2-day Training Course Research Articles

« Santé Mentale en Population Générale : Images et Réalités (Smpg) » : Présentation de La méthodologie d’enquête

Introduction Mental Health is a Public Health issue, however, access to relevant treatment often does not meet the population needs. Patients, their relatives, as well as Mental Health professionals are still victims of a high stigmatization process. Whatever the countries and the cultural settings, public beliefs and attitudes towards mental illness (insanity) and mentally ills (insane people) play a major role in the ranking of priorities given to Mental Health national prevention and care policies. This paper presents the methodology of the research-action entitled « Mental Health in General Population : images and realities (MHGP) » carried out by the World Health Organisation Collaborative Centre (Lille, France) and the Direction of research, studies, assessment and statistics (Drees) of the French Ministry of Health, in a sample of 36 000 French subjects over 18 years old, between 1999 and 2003. Objectives The MHGP Survey is an international multisite study aimed at : - Describing, in the general population, the representations attached to insanity, mental illness and depression, and the related care - Assessing the prevalence of major psychiatric disorders in the general population ; - Rising awareness about Mental Health issues among various social groups: social workers, local elected, care professionals, by including them in the research-action procedure ; - Promoting the development of Community Psychiatry, following WHO main Guidelines. Methods About 900 individuals were recruited in 47 centres in metropolitan France between 1999 and 2003 according to the following criteria: i) informed consent to take part in the study, ii) age over 18 yrs, iii) not residing in a care institution and not homeless. Subjects were selected by quota sampling stratified by age, gender, educational and occupational level with the general population of the general population of the centre as sampling frame. The quotas were defined on the basis of the 1999 national population census. The data was collected by 1700 nursing students using a 50-item structured questionnaire administered in face-to-face interviews ; mean length 40 minutes. The interviewers received a special 3-day training course. The assessment included a specially developed questionnaire enabling description of representations of insane, mentally ill and depressed individuals ; the Mini International Neuro-psychiatric Interview (Sheehan and Lecrubier) ; a specific questionnaire on care consumption in case of positive MINI diagnosis and a sociodemographic questionnaire. In each centre, a team of supervisors (psychiatric staff) coordinated the interviews and the data collection ; the local elected and the social and care networks were given information about the research and the results. The results of the local study were systematically presented to the general population, the local elected and the social and care professionals. Prevalence rates of mental disorders are very similar to those observed in other studies. Results on social representations and public beliefs in general population can compare with the international data available. MHGP research-action remains the first study of this scale on the topic of Mental Health in France, combining representations and prevalences description. It allowed the development of anti-stigma actions at a national and local level.

Reduction of radiation delivered to patients undergoing invasive coronary procedures. Effect of a programme for dose reduction based on radiation-protection training

Exposure of patients to radiation from invasive cardiac procedures is high and may be deleterious. To assess the effectiveness of a dose-reduction programme based on radiation-protection training, according to the recommendations of the Euratom Council, the International Commission on Radiological Protection and the French Society of Cardiology. In this single-centre survey, dose-area product (DAP, Gy.cm(2)), fluoroscopy time (minutes) and number of runs were evaluated in 3285 consecutive procedures (2077 coronary angiographies [CAs], 1208 percutaneous coronary interventions [PCIs]), performed one year before (2005) and two years after (2006 to 2007) implementation of a programme for radiation dose-reduction. The programme included a 2-day training course in radiological protection for all medical and paramedical staff and recommendations for routine use of low fluoroscopic and acquisition pulse rates (6.25 and 12.5 i/s, respectively), large field size (23cm), maximal collimation and optimal X-ray tube/patient/detector distances. Routine left ventriculography was discouraged. The radial approach was used in>80% of the procedures. Compared with 2005, a significant 50% reduction in DAP was observed in 2006 and 2007 during CA (median [interquartile range] 53 Gy.cm(2) [33-84] vs 26 [16-43] and 21 [14-32], respectively; p<0.0001) and PCI (125 Gy.cm(2) [78-184] vs 49 [31-79] and 44 [27-66], respectively; p<0.0001). Fluoroscopy time and number of runs did not vary significantly in 2006, and decreased slightly in 2007, likely due to an important reduction in rate of left ventriculographies (from 32 to 4%). Inter-operator variability in DAP was reduced. Training in radiation protection for interventional cardiologists and use of simple and cost-free dose-reduction techniques were associated with a 50% reduction in radiation exposure to patients undergoing invasive cardiac procedures, without any loss of diagnostic information.

