Adequate Supervision Research Articles

Salud comunitaria. Innovando en la formación de residentes de medicina familiar y comunitaria

ObjectiveTo know the opinions of the agents involved in the training of family and community medicine residents in order to improve the training process of the «Project to Support the Revitalization of Primary Care; Assets for Community Health» (PARAC) taking into account its adequacy, contextualization and the methodologies used. MethodQualitative interpretative-explanatory study of phenomenological orientation, multilevel and multicenter, in which the opinion of the participants is analyzed. Between 2018 and 2020, 12 focus groups and 24 semi-structured interviews were carried out, with the participation of sixty-seven professionals from six health districts of Andalusia (Spain), who were involved in the PARAC training process. ResultsThe participants consider it necessary to broaden training in community health for residents. To this end, they consider it necessary to make changes in the training plan of the specialty, giving more importance to primary health care than to hospital rotations. They value positively the methodologies used in the PARAC training process, which they consider «novel», and the choice of young teachers to serve as references. In order for their interventions in the territory to be carried out with quality and safety for the population, they ask that specific times and spaces be guaranteed for community health, as well as adequate supervision to help ensure the coherence and continuity of their interventions. ConclusionsTraining in community health for family and community medicine residents requires a pedagogical, didactic and curricular effort that prepares them for work with the community, as well as the guarantee of organizational conditions that allow this work.

The New Contributory Pension Scheme and the Investment of Pension Fund for Improved Benefits

The study examined the new contributory pension scheme and the investment of pension fund for improved benefits. Descriptive statistics was used in analyzing the responses elicited through questionnaire, from the sampled population. Data gathered from in-depth interview were analyzed qualitatively in other to test the hypothesis. It was found that the investment of pension funds has not led to fair returns in retirees Retirement savings accounts (RSA) balance. The study suggests diversification of the portfolio and modes of investment of pension funds by the PFAs to include greater emphasis on the real estate and infrastructures, a part from government secured bonds. It is also suggested that Pen Com as the regulator should ensure adequate supervision of the activities of the PFAs so they can declare fair returns.

Sources of Employee Grievances: Procedures and Employee Job Satisfaction among Seventh-day Adventist Institutions in Malawi

In the workplace, complaints and concerns arise from time to time. Organizations must have an effective grievance-handling mechanism to address such issues. This study aimed to assess the sources of employee grievances, the current procedures for handling grievances, and their relationship with employee job satisfaction in selected Seventh-day advisory institutions in Malawi. Two hundred thirty-one employees participated in the study. Based on the reported findings, sources of employee grievances are communication, workload, working conditions, organizational culture, and supervision. However, the regression analysis showed that among the procedures in handling grievances, only ‘able to resolve grievances’ was a significant predictor of job satisfaction. Hence, organizations, particularly SDA institutions that recognize their employees as the most critical organizational assets, must ensure adequate supervision and grievance-handling procedures for the organization’s benefit in such a way that dialogue is commonly used in handling grievances.

Budgeting approaches and employee motivation in the hospitality industry

The thorough appraisal of financial tools such as budgeting guides business leaders in effectively planning and controlling business activities for optimum productivity and profitability. Hence, proper budgeting can be used to motivate employees. This study seeks to investigate the functional association between budgetary approaches and employee motivation in the Nigerian hospitality industry. The descriptive research design was employed, and data were garnered via a structured questionnaire (using a five-point Likert) administered to 85 hospitality industry employees spanning accommodation, catering, tourism, and recreation spheres. The paper employed a purposeful sampling technique. Motivation, which is the dependent variable, was determined using the path-goal model. Both descriptive statistics and ordinary least square regression were conducted to gauge the magnitude and direction of the relationship between the variables under consideration. The outcome signposts a significant positive correlation between budgeting style and employee motivation up to 48.9%. Specifically, the participatory budgeting style was shown to boost the motivation of employees to work with set budgets and to pursue company objectives. However, budget standard and success rates were observed to be slightly higher with imposed budgeting. The paper recommends that, while participatory budgeting is good for maintaining a well-motivated workforce, it should be practiced with adequate supervision to avoid having low-performing budgets.

