in smoking cessation counseling.

BACKGROUND: Physician training in smoking cessation counseling has been shown to be effective as a means to increase quit success. We assessed the cost-effectiveness ratio of a smoking cessation counseling training programme. Its effectiveness was previously demonstrated in a cluster randomized, control trial performed in two Swiss university outpatients clinics, in which residents were randomized to receive training in smoking interventions or a control educational intervention. DESIGN AND METHODS: We used a Markov simulation model for effectiveness analysis. This model incorporates the intervention efficacy, the natural quit rate, and the lifetime probability of relapse after 1-year abstinence. We used previously published results in addition to hospital service and outpatient clinic cost data. The time horizon was 1 year, and we opted for a third-party payer perspective. RESULTS: The incremental cost of the intervention amounted to US$2.58 per consultation by a smoker, translating into a cost per life-year saved of US$25.4 for men and 35.2 for women. One-way sensitivity analyses yielded a range of US$4.0-107.1 in men and US$9.7-148.6 in women. Variations in the quit rate of the control intervention, the length of training effectiveness, and the discount rate yielded moderately large effects on the outcome. Variations in the natural cessation rate, the lifetime probability of relapse, the cost of physician training, the counseling time, the cost per hour of physician time, and the cost of the booklets had little effect on the cost-effectiveness ratio. CONCLUSIONS: Training residents in smoking cessation counseling is a very cost-effective intervention and may be more efficient than currently accepted tobacco control interventions.

Combined effects of endurance training and dietary unsaturated fatty acids on physical performance, fat oxidation and insulin sensitivity.

Endurance training improves exercise performance and insulin sensitivity, and these effects may be in part mediated by an enhanced fat oxidation. Since n-3 and n-9 unsaturated fatty acids may also increase fat oxidation, we hypothesised that a diet enriched in these fatty acids may enhance the effects of endurance training on exercise performance, insulin sensitivity and fat oxidation. To assess this hypothesis, sixteen normal-weight sedentary male subjects were randomly assigned to an isoenergetic diet enriched with fish and olive oils (unsaturated fatty acid group (UFA): 52 % carbohydrates, 34 % fat (12 % SFA, 12 % MUFA, 5 % PUFA), 14 % protein), or a control diet (control group (CON): 62 % carbohydrates, 24 % fat (12 % SFA, 6 % MUFA, 2 % PUFA), 14 % protein) and underwent a 10 d gradual endurance training protocol. Exercise performance was evaluated by measuring VO2max and the time to exhaustion during a cycling exercise at 80 % VO2max; glucose homeostasis was assessed after ingestion of a test meal. Fat oxidation was assessed by indirect calorimetry at rest and during an exercise at 50 % VO2max. Training significantly increased time to exhaustion, but not VO2max, and lowered incremental insulin area under the curve after the test meal, indicating improved insulin sensitivity. Those effects were, however, of similar magnitude in UFA and CON. Fat oxidation tended to increase in UFA, but not in CON. This difference was, however, not significant. It is concluded that a diet enriched with fish- and olive oil does not substantially enhance the effects of a short-term endurance training protocol in healthy young subjects.

Hvordan øve hellige handlinger? : en profesjonsdidaktisk studie av øving av muntlige ferdigheter innenfor en norsk presteutdanning

How can the holy craft of liturgy be trained? A study of approaches to instruction in training oral skills within education of the Norwegian clergy The theme of this study is the competence of expression of clerics performing liturgies as part of their duties in the Norwegian Lutheran Church. The aim of the study is to find a teaching practice which can raise the competence in oral expression characteristic of the clergy profession. The teaching practice is explored and discussed within the context of the basic education of the clergy. The main thesis is formulated as a question: How can the holy craft of liturgy be trained? An underpinning of the study is that liturgical acts are holy, which gives these performances an aspect of otherness. This otherness constitutes a clear agreement between the students and the teacher, and between the professional and the employer. The pre-understanding of the researcher is that these liturgical oral acts are trainable, and that there is a need and a necessity to train in these skills. Three research questions are elaborated on in the explorative section of the study: • What is characteristic of a competence of expression connected to the profession? • How can this competence of expression connected to liturgical performance be developed? • What is the importance of this competence in the holy craft of liturgy for the development of a cohesive professional self-understanding? The study is based on a research and development project where the researcher as the teacher and students from one specific clergy education in Norway (MF) were the source of the empirical material. The empirical data came from practice with two external observers› logs on the coaching, video observations, of the teacher and the students› texts on the practice under study, which is liturgical performance. The researcher›s log and field notes also provide material for the analysis. This is a qualitative project and an arts education project carried out within an interpretative framework. The theoretical framework has three perspectives: a structural approach based on the system theory of Niklas Luhmann, an epistemological approach discussing forms of knowledge in practice or informing practice and an arts education approach. The results indicate that the competence in oral liturgical performance can be considered a trainable skill, and that this training can be understood as an arts education method of instruction based on meaningful communication, dramaturgical thinking and the development of authenticity. The main result from this study can be considered as articulating and sketching the contours of the field of knowledge where the students embody the meaning of the clergy profession ‒ and this articulation has an innovative potential as knowledge combining experience and theoretical understanding.