The EPICure study: Comparison of pediatric spirometry in community and laboratory settings

Accuracy of spirometry testing is a prerequisite for its use as an objective outcome measure in large epidemiological studies. We compared spirometry measurements obtained by trained pediatricians in a variety of school settings with those obtained in the laboratory by respiratory physiologists. Following a 3-day training course, three pediatricians carried out spirometry in children born extremely preterm (EP) and age matched controls in schools across the UK and Ireland (The EPICure study). A subgroup had repeated measurements in the laboratory. Spirometric flows and volumes were expressed as Z-scores. Bland-Altman analysis was used to calculate within-subject differences. Fifty children (40% boys), 37 (74%) of whom were born EP, with a mean age 10.8 years had paired spirometry results (average interval between tests: 20.3 weeks). There was no statistically significant difference between any of the outcome variables: mean (95% CI of difference) in Z-scores [school-laboratory]) being 0.0 (-0.1; 0.1) for FEV(1), 0.1 (-0.1; 0.3) for FVC, -0.1 (-0.3; 0.1) for FEF(25-75), and 0.0 (-0.3; 0.1) for FEV(1)/FVC. Within individuals, the 95% limits of agreement for repeated measures were within +/- 1 Z-score for FEV(1) and FVC, and within +/- 1.5 Z-score for FEF(25-75) and FEV(1)/FVC. With appropriate training, quality control, and support, pediatric spirometry can reliably be performed outside the lung function laboratory.

Robotic-assisted laparoscopic radical prostatectomy: initial 15 cases in Japan.

Recently, we have introduced robotic-assisted laparoscopic radical prostatectomy (RALP) in Japan. This article describes the details of a training program to shorten the learning curve in the absence of an urologist with expertise in robotic surgery. Five months after a 2-day training course of robotic surgery, RALP was first performed in Japan, and a total of 15 cases were performed in the subsequent 4 months. Our training program consisted of: (1) image training using surgical operation videos, (2) dry lab training using a sham pelvic cavity model, and (3) intraoperative mentoring. The operative procedure was divided into five consecutive stages, and time required to complete each stage was recorded. Robotic radical prostatectomy was completed in all patients without conversion to open surgery, except for the first patient in whom a restriction to a 2-h operation had been imposed by the ethics committee. The mean console time and the mean intraoperative blood loss (including urine) reduced from 264.2min and 459.4ml, respectively, in the first 11 cases, to 151min and 133.3ml, respectively, in the last three cases. With direct intraoperative guidance by the mentor during cases 13 and 14, the operation time was reduced at all five stages of the operative procedure. Our training program proved remarkably effective in reducing the learning curve of RALP in Japan, where there is no person with expertise in robotic surgery.

The Benefits of a Human Simulator Training Course for Initial First-Year Anesthesia Residency Education§

Introduction: Simulator training offers an opportunity to safely educate new residents in a conducive learning environment. Methods: New, first-year anesthesia residents received a 3-day training course prior to beginning clinical training. Instruc- tion focused on developing knowledge and skills for operating room preparation, general anesthesia induction, airway and anesthesia management, and post-operative transfer of care. Before training, residents rated their confidence for perform- ing basic anesthesia skills and completed a knowledge test. At course completion, residents performed operative manage- ment for a simulated healthy patient undergoing uncomplicated general anesthesia and repeated the confidence and knowledge tests. Results: Forty-five new, first-year residents enrolled in and completed the simulator course. Prior to training, residents were neutral about their confidence for performing laryngeal mask airway placement, operating room preparation, general anesthesia induction, or transfer of patient care. They were confident that they could perform bag-mask ventilation and di- rect laryngoscopy prior to training. Mean percentage of correct answers on the knowledge test was 53% before training. After training, confidence for performing each of the six assessed anesthesia skills increased numerically, with residents expressing confidence in performing every skill. Increases achieved statistical significance (P<0.01) for all skills except for bag-mask ventilation. Mean correct responses on the knowledge test after training increased to 69%. Conclusions: A brief, 3-day didactic and simulator training course for new, first-year anesthesia residents can improve resident confidence and competency to begin clinical anesthesia training.

