Ergonomic considerations in natural orifice translumenal endoscopic surgery (NOTES): a case study

Surgical technique evolved from traditional open surgery to laparoscopic surgery, offering patients reduced pain and quick recovery. Recently, a new approach called natural orifice translumenal endoscopic surgery (NOTES) has emerged. In NOTES, procedures may be transvaginal, transgastric, or transrectal or transesophageal. NOTES procedures present new ergonomic challenges to surgeons due to visualization and tissue manipulation challenges. An ergonomic analysis of NOTES cholecystectomy was conducted. As there is currently no standardization for performing NOTES, this analysis presents the results as a case study. Results showed NOTES procedures impose unique limitations on the surgeon's ability to perform surgical tasks autonomously, requiring collaboration and coordination amongst the surgical team members.     

“Scissors,Please”: The Practical Accomplishment of Surgical Work in the Operating Theater

The focus of this article is on professional activity in the operating theater. We explore how surgeons and nurses organize their activities, how social interaction is used to help structure and define situations, and how differentials in knowledge are constructed and oriented to. We utilize some ideas and concepts from symbolic interactionism, ethnomethodology, and conversation analysis to analyze small clips of audio‐ and video‐recorded interaction. Focusing on how surgeons and nurses request, provide, and apply surgical instruments, the analysis shows how surgical work is accomplished through talk and bodily conduct. We conclude that, examined in detail, the social interaction between surgeons and nurses is analytically inseparable from the “technical” demands of their work.     

Assessment of Intimate Partner Violence by Child Welfare Services

The purpose of this study was to describe policy and practice with respect to the assessment of intimate partner violence in a sample of child welfare agencies located throughout the United States and to examine the relationship of contextual characteristics and assessment practices. Telephone interviews were conducted with key informants from child welfare agencies. A snowball interviewing strategy was used to identify the best informant in each agency. Almost all of the participating agencies conducted some assessment of intimate partner violence, with most reporting that the majority of screening or assessment occurred during investigation of referrals. However, only 43.1% reported that all of the families referred to the child welfare system were assessed for intimate partner violence, and 52.8% indicated they had a written policy pertaining to screening and assessment of the problem. There was little relationship between county or agency characteristics and assessment practices. Additional research is needed to determine factors that influence assessment practices and to identify strategies to support and extend efforts to identify intimate partner violence and provide appropriate services for families in the child welfare system.     

Integrating Spirituality into MFT Training: A Reflexive Curriculum and Qualitative Evaluation

When clients enter the therapy room they bring unique spiritual beliefs and values in with them; however, marital and family therapists (MFTs) often lack training to assist in this important area of diversity. Current training recommendations encourage therapists to explore their own spirituality to identify personal limitations that may occlude positive client outcomes; however very little information exists on the implementation and usefulness of this type of training. This article will describe a curriculum and report results from a qualitative study of students who participated in a reflexive spirituality practicum course offered in a COAMFTE accredited doctoral program at a private, religious institution. Through this, we hope to provide a training model to further spiritual integration activities in MFT.     

Building an evidence-base for the training of evidence-based treatments in community settings: Use of an expert-informed approach

In order to make EBTs available to a large number of children and families, developers and expert therapists have used their experience and expertise to train community-based therapists in EBTs. Understanding current training practices of treatment experts may be one method for establishing best practices for training community-based therapists prior to comprehensive empirical examinations of training practices. A qualitative study was conducted using surveys and phone interviews to identify the specific procedures used by treatment experts to train and implement an evidence-based treatment in community settings. Twenty-three doctoral-level, clinical psychologists were identified to participate because of their expertise in conducting and training Parent–Child Interaction Therapy. Semi-structured qualitative interviews were completed by phone, later transcribed verbatim, and analyzed using thematic coding. The de-identified data were coded by two independent qualitative data researchers and then compared for consistency of interpretation. The themes that emerged following the final coding were used to construct a training protocol to be empirically tested. The goal of this paper is not only to understand the current state of training practices for training therapists in a particular EBT, Parent–Child Interaction Therapy, but also to illustrate the use of expert opinion as the best available evidence in preparation for empirical evaluation.     