Impact of training at ventilatory threshold on cardiopulmonary and functional capacity in overweight patients with chronic kidney disease

INTRODUCTION: Chronic kidney disease (CKD) and obesity are both associated with reduced physical capacity. The potential benefit of aerobic training on physical capacity has been recognized. The exercise intensity can be established using different methods mostly subjective or indirect. Ventilatory threshold (VT) is a direct and objective method that allows prescribing exercise intensity according to individual capacity. OBJECTIVES: To evaluate the impact of aerobic training at VT intensity on cardiopulmonary and functional capacities in CKD patients with excess of body weight. METHODS: Ten CKD patients (eight men, 49.7 ± 10.1 years; BMI 30.4 ± 3.5 kg/m², creatinine clearance 39.4 ± 9.8 mL/min/1.73 m²) underwent training on a treadmill three times per week during 12 weeks. Cardiopulmonary capacity (ergoespirometry), functional capacity and clinical parameters were evaluated. RESULTS: At the end of 12 weeks, VO2PEAK increased by 20%, and the speed at VO2PEAK increased by 16%. The training resulted in improvement in functional capacity tests, such as six-minute walk test (9.2%), two-minute step test (20.3%), arm curl test (16.3%), sit and stand test (35.7%), and time up and go test (15.3%). In addition, a decrease in systolic and diastolic blood pressures was observed despite no change in body weight, sodium intake and antihypertensive medication. CONCLUSION: Aerobic exercise performed at VT intensity improved cardipulmonary and functional capacities of overweight CKD patients. Additional benefit on blood pressure was observed. These results suggest that VT can be effectively applied for prescribing exercise intensity in this particular group of patients.

Explicit versus implicit spelling strategy instruction and its effects on grade one children's invented spellings

The intent of this study was to investigate .the effectiveness of teaching thirty-five Grade One children a variety of effective spelling strategies in comparison to tradit~onal spelling instruction. Strategy instruction included training in phonology, imagery and analogy. In addition, the type of instruction pro~ided (implicit versus explicit) was also examined. Children were seen in small groups of four or five, for four, twenty-five minute sessions. All children were tested prior and immediately following the training sessions, as well as at 14-day follow-ups. Pretest and posttest measures included a dictated spelling test (based on words used in training), a developmental spelling test and a sample of each child's writing. In addition, children completed a metacognitive spelling test as a measure of their strategy awareness. Performance scores on the pretest and posttest measures were compared to determine if any differences existed between the three spelling instruction groups using the Dunn-Bonferroni and Dunnett procedures. Findings revealed that explicit strategy instruction was the most effective spelling program for improving Grade One children's invented spellings. Children who received this instruction were able to spell targeted words more accurately, even after a 14-day follow-up, and were able to recall more effective spelling strategies than children who received either implicit strategy instruction or traditional strategy instruction.

Sector-Specific on-the-Job Training: Evidence from U.S. Data.

Using data from the National Longitudinal Survey of Youth (NLSY), we re-examine the effect of formal on-the-job training on mobility patterns of young American workers. By employing parametric duration models, we evaluate the economic impact of training on productive time with an employer. Confirming previous studies, we find a positive and statistically significant impact of formal on-the-job training on tenure with the employer providing the training. However, the expected net duration of the time spent in the training program is generally not significantly increased. We proceed to document and analyze intra-sectoral and cross-sectoral mobility patterns in order to infer whether training provides firm-specific, industry-specific, or general human capital. The econometric analysis rejects a sequential model of job separation in favor of a competing risks specification. We find significant evidence for the industry-specificity of training. The probability of sectoral mobility upon job separation decreases with training received in the current industry, whether with the last employer or previous employers, and employment attachment increases with on-the-job training. These results are robust to a number of variations on the base model.