The effects of staff training on staff confidence and challenging behavior in services for people with autism spectrum disorders

The effects of a 3-day training course in the management of aggressive behavior in services for people with autism spectrum disorders were investigated using a quasi-experimental design. An experimental group received training over a 10-month period and a contrast group, which had received training before this study, did not. Staff training increased carer confidence, but there were no training effects of measures of staff coping, support or perceived control of challenging behaviors. Staff reports of service user challenging behavior management difficulties decreased in both the experimental and contrast groups. This study showed that staff training can increase staff confidence in managing aggression in people with autism spectrum disorders.

Occupational Therapy for Children with Attention Deficit Hyperactivity Disorder (ADHD), Part 2: A Multicentre Evaluation of an Assessment and Treatment Package

A family-centred occupational therapy assessment and treatment package for children with attention deficit hyperactivity disorder (ADHD) was evaluated. The package involves a multidimensional evaluation and a multifaceted intervention, which are aimed at achieving a goodness-of-fit between the child, the task demands and the environment in which the child carries out the task. The package lasts for 3 months, with 12 weekly contacts with the child, parents and teacher. A multicentre study was carried out, with 20 occupational therapists participating. Following a 3-day training course, they implemented the package and supplied the data that they had collected from 20 children. The outcomes were assessed using the ADHD Rating Scales, pre-intervention and post-intervention. The results showed behavioural improvement in the majority of the children. The Measure of Processes of Care – 20-item version (MPOC-20) provided data on the parents' perceptions of the family-centredness of the package and also showed positive ratings. The results offer some support for the package and the guiding model of practice, but caution should be exercised in generalising the results because of the small sample size, lack of randomisation, absence of a control group and potential experimenter effects from the research therapists. A larger-scale randomised controlled trial should be carried out to evaluate the efficacy of an improved package.

Fostering a culture of engagement: a pilot study of the outcomes of training mental health nurses working in two UK acute admission units in brief solution‐focused therapy techniques

It is widely acknowledged that there are major concerns about quality of care, ward atmosphere, the nature of nurse-patient interactions and patient outcomes in UK psychiatric acute admission units. Brief solution-focused therapy (SFT) is an approach which aims to shift the focus of interactions in professional care away from the traditional concentration on an individual's problems and weaknesses towards a more proactive identification of their strengths and positive coping mechanisms. This approach relies on a collaborative engagement with patients, in which the nurse or therapist using simple language aims to help the patient construct a plan to ensure their immediate safety while working to identify, focus on and reinforce their strengths and coping mechanisms in the achievement of identified future goals. This paper reports on a pilot study whose principal objective was to determine whether a short training in brief SFT for psychiatric nurses can produce measurable improvements in nurse-patient interactions in two psychiatric acute admission wards. In this study, 36 nurses undertook a 2-day training course in SFT and were followed up 3 months after training. Positive results were obtained on a number of measures indicating that nurses had acquired knowledge and skills and were applying SFT techniques in their clinical work.

Endoscopy Training for GI Trainees: The Impact of a 2-Day Introductory Training Course On Cognitive Knowledge

Background: The cognitive aspects of endoscopic competence encompass informed consent, endoscope and accessory design, safety, sedation, indications and complications. A structured pre-endoscopy training course has been proposed as an important component of the core GI training curriculum. However, the impact of a short training course on participants' cognitive knowledge of endoscopy remains unknown. Aim: To assess the impact of a short, structured endoscopy course incorporating didactic teaching and hands-on experience, on the cognitive knowledge of endoscopy among Canadian first-year GI trainees.

Improvement of Technical and Analytical Performance in DNA Sequencing by External Quality Assessment-Based Molecular Training

From 2003 to 2005, the European Union supported the EQUAL-initiative to develop methodological external quality assessment (EQA) schemes for genotyping (EQUALqual), quantitative PCR (EQUALquant), and sequencing (EQUALseq). As a relevant part of the EQUALseq program, a training course was held subsequent to the first EQA Program (EQAP1). The success of this course was reassessed in a 2nd EQUALseq round (EQAP2). In September 2005, a 3-day training course took place. We invited 8 laboratories with below-average performance in EQAP1 to improve their methodological and analytical/proficiency skills by lectures and practical work. To compare the results of the pretraining and posttraining EQUALseq rounds, we distributed 2 samples used in the first EQUAL round, but this time we provided different oligonucleotide sets. We evaluated the results by means of a previously described scoring system. In EQAP2, 6 laboratories returned complete data sets, corresponding to an overall 14% of the 43 laboratories that had finished EQAP1. The scoring results for samples A (P=0.0025) and B (P=0.0125) demonstrated a significant improvement in EQAP2. Overall, a substantial improvement of technical and interpretative skills was demonstrated (P=0.0051). In general, the workshop experience was highly rated by the participants. Methodologic EQAPs in DNA sequencing are appropriate tools to uncover strengths and weaknesses in both technique and proficiency, emphasizing the need for mandatory EQAPs. Training courses, together with 2nd-round reiterations, should be implemented into methodological EQAPs in molecular diagnostics to improve technical performance and proficiency in genetic testing.