Developing an instrument to assess physician knowledge of initial care for burn patients

IntroductionBurns are associated with high rates of morbidity and mortality, especially in low- and middle-income countries, such as Brazil, because there are no routine prevention programs, a lack of adequate legislation and supervision, and care quality in the acute phase is precarious. In most cases, initial care for burn patients is provided by emergency services without specialized personnel, which leaves the majority of cases to general practitioners who have no specific training in initial burn care, which can lead to worse prognoses and outcomes. ObjectiveTo develop an instrument to assess physician knowledge of initial care for burn patients. MethodsThis primary quantitative study used the Delphi technique, which involves consensus from a panel of expert panel, as a methodological reference. The instrument was based on information provided in the Ministry of Health’s booklet on emergency burn treatment, and an agreement index of 80% was required for item inclusion. ResultsAfter 3 Delphi phases, the instrument was approved by the panel with an agreement index of 100%. ConclusionAlthough the instrument was finalized, other psychometric properties must still be assessed to further determine its validity and reliability.

Evolutionary game analysis of strategic interaction of environmental regulation among local governments

The effective implementation of environmental regulations is vital for constructing China's ecological civilization. From the perspective of local government competition, this paper constructs an evolutionary game model for the interaction of Chinese local government environmental regulation strategy. Then, the mechanism of local government environmental regulation competition and its influencing factors are explored. The results show that local governments are more inclined to relax environmental regulations when the losses of strengthening environmental regulations increase, which results in the race to the bottom in environmental regulation. However, environmental regulatory competition among local governments will be affected by externalities. In addition, adequate supervision by the superior government and an increase in the weight of environmental indicators in the performance appraisal system are conducive to the race to the top in environmental regulation among local governments. These research results can provide policy enlightenment for the central government to strengthen environmental supervision and win the battle against pollution.

Biomedical Waste Management among Primary Health Care Workers, Bauchi Local Government Area, Bauchi State, NIGERIA

Biomedical waste management is a serious issue to health and environment that must be addressed at primary health care level, especially in Bauchi local government area of Bauchi state. The objectives of this study were to assess on the knowledge, methods and problems of biomedical waste management among the primary health care workers in some selected Health Care Centers of Bauchi L.G.A. of Bauchi state. A cross sectional study was employed and sampling techniques were used to distribute a questionnaire and interview among the health workers at twenty (20) selected primary health centers with (200) sample respondents from public and private health care centers. The result from the current study shows that the knowledge of biomedical waste management awareness among the workers was represented (94%), and only (6%) were not aware. The majority of PHC workers practiced open dumping and burning method (74%), incineration (7%), chemical treatment and only 1% for autoclave methods. while, microwaving (0%), encapsulation (0%) and sanitary landfill methods (0%) were not practiced. The problems of biomedical waste management included improper planning (33%), insufficient funds (25%), lack of material (19%) and (15%) lack of staffs training. There was improper segregation, lack of planning, lack of funds and practiced open dumping and burning, which is against the biomedical Waste (Management and Handling) Rules of 2016. There was improper biomedical waste management at primary health care level in Bauchi local government of Bauchi state. Thus, the Bauchi government should give more consideration towards good plan, allocation resources, set a committee of adequate supervision, monitoring and evaluation for the sustainable biomedical waste management at Bauchi local government of Bauchi state.
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Usefulness of Inhaled Sedation in Patients With Severe ARDS Due to COVID-19.

Sedation in intensive care is fundamental for optimizing clinical outcomes. For many years the world has been facing high rates of opioid use, and to combat the increasing opioid addiction plans at both national and international level have been implemented.1 The COVID-19 pandemic posed a major challenge for health systems and also increased the use of sedatives and opioid analgesia for prolonged periods of time, and at high doses, in a significant proportion of patients. In our institutions, the shortage of many drugs for intravenous (IV) analgosedation forces us to alternatives to replace out-of-stock drugs or to seek sedation goals, which are difficult to obtain with traditional drugs at high doses.2 METHODS: This was an analytical retrospective cohort study evaluating the follow-up of subjects with inclusion criteria from ICU admission to discharge (alive or dead). Five end points were measured: need for high-dose opioids (≥ 200 µg/h), comparison of inhaled versus IV sedation of opioid analgesic doses, midazolam dose, need for muscle relaxant, and risk of delirium. A total of 283 subjects were included in the study, of whom 230 were administered IV sedation and 53 inhaled sedation. In the inhaled sedation group, the relative risks (RRs) were 0.5 (95% CI 0.4-0.8, P = .045) for need of high-dose fentanyl, 0.3 (95% CI 0.20-0.45, P < .001) for need of muscle relaxant, and 0.8 (95% CI 0.61-1.15, P = .25) for risk of delirium. The median difference of fentanyl dose between the inhaled sedation and IV sedation groups was 61 µg/h or 1,200 µg/d (2.2 ampules/d, P < .001), and that of midazolam dose was 5.7 mg/h. Inhaled sedation was associated with lower doses of opioids, benzodiazepines, and muscle relaxants compared to IV sedation. This therapy should be considered as an alternative in critically ill patients requiring prolonged ventilatory support and where IV sedation is not possible, always under adequate supervision of ICU staff.