The current role of post-conviction sex offender polygraph testing in sex offender treatment

Polygraph testing is becoming increasingly important in sex offender treatment. Polygraph advocates cite dramatic increases in historical disclosures that presumably allow more precise targeting of treatment interventions, earlier detection of risky behaviors that often lead to new offenses, and improved treatment and supervision compliance. Based on this, they believe the procedure supports desirable behavior that continues to various degrees after treatment and supervision end. Opponents cite ethical problems related to inaccurate results, unproven accuracy rates, and the risk that examinees may be coerced into making false admissions. To counter these criticisms, proponents have developed standards, best practices, and examiner training and certification programs intended to reduce error rates and address ethical issues. Opponents argue that these measures have not been tested and that empirically established error rates and best practices may not be possible for a variety of reasons. This article reviews the current situation, leaving readers to decide the wisdom and ethics of using polygraph testing in their own practices.     

Teaching Reflective Social Work Practice in Health Care: Promoting Best Practices

Reflection on case material is traditionally believed to promote better clinical practice; recent neurobiological understandings explain why reflection consolidates learning and allows professional heuristics to develop. Here, we describe a practice in context (PIC) framework that requires reflection on the contextual and decisional aspects of a case and further reflection on potential changes for use in similar cases in the future. We analyze cases using the PIC framework to identify themes related to the use of self to identify potential best practices. The framework is shown to function to promote reflection at all levels of practice; published cases provide “role-modeling” for students, while also creating data for analysis of best practices.     

Community college field placement internships: supervisors’ perspectives and recommendations

ABSTRACT

Community College human services students represent the future social service workforce. The defining feature of their training is 250 h supervised field placement internship. Despite burgeoning research describing best practices for supervision of Bachelors of social work (BSW) and Masters of social work (MSW), there is no research aimed at supervision for community college students, leaving a gap in our understanding of best practices for supporting community college students’ pedagogy and sustaining partnerships with agencies. This exploratory study offers recommendations for best practices supported by our discovery of the benefits, challenges, and strategies involved with offering community college student internships in New York City human services agencies. We analyzed data from semi-structured interviews with 30 field supervisors through qualitative content analysis. Community college students and agencies both benefit substantially from the field placement, however agencies identified significant social and structural challenges specific to working with community college students that require interventions for both field supervisors and students alike. Suggested interventions aimed at improving supervisor training, procedures for focusing goals of supervision sessions, assisting students in meeting their academic and social needs, as well as supporting supervisors’ professional goals to promote best practices are proposed.     

Managing the Emotions of Others

Although research has focused on how individuals manage their own emotions, little attention has been paid to how individuals manage the emotions of other people. Here, I describe several techniques of interpersonal emotion-management, drawing from observations of a psychodrama-based encounter group which deliberately manipulated its members' feelings. Analysis reveals a number of strategies (e.g., group enactments, provocations, comforting) which, when used sequentially, produced first emotional loss of control in the individual and then positive emotion. Group solidarity was sometimes affected by these interpersonal emotion-management techniques as well. Some techniques may be similar to those used in military training and cult group recruitment, although further research attention is needed in these arenas. Other settings in which members play upon the emotions of others should be examined to identify other interpersonal techniques and the sequencing of strategies which produce desired individual and group outcomes.     

Interprofessional Client-Centered Reasoning Processes in Home Modification Practice

We investigated the complex reasoning processes of professional home evaluators involved with home safety assessments. Twenty evaluators with varied professional training engaged in in-depth qualitative interviews. Two primary themes emerged: integrating expertise and tailoring interventions. Within these themes, evaluators expressed differences and similarities in how they obtained information, developed interventions, and addressed professional-client interactive reasoning as they identified needs. We propose an adapted ecological model to describe best practices for personalizing home modifications through an interprofessional lens. Differences among professional home evaluators reveal unique, yet overlapping reasoning processes. Interprofessional teams may better meet the holistic needs of home modification consumers.     