Development of a peer education programme for advance end-of-life care planning

to develop and evaluate an education programme to help older people find out about treatment and care choices at the end of life. an action research approach was used to develop an education booklet about end-of-life care. A programme of qualitative evaluation ran alongside the project. It comprised a combination of methods, including face-to-face and telephone interviews and questionnaires with those who took part in the small group discussions. the research team consisted of five academic researchers and eight people recruited from voluntary groups representing older adults to act as community advisors in developing the programme. The booklet was tested in small group discussions with members of the general public. Five community advisors volunteered to act as 'peer educators' and helped to lead the small group discussions after receiving a 3-day training course to prepare them for their role. The project took place in Sheffield. the education discussions and the related booklet were perceived as acceptable in providing information about a sensitive issue. Peer educators felt that the training course prepared them well. Community advisors felt that they were treated as equal members of the research team. This project has served as a useful pilot study of the education programme that has now been extended to other areas of the UK.

Using survival analysis to demonstrate the effects of training on employee retention

In order to thrive, companies are waging war with competitors to hire and retain the most knowledgeable and skilled employees. Personnel with industry experience are the highly valued field generals who will win new business and generate revenue. The cost of acquiring experienced personnel and the cost of losing such personnel is substantial, upwards of $100,000 per person. To remain profitable, companies must retain personnel as long as possible. Training is among the many tactics that have been implemented to increase retention among employees. This article focuses on assessing the impact of a 3-day training course designed to acclimate experienced hires to one company's policies, formal and informal procedures, and pathways to success. A quasi-experimental design, wherein study participants self-selected to attend training, was used to test the hypothesis that training would increase retention and justify the substantial financial investment in training. Attention is given to the benefits of using survival analysis as a data analytic technique applicable for employee retention studies.

Clinical cytometry in Europe, 2005

This year, the European Working Group on Clinical Cell Analysis (EWGCCA) organises her 5th annual conference in collaboration with the Hellenic Cytometry Society in Athens, Greece. The last 10 years have seen an explosion of novel assays for clinical cell analysis. This development is being driven by inventions such as multicolor (>4) flow cytometry, major histocompatibility complex (MHC) multimers to identify and enumerate antigen-specific T lymphocytes, and intracellular staining assays that allow the analysis of signal transduction pathways and cytokine production. As a result, phenotypic and functional cell analyses go now hand in hand (1). The overall goal of EWGCCA's Euroconferences is to provide the participants, all throughout Europe, with information on the latest developments in the field of clinical cell analysis. The emphasis is on flow cytometric assays but genomics and proteomics are also covered wherever appropriate. As such, these conferences address a broad range of topics all tied together by the common need to quantify and characterize the cells of interest. Specifically, leukemia/lymphoma immunophenotyping, antigen-specific T-cell responses in cancer, viral diseases, vaccination and autoimmunity, CD20 antibody-targeted therapy, circulating endothelial cells as biomarkers for cancer and vascular disease, as well as the use of flow cytometry for allergy diagnosis and the analysis of multiplexed arrays and intracellular signaling processes are addressed at the 5th Euroconference. This conference is concluded by a workshop on controversial areas in the field of clinical cell analysis, including affordable vs. comprehensive methods for CD4+ T-cell counting, cell enrichment vs. flow cytometry for circulating endothelial cell detection, minimal vs. comprehensive panels for leukemia/lymphoma immunophenotyping, and quantitative flow cytometry with ZAP-70 expression as a case in point. For the first time, the conference is preceded by a 2-day practical training course in clinical cytometry, which is inspired by the successful series of annual courses by the Clinical Cytometry Society. The European Working Group on Clinical Cell Analysis (EWGCCA) was established in 1996 in order to establish collaboration between large European centers using (flow) cytometric cell analysis for clinical purposes. The aims of EWGCCA are the advancement and standardization of techniques and assays used for clinical cell analysis. These techniques encompass the analytical characterization of intact cells (using flow cytometry and/or quantitative microscopy) as well as the analytical characterization of genes and gene expression (using molecular techniques). EWGCCA seeks to achieve its goals through the organisation of annual Euroconferences and workshops, through the conduction of multicenter standardization trials, and through the publication of guidelines (2, 3). In 2002, EWGCCA was established as a nonprofit foundation in The Netherlands. Thus far, some 40 laboratories have participated to multicenter standardization trials organised by EWGCCA. The objectives of the Hellenic Cytometry Society are: (i) to promote in Greece the scientific collaboration in the field of flow cytometry by organising scientific meetings; (ii) to exchange information with other (inter)national organisations in the same field; (iii) to advance the quality in cytometry by recommending internal and external quality control procedures, exchanging reagents for standardization and establishing technical recommendations, as well as recommendations to achieve accreditation; (iv) to advance education in all fields and levels of cytometry; (v) to stimulate scientific collaboration between cytometry users and manufacturers of products for cytometry. As scientific organizing committee, we are very pleased with the endorsement and financial support of the International Society for Analytical Cytology (ISAC) to the 5th Euroconference, and with the opportunity offered by Clinical Cytometry to publish the 45 peer-reviewed and selected abstracts that have been submitted to us before 1 July 2005. These are shown in the following section.