Remote Patient Monitoring System Implementation

Remote Patients’ Monitoring System is an essential feature of remote healthcare efficiency and durability. It assures adequate clinical supervision and care to admitted patients in a timely and effortlessly manner. The objective of this case study is to show the impact of a health informatics solution application through the implementation of a remote physiological monitoring system in a cardiac care center. It also discusses the following questions: how health informatics was employed in this case study? how did this case study help healthcare providers to a better performance? how can we decide if we need to implement such a system in other organizations? In addition, an overview of the Philips, IntelliVue Patients’ Monitoring System (PMS) will be demonstrated and justified. The problem statement will be introduced, then, the organizational contextual settings, summary of key facts, problem implications, and the actual solution tailored and achieved by KACC management is verified in an advance detail.

Agricultural education for youth empowerment in Nigeria: a brief review.

This study was carried out to review agricultural education for youth empowerment in Nigeria. The study adopted a qualitative research approach and existing studies on related studies were sourced online. The major findings of the study disclosed that motivational strategies for effective implementation of youth empowerment programmes in Nigeria include: adequate remuneration of trainers, disbursement of long and short term loans, bursary scheme for youth educational empowerment, sharing of sewing machines, among others. Supervisory strategies for effective implementation of youth empowerment programmes in Nigeria include, provision of adequate supervision task force for youth empowerment programmes and preparation of guidelines for reporting youth empowerment training activities. Managerial strategies for effective implementation of youth empowerment programmes in Nigeria among others include: development of scopes and sequence of the training programmes, provision of a curriculum for youth empowerment programmes and proper adherence to the curriculum contents. The policy strategies for effective implementation of youth empowerment programmes in Nigeria include, promulgation of decree for compulsory youth empowerment training programmes and centres, adoption of youth oriented policies in the States and formulation of decrees for formal entrepreneurship training programmes in institutions. Based on the findings of the study, the following recommendations were made: youth empowerment programmes should be introduced in the curriculum of institutions of higher learning. Tertiary institutions should put in efforts in teaching vocational education and agricultural skills acquisition programmes to enable every Nigerian to be self-reliant, self-developed and creative.

The clinical elective course and its effects on medical students and graduates of Jordanian medical schools

BackgroundThe elective course is part of the 6th-year medical school curriculum in Jordan. Students choose the specialty in which they wish to spend 8 weeks and choose their location even if it is outside their university’s affiliated hospitals. In this study, we try to understand student choices regarding the country of elective, chosen specialty, type of placement (observership/clerkship), and elective general value from participants' perspectives.MethodsThis paper used a cross-sectional study. The survey was distributed through social media platforms (mainly Facebook and WhatsApp) targeting 6th-year medical students and doctors who graduated from one of the 5 Jordanian medical schools (the University of Jordan, Jordan University of Science and Technology, Mutah University, Yarmouk University, and Hashemite University).ResultsThe majority of participants had an international elective (69.6%), mainly in the USA, followed by the UK. Internal medicine was the primary field of interest for 14.8%, followed by general surgery. Of these, 241 (62.6%) actively participated in work at their chosen hospitals as they had a clerkship/hands-on experience. In contrast, 142 (36.9%) were observers. The majority indicated that the elective is worth the time, money, and effort. Moreover, they had adequate supervision throughout the course and could achieve their preset objectives.ConclusionsThe elective course gives a unique experience to our students. General satisfaction is an indicator of the success of the course in actively exposing medical students to clinical practice.

Non-motorised active mobility device use by children in Singapore: Injury patterns and risk factors for severe injury

Wheeled recreational devices (WRDs) include tricycles, bicycles, scooters, inline skates, skateboards, longboards and waveboards, and can cause significant morbidity and mortality. This study aimed to describe the epidemiology and nature of injuries sustained by children from WRD use, and risk factors for severe injury. We described injuries relating to WRD use in children <18 years who presented to the emergency department of an Asian tertiary hospital between 2016 and 2020. Demographic data, site and nature of the injury, and historical trends were analysed. Risk factors for severe injury (defined as fractures or dislocations), Injury Severity Score ≥9, and injuries resulting in hospitalisation, surgery or death were evaluated. A total of 5,002 patients with 5,507 WRD-related injuries were attended to over the 5-year study period. Median age was 4.7 years. Injuries related to bicycles (54.6%) and scooters (30.3%) were most frequent, followed by skateboards and waveboards (7.4%), inline skates (4.7%), and tricycles (3.0%). Injuries occurred most frequently in public spaces. Soft tissue injuries (49.3%) and fractures (18.7%) were the most common diagnoses. Upper limb (36.4%) and head and neck (29.0%) regions were the most common sites of injury. Among the patients, 1,910 (38%) had severe injuries with potential morbidity. On multivariate analysis, heavier children of the school-going age who use either scooters, skateboards or inline skates are more prone to severe injuries. Involvement in a vehicular collision was a negative predictor. WRD use in children can result in severe injuries. Wrist and elbow guards, as well as helmets are recommended, along with adequate parental supervision.