The Current Role of Post-Conviction Sex Offender Polygraph Testing in Sex Offender Treatment

SUMMARY

Polygraph testing is becoming increasingly important in sex offender treatment. Polygraph advocates cite dramatic increases in historical disclosures that presumably allow more precise targeting of treatment interventions, earlier detection of risky behaviors that often lead to new offenses, and improved treatment and supervision compliance. Based on this, they believe the procedure supports desirable behavior that continues to various degrees after treatment and supervision end. Opponents cite ethical problems related to inaccurate results, unproven accuracy rates, and the risk that examinees may be coerced into making false admissions. To counter these criticisms, proponents have developed standards, best practices, and examiner training and certification programs intended to reduce error rates and address ethical issues. Opponents argue that these measures have not been tested and that empirically established error rates and best practices may not be possible for a variety of reasons. This article reviews the current situation, leaving readers to decide the wisdom and ethics of using polygraph testing in their own practices.     

Student perspectives on disclosure of mental illness in post-compulsory education: displacing doxa

This paper reports findings from a 12-month Australian study exploring beliefs and experiences of disclosure and course success in post-compulsory education for 20 students with mental illness. Enrolled students with disclosed or non-disclosed mental illness, teaching and support staff, and institutional practices across four sites providing vocational education and training were the three cases selected for this collective case study. Students participated in two semi-structured interviews over the course of one academic year. Disclosure was not preferred by students, most fearing that it would negatively impact upon their capacity to obtain employment in the occupation for which they were training. Further research exploring the processes, timing and outcomes of disclosure, in a wide range of post-secondary settings and with larger numbers of students, would allow for a deeper exploration of issues raised by this small study.     

Geographic variation in surgical treatment for work-related carpal tunnel syndrome: does improved return to work matter?

Medical treatment of compensated work-related conditions has two objectives--improve injured workers' health status and allow safe and sustained return to work (RTW). Theoretically, the choice of treatment method should be based primarily on these objectives. Surgical treatment of work-related carpal tunnel syndrome (CTS) provides an opportunity to evaluate whether this occurs. The traditional method of open release has been complemented by an endoscopic procedure, particularly useful in work-related cases due to the anticipated benefit of earlier RTW. The objective of this study was to investigate the differences in surgical treatment for work-related CTS across eight US workers' compensation (WC) jurisdictions, and the factors associated with these differences. From all WC claims reported to a single insurer during the 1995-1999 period, we identified individuals with a one or two surgical procedures for work-related CTS. Among selected individuals (n=4,421), about 20% were treated using the endoscopic procedure; this percentage had a ten-fold variation across the eight jurisdictions. However, utilization of endoscopic release did not increase during the study period, despite reports of better RTW outcomes. The highly jurisdictional nature of the US WC system, with significant differences in reimbursement levels for endoscopic procedures, and geographical differences in medical training were among the potential contributors to the observed variation in utilization.     

An evaluation of transit procurement training

We evaluated a training course called “Orientation to Transit Procurement”, designed and conducted by the National Transit Institute. This course is designed to provide Federal Transit Administration (FTA) grantees an overview of regulations and best practices related to the procurement process. Our objective in conducting the evaluation was to understand how transit agency staff made changes in procurement practices in response to the course training. The evaluation was mixed mode: an Internet survey followed by in-depth interviews with a small group of respondents. Survey respondents were also provided with an open-ended question providing us with additional context for our evaluation. Results show that the training is substantially successful at meeting the goal of improving procurement practices at transit agencies; indeed, most respondents report making changes at their agencies as the proximate result of the training. This was at odds with our exploration of knowledge of procurement topics, as most respondents gave inaccurate answers on multiple-choice “knowledge questions”. This may have been due to question structure or, more likely, the nature of online surveys. Suitable training on the procurement of information technology was also a main concern. The lack of training in this area is indicative of the broader challenge facing public transit agencies in how to incorporate new forms of technology into their existing practices and bureaucratic structures.     