Training and assessment of competency in the transfer of critically ill patients

In their recent letter, Spencer and colleagues [1] noted a decade's worth of requirements and guidelines for the transfer of the critically ill patient [2, 3]. They also comment that the CCST in Anaesthesia requires competence in such transfers [4] and that many of the trainees they surveyed had little such experience when first transferring a critically ill patient. Steps One and Two of Training in Intensive Care Medicine also require the demonstration of such competencies [5]. They conclude by hoping that their measures will increase the satisfaction of trainees and ensure competency amongst SHOs undertaking transfers. Their comments mirror our experience in the Northern and Yorkshire Regional Health Authority. Similar discussion combined with personal anecdote of intra- and interhospital transfer led to the development of a 2-day training course in 1998: ‘Training for Transfer’. The course aimed to increase awareness of problems relating to the transfer of critically ill patients and to expand the knowledge of participants in terms of pathophysiological, clinical, practical, communication and ethical issues. The educational setting is informal, away from the Critical Care area. It attempts to foster a multidisciplinary approach. The participants (24 at a time) are mainly doctors and nurses but have included operating department practitioners, paramedics and physiotherapists. A course manual is sent to candidates 6 weeks before the start. The early part of the course is a series of interactive lectures and small group teaching. The latter part of the course is problem-based small group teaching and scenario based situations. Assessment occurs in two parts. Firstly, the candidates sit multiple-choice examinations. The precourse test assesses background knowledge and the level of self-directed learning. A second test occurs on the final day as a means of further such assessment. Candidates also have to apply acquired knowledge to OSCEs and role-play scenarios. To date there have been 17 courses. Post-course evaluation has been positive and qualitatively it provides a number of advantages; education for competence, problem-based learning, integration into a critical care curriculum (for doctors and nurses) and quality control through regular review of the course content and structure. Awareness has grown in the Region and course providers have returned to base hospitals to educate colleagues. A 1-day course for nursing staff (excluding the assessment element) now runs within some of the Region's hospitals. At a quantitative level, data has been difficult to assimilate but evidence exists to suggest that aspects of interhospital transfer in our Region have improved since the introduction of the course. Consecutive audit has demonstrated increased use of appropriate drugs, invasive monitoring and capnography [6, 7]. The level and standard of transfer documentation has improved in transfers from some centres within the Region [8]. In summary, as a move towards competency-based training in transferring critically ill patients we would suggest that assessing candidate performance in OSCEs and scenarios would supplement measures outlined by Spencer et al. such as ‘Consultant Supervised’ transfer. If these intuitive and qualitative advantages are to be justified, an ongoing review of accurate transfer audit data is necessary. If the issues raised are to be advanced further, is there scope for increased collaboration of such courses at a national level?