L'intégration et la mise en oeuvre de la pratique de différenciation pédagogique chez les enseignants québécois du premier cycle du secondaire

La présente recherche de type qualitatif veut décrire, analyser et comprendre la pratique de différenciation pédagogique chez des enseignants québécois du premier cycle du secondaire. Cette pratique s’insère au cœur des programmes de formation dont la principale visée est la réussite pour tous. Cependant, elle est constituée d’un flou théorique qui la rend parfois difficile à définir et à mettre en application, particulièrement chez les enseignants du secondaire. Ce travail dresse donc le portrait de trois enseignantes du premier cycle du secondaire qui choisissent tout de même de la comprendre et de la mettre en œuvre. À ce titre, l’étude des pratiques sous l’angle du travail tel que décrit par Tardif et Lessard (1999) permet de cerner la nature complexe et composite de leur travail et de tenir compte des facteurs personnels, internes et externes qui régissent leur travail d’adaptation des programmes, appelé travail curriculaire. Ainsi, une grille d’analyse inédite, construite au regard de ces facteurs et à partir des concepts inhérents à la différenciation pédagogique, permet d’étudier trois cas de manière complète et approfondie. De manière générale, l’analyse des facteurs personnels, internes et externes à la pratique de différenciation pédagogique des enseignantes donnent des informations pertinentes sur leurs façons de différencier, sur leur motivation à différencier et sur l’influence de leur milieu de travail dans l’exercice de cette pratique. Ces résultats permettent non seulement de mieux comprendre cette pratique effectuée par des enseignants du secondaire, mais permet aussi l’élaboration des principaux facteurs pouvant faciliter sa mise en œuvre ou au contraire la limiter. Au final, les propos recueillis chez les enseignantes interrogées signalent qu’au-delà de la réussite éducative, d’autres éléments entrent en jeu dans l’exercice de cette pratique. En fait, malgré plusieurs contraintes liées aux ressources matérielles, organisationnelles et humaines, la pratique de différenciation pédagogique génère entre autres une grande source de motivation scolaire pour les élèves et contribue à augmenter la satisfaction professionnelle de ces enseignantes dans leur travail au quotidien.

De la relation d’aide à la rencontre créative : le récit numérique comme outil de reconnaissance mutuelle

Cette recherche exploratoire vise à documenter, du point de vue des intervenants, les conditions nécessaires à la mise en place de projets utilisant des outils de narrativité numérique, de même que les principaux apports de ces outils à l’intervention. Ces outils peuvent être des récits numériques qui sont de courtes vidéos (deux à cinq minutes) intégrant images, musique, texte, voix et animation, ou encore de courts fichiers audio, aussi appelés podcasting ou baladodiffusion. Il peut aussi s’agir de jeux vidéo interactifs ou d’un montage vidéo à partir d’extraits de témoignages. Dans un contexte où les pratiques d’intervention, dans les services publics en particulier, sont de plus en plus normées et standardisées, une recherche qui explore des outils d’intervention recourant à la créativité s’avère des plus pertinentes. Par ailleurs, ce champ n’a été que très peu exploré en service social jusqu’à maintenant. Des entrevues semi-dirigées ont été menées auprès de huit intervenants ayant utilisé ces outils dans leur pratique. L’analyse de leurs propos met d’abord en lumière les conditions nécessaires à la réalisation de ce type de projet, de même que les questions éthiques qui les accompagnent. Ensuite, du côté des principaux apports de ces outils, ils se situent, d’une part, dans le processus créatif collaboratif. Celui-ci permet d’enrichir l’intervention en donnant un espace de parole plus libre où intervenants et usagers créent des liens qui modifient le rapport hiérarchique entre aidant et aidé. D’autre part, l’attention professionnelle accordée à la réalisation des produits et à leur diffusion contribue à donner une plus grande visibilité à des personnes souvent exclues de l’espace public. Ainsi, en plus d’explorer les apports d’un outil artistique à l’intervention, cette recherche permet également d’analyser les enjeux de visibilité et de reconnaissance associés à l’utilisation de médias participatifs.

Independent component analysis of climate data: A new look at EOF rotation

The complexity inherent in climate data makes it necessary to introduce more than one statistical tool to the researcher to gain insight into the climate system. Empirical orthogonal function (EOF) analysis is one of the most widely used methods to analyze weather/climate modes of variability and to reduce the dimensionality of the system. Simple structure rotation of EOFs can enhance interpretability of the obtained patterns but cannot provide anything more than temporal uncorrelatedness. In this paper, an alternative rotation method based on independent component analysis (ICA) is considered. The ICA is viewed here as a method of EOF rotation. Starting from an initial EOF solution rather than rotating the loadings toward simplicity, ICA seeks a rotation matrix that maximizes the independence between the components in the time domain. If the underlying climate signals have an independent forcing, one can expect to find loadings with interpretable patterns whose time coefficients have properties that go beyond simple noncorrelation observed in EOFs. The methodology is presented and an application to monthly means sea level pressure (SLP) field is discussed. Among the rotated (to independence) EOFs, the North Atlantic Oscillation (NAO) pattern, an Arctic Oscillation–like pattern, and a Scandinavian-like pattern have been identified. There is the suggestion that the NAO is an intrinsic mode of variability independent of the Pacific.