When practice and policy collide: Child welfare workers' perceptions of investigation processes

This qualitative study examines variability in practices surrounding Child Protective Services (CPS) investigations regarding the allegations of child maltreatment. Working under the auspices of a community-research collaboration with Department of Human Services officials, university researchers conducted a series of focus groups with CPS caseworkers in a state that was under court-ordered consent decree to improve child welfare investigations. Focus groups with caseworkers sought to better understand caseworkers' common investigative practices and their perceptions of best practices in conducting child welfare investigations. Two main areas were noted for improvement: (1) the need for ongoing training of CPS workers, particularly at the stage of initial intake of the allegations of maltreatment, and cross-training of police and hospital staff who regularly work with CPS, and (2) implementation of an improved risk assessment tool. These recommendations are discussed in detail.     

Care Provision,Empowerment, and Market Forces: The Art of Establishing Legitimacy for Work Integration Social Enterprises (WISEs)

Using Suchman’s taxonomy, the generation of legitimacy in relation to both external parties/stakeholders and employees by four Swedish work integration social enterprises (WISEs) was investigated. Data were collected through focus group and individual interviews. When operating in fiercely competitive markets, a pragmatic exchange legitimacy was mainly used. When selling complex products, such as investigations of work capacity, normative, and cognitive forms of legitimacy were common. As regards internal relations, normative legitimacy established though robust internal procedures was of importance. In addition, relational legitimacy when dealing with clients, funders, and employees emerged as important. The study indicates that WISEs tend to imitate profit-generating organizations in generating legitimacy. Although short-term resource-generation can be facilitated, the replication of for-profit practices can create a tension with the concurrent aim of being an innovative and empowering enterprise for people who otherwise would be excluded from the labor market.     

The impact of procedure type, jurisdiction and other factors in workers' compensation on work-disability outcomes following carpal tunnel surgery

Carpal tunnel syndrome (CTS) is often work-related and associated with prolonged disability. While surgical treatment is common, an alternative endoscopic procedure has been promoted as a way of achieving better outcomes. However, little is known about typical use of the procedure and whether it actually achieves outcomes in community settings. From workers' compensation claims reported to an insurer in six jurisdictions during 1995-1999, we identified 1697 individuals with a single CTS surgery, 17% were treated using the endoscopic procedure. Bivariate analyses of post-surgical outcomes demonstrated that post-surgical work disability was shorter for those with endoscopic procedures (median 27 vs. 34 days, mean 62 vs. 85 days; p< 0.01). Medical costs following the procedure were also lower in the case of endoscopic procedure for those with any post-surgical medical costs (median $1,201 vs. $1,717, mean $5,733 vs. $7,084; p< 0.01). However, controlling for jurisdiction and other factors, these differences disappeared, suggesting that in CTS the type of care received was not a major determinant of outcomes. These findings reinforce the importance of community-based evaluations which include potential confounders to accurately evaluate the impact of medical technologies on work disability in occupational conditions.     

A Collaborative Approach to Infant Research: Promoting Reproducibility,Best Practices,and Theory‐Building

The ideal of scientific progress is that we accumulate measurements and integrate these into theory, but recent discussion of replicability issues has cast doubt on whether psychological research conforms to this model. Developmental research—especially with infant participants—also has discipline‐specific replicability challenges, including small samples and limited measurement methods. Inspired by collaborative replication efforts in cognitive and social psychology, we describe a proposal for assessing and promoting replicability in infancy research: large‐scale, multi‐laboratory replication efforts aiming for a more precise understanding of key developmental phenomena. The ManyBabies project, our instantiation of this proposal, will not only help us estimate how robust and replicable these phenomena are, but also gain new theoretical insights into how they vary across ages, linguistic communities, and measurement methods. This project has the potential for a variety of positive outcomes, including less‐biased estimates of theoretically important effects, estimates of variability that can be used for later study planning, and a series of best‐practices blueprints for future infancy research.