Getting Evidence into Practice: Implementing a Behavioural Joint Protection Education Programme for People with Rheumatoid Arthritis

Researchers must disseminate their research findings, but this alone is often insufficient to change practice. To improve research implementation by rheumatology occupational therapists, a 2-day training course for changing joint protection practice was developed. This aimed to improve understanding of joint protection, patient education and health behaviour research; develop skills in delivering a group joint protection programme; and reduce potential barriers to changing practice. To evaluate the course's effectiveness, a postal survey with attendees was conducted. Of the 48 respondents, 45 subsequently changed individual patient education practice; 13 implemented the group programme, 25 contemplated doing so and 10 did not (precontemplators). The implementers and contemplators rated the joint protection programme as significantly more effective (p = 0.02) and relevant (p = 0.001) in practice than the precontemplators. The barriers to change were limited staffing, access to facilities, time to make practice changes, funding for programme costs and clinical time to deliver the programme. The implementers considered that supportive managers and teams helped to overcome these. Changing practice needs clinicians, researchers and managers to work together. This research implementation strategy helped most of the participating clinicians to make practice changes that were readily within their control (that is, individual patient education). Group education requires greater organisational change and manager support is important to facilitate this.

P629 An intensive computer-based interactive training program improves interpretation of dobutamine stress echocardiography

Objectives: This study aimed to evaluate the effect of an intensive computerbased interactive training course on accuracy of interpretation of dobutamine stress echocardiography (SE).Methods: 27 cardiologists with minimal experience in SE attended a 2-day training course involving lectures on SE interpretation and computer-based interactive readings of 40 dobutamine studies with experts. Participants completed a test of 10 studies before and after the course. Interpretations to each study were reported in terms of ’Site of Abnormality’ and ’Nature of Pathology’ and were scored against expert interpretation. The before- and after-training scores are compared using the Wilcoxon signed-rank test. Sensitivities and specificities, defined by comparison with the presence or absence of coronary disease from angiographic data, were compared using the paired t test. Results: Specificity (mean±SD) improved markedly from 48%±31% to 73%±28% (p=0.002), but sensitivity was changed little from 95%±11% to 98%±5% (p=NS). Overall scores (out of 10) were 4.93 ±1.51 before and 6.24±1.40 after the course (p=0.002). The ’site’ scores (out of 5) were 2.80±1.02 before and 3.59±0.82 after training (p=0.003). Improvements were especially made in the RCA territory (Table). The scores for ’nature of pathology’ (out of 5) were 2.13±0.70 before and 2.65±0.68 after training (p=0.029). No particular subgroup seemed to benefit more than the others (Table).

日本語版Rathus Assertiveness Schedule (RAS)の作成と信頼性・妥当性の検討

The present study investigated the reliability and validity of the Japanese version of the Rathus Assertiveness Schedule (RAS) preparatory to study the relationship between self-expression skills and mental health status of employees at a Japanese worksite. Assertiveness is one of self-expression skills and defined as standing up for one's own rights as well as for others. RAS that the most widely used was developed by Rathus in the U.S.A. and consists of 30 items. We developed the Japanese version of RAS (J-RAS) along with a back-translation. The subjects were 173 participants of a 2-day assertiveness training course from July to December, 2001 and 364 workers in a manufacturing company in the Kyushu area. We sent the J-RAS to the 173 participants before they commenced the course, and of them 170 participants returned sufficient answers for analysis. During the course their trainers completed the objective evaluations on assertive self-expression. We compared their answers with the trainers' evaluations by the Pearson's correlation to certify the J-RAS's validity. We also mailed the J-RAS to the manufacturing workers in June, 2001. Of them, 266 workers returned sufficient answers by the end of the month. We calculated the Cronbach's alpha coefficient by them to certify the internal consistency reliability of the J-RAS. In August, 2001, we mailed the J-RAS again to 98 workers who agreed to retake the test. We studied the Pearson's correlation between the initial answers and the following ones to certify the test-retest reliability of the J-RAS, using the 98 answers of the workers who agreed to be retested. Our results found that 19 item sets, excluding Q3--7, 9, 13, 19, 20, 25, 28, had significantly positive correlation with the objective evaluations. The sum of the 19 items of the J-RAS (19-item J-RAS) had significantly higher correlations with the objective evaluation than that of 30 items of the J-RAS (30-item J-RAS). The internal consistency reliability of the 19-item or 30-item J-RAS was high, because their Cronbach's alpha coefficient was more than 0.80. Their test-retest reliability was also high, because the Pearson's correlation coefficient between the initial test and the subsequent test was more than 0.84 (ps < 0.001). Our results implied that the validity and reliability of the J-RAS was could be considered as acceptable and that the 19-item J-RAS measured the assertiveness of Japanese people more exactly than the 30-item J-RAS.