Is contact with birth parents beneficial to children in non-kinship foster care? A scoping review of the evidence

Many children in non-kinship foster care maintain contact with their birth parents, although debate continues about whether or not, or under what circumstances, it is beneficial to the child. In this scoping review we analyze the findings of studies conducted over the past two decades that have specifically examined face-to-face contact with birth parents for children in non-kinship foster care, our aim being to determine more clearly when it may contribute positively to the child's well-being. The review was conducted in accordance with PRISMA-ScR guidelines and involved a search of nine electronic databases. A total of 21 studies met the criteria for inclusion in the review, namely primary studies analyzing one or more aspects of these contact visits, written in English or Spanish, and published during the period 1997–2022. In analyzing these studies we grouped their findings according to four broad areas of interest: characteristics of contact visits, appraisal of visits by families and professionals, relationship between contact and fostering outcomes, and impact of contact on children. The four main conclusions we draw from the review are: a) surprisingly few studies have specifically examined the effects of face-to-face contact with birth parents in non-kinship foster care; b) the findings to date are neither conclusive nor generalizable, although they are not generally encouraging; c) under the right circumstances (e.g., adequate supervision, conducted in a context of emotional security for the child), contact can contribute to the child's well-being and increase the likelihood of family reunification; and d) more robust research is needed to guide the development of interventions that can improve parent–child relationships and the quality of contact visits.

A national intercalated medical student research program – student perceptions, satisfaction, and factors associated with pursuing a PhD

ABSTRACT Background To counteract a decreasing number of physician-scientists, a national intercalated Medical Student Research Programme (MSRP) was launched in Norway in 2002. We aimed to assess whether the students’ favourable perceptions and satisfaction with the program had prevailed since the inception in 2002 and until 2015, and to identify factors associated with pursuing a PhD. Methods The study was an incorporation of data from two previous national evaluations of the MSRP performed in 2007 and 2015. We used electronic questionnaires to explore demographic characteristics, area and type of research, student satisfaction, and future scientific goals. In 2007, questionnaires were sent to all 208 students, and 183 (88%) replied. In 2015, the corresponding numbers were 279, and 240 (86%). Categorical data were analysed using either Kruskal-Wallis or Pearson’s chi square test. Differences between sample means were assessed with Student`s t-test while logistic regression was used to test associations between selected covariates and the students’ ambitions to pursue a PhD degree. Results Overall, the student satisfaction was 79%. However, more students in 2015 received less regular and less supervision time and expressed a need for more of it. Seventy-seven per cent expressed an ambition to pursue a PhD. Students were more likely to have a PhD ambition if they were satisfied with the program, had a supervisor with high expectations for them, or had already published some of their results. At both time points, students (86% vs. 89%) responded that the MSRP had a positive impact on their regular curriculum achievements. Conclusions The high degree of satisfaction with the national MSRP among undergraduate students has prevailed since the inception in 2002. By far, the program has also met its goal to increase the number of aspiring physician-scientists. However, to maintain that goal over time, adequate and personal supervision is a prerequisite.

Outcome and learning curve for laparoscopic intra-corporeal inguinal hernia repair in children.

Laparoscopic inguinal hernia repair is one of the procedures most commonly performed by paediatric surgeons. Current research on the learning curve for laparoscopic hernia repair in children is scarce. This study aims to evaluate the clinical outcome and learning curve of laparoscopic intra-corporeal inguinal hernia repair in children. A retrospective single-centre analysis of all paediatric patients who underwent laparoscopic intra-corporeal inguinal hernia repair between 2010 and 2019 was performed. The clinical outcomes were analysed. The data on the achievement of the learning curve by surgical trainees were evaluated with the CUSUM technique, focusing on operative time. There were 719 patients with laparoscopic intra-corporeal inguinal hernia repair (comprising 1051 sides) performed during the study period. The overall ipsilateral recurrence rate was 1.8% without other complications detected. CUSUM analysis showed that there were 3 phases of training, for which the trainees underwent initial learning phase (Phase 1) for the first 7 cases. After mastering of the skills and extrapolating the skills to male patients with smaller body size (Phase 2), they then achieved performance comparable to that of the senior surgeons after 18 procedures (Phase 3). 18 procedures seem to be the number required to reach the learning curve plateau in terms of operative time by surgical trainees. The clinical outcomes show that laparoscopic intra-corporeal inguinal hernia repair is a safe and transferrable technique, even in the hands of trainees, with adequate supervision and careful case selection. It also provides skill acquisition for minimally invasive surgery.