The findings from a single pass deghoster prototype for terrestrial transmitted video

A deterministic prototype video deghoster is presented which is capable of calculating all the multipath channel distortion characteristics in one single pass and subsequently removing the multipath distortions, commonly termed ghosts. Within the system, a channel identification algorithm finds in isolation all the ghost components while a dedicated DSP filter subsystem is capable of removing ghosts in real time. The results from the system are presented.

Training pharmacists to deliver a complex information technology intervention (PINCER) using the principles of educational outreach and root cause analysis

Objective: To describe the training undertaken by pharmacists employed in a pharmacist-led information technology-based intervention study to reduce medication errors in primary care (PINCER Trial), evaluate pharmacists’ assessment of the training, and the time implications of undertaking the training. Methods: Six pharmacists received training, which included training on root cause analysis and educational outreach, to enable them to deliver the PINCER Trial intervention. This was evaluated using self-report questionnaires at the end of each training session. The time taken to complete each session was recorded. Data from the evaluation forms were entered onto a Microsoft Excel spreadsheet, independently checked and the summary of results further verified. Frequencies were calculated for responses to the three-point Likert scale questions. Free-text comments from the evaluation forms and pharmacists’ diaries were analysed thematically. Key findings: All six pharmacists received 22 hours of training over five sessions. In four out of the five sessions, the pharmacists who completed an evaluation form (27 out of 30 were completed) stated they were satisfied or very satisfied with the various elements of the training package. Analysis of free-text comments and the pharmacists’ diaries showed that the principles of root cause analysis and educational outreach were viewed as useful tools to help pharmacists conduct pharmaceutical interventions in both the study and other pharmacy roles that they undertook. The opportunity to undertake role play was a valuable part of the training received. Conclusions: Findings presented in this paper suggest that providing the PINCER pharmacists with training in root cause analysis and educational outreach contributed to the successful delivery of PINCER interventions and could potentially be utilised by other pharmacists based in general practice to deliver pharmaceutical interventions to improve patient safety.

Como inserir um arquivo de áudio no software Acid Xpress

O professor, sentado diante de um computador, demonstra como inserir um arquivo de áudio na Timeline (linha do tempo) do software Acid Xpress. Basta localizar o arquivo em seu computador utilizando o Painel de exploração e arrastá-lo até a Timeline, onde irá soltá-lo. Em seguida o professor demonstra as ferramentas de “Zoom (para visualização das ondas sonoras)”, “Borracha”, “Draw tool (lápis)”, “Time selection tool (ferramenta de seleção de tempo)” do software, explicando suas funcionalidades. Encerra demonstrando como mover o arquivo de áudio na Timeline e também como encurtá-lo ou esticá-lo novamente.

O ensino da história e o pensamento reflexivo-crítico da professora no 3º ano do Ensino Fundamental

This collaborative research is a qualitative approach, from historical and cultural perspective, made about a teacher of third grade of basic education in the area of history, in the municipality of Caicó / RN. It has as objective to investigate, in a collaborative action, if the design process of teaching and learning the discipline of history based on the relationship before / after allows the development of critical reflective thinking of the teacher in school practices. The theoretical and methodological approaches are supported in the postulates of Vygotsky (1998), Rubinstein (1973) and Linblinskaia (1979), among others, whose understanding has led us to reflect if the teacher develops the reflective critical-thinking in history discipline classes. The complexity of the study led us to an analysis exercise, using different methodological procedures, such as: bibliographic review of the literature, considering also the literature of the history area, interviews, observation in the classroom, video recordings and reflective sessions, enabling clarify the construction and reconstruction of thought that the teacher had been developing during the process of teaching and learning. The test results point to a dichotomy between theory and practice, and also to a certain fragility in the position of professor in teaching and learning the discipline of history, at the third grade of basic education. The teacher recognizes that she requires a theoretical deepening with more intensity, as a process of continuous training to improve the practice of teaching in history school, though, stating in her speech that her teaching practice is based on critical reflection. However, she presents serious limitations in classroom practices. We conclude that, although she has shown willing to work on a critical perspective of reality, showed also poor change at school practices, starting to reflect about her own actions, pointing her limits and the changes needed that didn t become reality yet. It s necessary a formative process for her. The study therefore showed that even with the sessions and reflective of deepening theoretical studies, the teacher does not change its profile, while maintaining its traditional vision in any pedagogical action. This research recommends the formation of school groups for further studies and discussion on the practices of education in history area from a reflective-critical thought perspective as a mean of personal and professional development