Clinical Applicability of an Educational-Behavioural Joint Protection Programme for People with Rheumatoid Arthritis

Joint protection is a major part of rheumatology occupational therapy. Recent research emphasises that an educational-behavioural approach is more effective than current practice in enabling people with rheumatoid arthritis (RA) to increase their use of joint protection and benefit from reduced pain and inflammation and improved function. The aim of this study was to evaluate whether occupational therapists, following a 2-day training course in delivering an educational-behavioural joint protection programme, could enable people with RA to improve use of joint protection significantly and obtain similar results to previous clinical trials. This tested whether it would be feasible to introduce the programme into clinical practice. Three occupational therapists attended a ‘Looking After Your Joints’ training course for leaders. A single-blind crossover trial was conducted. Three centres participated, with each therapist delivering two or three joint protection programmes. Thirty participants with RA attended: 27 women and 3 men, with a mean age of 52.3 years (SD 12.08) and a mean disease duration of 6.76 years (SD 7.02). The primary outcome measure was an observational assessment of use of joint protection, the Joint Protection Behaviour Assessment (JPBA; Hammond and Lincoln 1999b). The median baseline JPBA score for all 30 participants was 15.39% (IQR 11.45–26.82%), which rose significantly to 35% (IQR 25–42.40%) (Z = −3.97; p = 0.0001) at 6 months following the programme. Both participants and therapists expressed positive views of the efficacy of this training approach. Sixteen participants increased use of joint protection by 20% or more. The findings highlight that the 2-day training course facilitated therapists in delivering the programme effectively and they could gain similar behavioural improvements to previous clinical trials.

Survey of infection control training program graduates: Long-term care facility and small hospital practitioners

Graduates of a 2-day basic training course in infection control were surveyed. Respondents were generally from Midwestern long-term care facilities and small hospitals. These infection control practitioners had multiple roles in addition to infection control, most notably employee health and quality assurance. Infection control practitioners demonstrated significant job stability. The vast majority of institutions where survey respondents were employed followed recommended infection control practices. (Am J Infect Control 2002;30:311-3.)

Final results of the Department of Defense multicenter breast lymphatic mapping trial.

Lymphatic mapping and sentinel lymph node (SLN) biopsy have the potential to become the standard of care for nodal staging in breast cancer patients, but their widespread utility outside of university-based centers has not been determined. This study describes the final results from a national multi-institutional trial designed to determine the role of preoperative lymphoscintigraphy in breast lymphatic mapping, the rate of success for finding an SLN, and the rate of skip metastasis for patients with invasive breast cancer across all practice scenarios. Lymphatic mapping techniques involving the combined use of blue dye and radiocolloid were taught to participating surgeons through a formal 2-day training course at the Moffitt Cancer Center. In protocol 1, surgeons performed their first 20 to 25 cases of breast mapping with SLN biopsy followed by complete axillary lymph node dissection. In protocol 2, after the learning phase, surgeons did not perform axillary lymph node dissection unless a SLN was positive for metastatic disease. Forty-two institutions, including 12 university-based research centers, participated in the trial. From July 1, 1997, through January 31, 1999, a total of 965 patients were accrued. Lymphoscintigraphy identified drainage to an axillary SLN 64% of the time, but by using sensitive handheld gamma probes at the time of the operation, an axillary SLN could be identified 86% of the time. The rate of success for finding an axillary SLN was 92.8% for cases performed at the Moffitt Cancer Center. For other university centers, the rate of success of identifying an axillary SLN was 91.4%, and for other community/regional hospitals in the study, it was 85.2%. For cases in which protocol 1 was followed, the rate of false-negative SLN biopsy was 4%. There was no axillary nodal recurrence after a negative SLN in protocol 2 when a negative SLN biopsy was followed by observation. The median follow-up for the patients on protocol 2 was 16 months. These data show a high rate of success for finding an axillary SLN and a low rate of skip metastasis in a national multicenter study of lymphatic mapping for breast cancer. This study suggests that SLN biopsy for breast cancer can be performed successfully in community/regional hospitals, as well as in major university-based centers.