'Trial by fire': An online survey exploring confidence of junior doctors in managing toxicology presentations to the emergency department.

The often unknown nature of acute drug intoxication, especially with illicit drugs and emerging novel psychoactive substances, can present a significant challenge for emergency clinicians. Less experienced clinicians are particularly vulnerable to the diagnostic dilemmas of complex toxicology emergencies. We sought to better understand the confidence of junior doctors in assessing and managing toxicological emergencies across two emergency departments in Perth, Australia. An online survey was conducted between August 2020 and February 2021. Self-rated confidence was measured on a five-point Likert Scale across 10 statements. Two open-ended questions were included to capture perceived barriers and facilitators impacting clinical confidence. Quantitative data were analysed using descriptive methods and Fisher's exact test. Free-text responses were analysed using content analysis. A total of 104 surveys were completed (19.2% interns, 40.4% resident medical officers and 40.4% registrars). Self-rated confidence varied across statements and by staff type. The lowest confidence rating was for managing a patient who had overdosed from an unknown substance (31.7%) and the highest rating for referring a patient to psychiatry following deliberate self-poisoning (86.6%). Confidence increased with greater clinical experience for all statements. Qualitative analysis revealed perceptions of clinical preparedness, complexity of patients and a safe and supportive culture as key factors impacting confidence. Overcoming perceived deficits in knowledge and clinical experience were key to building confidence. Our findings highlight the need for improved access to toxicology-specific curricula and training, and strategies to ensure adequate supervision from senior clinicians.

Building peace through tourism: The analysis of an ongoing Siachen Glacier dispute between India and Pakistan

The current article aims to analyse the effectiveness of the conversion of the Siachen Glacier into a peace park on India–Pakistan relations. It further investigates how the peace park can build mutual understanding leading to cooperation and peace between the two countries. The article presents the conceptual framework for adequate supervision of the Siachen Glacier jointly by India and Pakistan to mitigate the existing tensions and conflicts through tourism within the context of the tourism–peace nexus and peace park concept. The Siachen Peace Park proposition offers an amazing way out for the policymakers to diffuse tensions between the military establishments of India and Pakistan. Both the nations have been losing the lives of their soldiers among the snow-capped peaks not due to any gunfight but mainly because of climatic extremities and frostbite. The suggestion of the Siachen Peace Park has been explicated with the help of a four-stage peace park conversion model conceived by the authors, which gives a conceptual understanding of the outcomes of this Peace Park for both countries.

Farmer's Perception of Fruit Fly Bactrocera spp. in Mandarin Orange and their Management in Sankhuwasabha District of Nepal

The study was conducted from October to December, 2020 to evaluate farmers' understanding of loss incurred by Bactrocera spp. on mandarin orange and practices adopted by farmers for their management. Eighty households of mandarin orange growers and 15 agro-vets were purposively selected and information was collected using a semi structured questionnaire. The findings indicated severe infestation of fruit fly in mandarin with 53% of the farmers having low (&gt;15%), 36% having medium (15-30%) and 11% having high (&gt;30%) level of fruit damage in their orchards. The survey identified several management practices like collection and destruction of fallen fruits, pruning, use of traps and chemical pesticides in controlling fruit fly. About two-third (61.25%) of the respondents used chemicals and 15% of the farmers collected and destroyed affected fallen fruits. Some farmers also practiced pruning in the study area for the control of fruit fly. The use of traps was a rarity and its use was limited to only 10% of the total respondents. Since farmers were not much aware of the impact, life cycle and different species of fruit fly, lacked adequate training, support, and supervision, effective management of fruit fly was not possible and resulted in a much greater damage in mandarin fruit.

STATUS OF FOOD HANDLING PRACTICE AND ASSOCIATED FACTORS AMONG WORKERS IN PUBLIC FOOD CATERING ESTABLISHMENT, ETHIOPIA: A SYSTEMATIC REVIEW

Background: Foodborne disease is one of the most frequent and life-threatening diseases on the planet. The aim of this study is to determine food handling practice and factors associated with good food handling status among food handlers in public food catering establishments, in Ethiopia.&#x0D; Methods: One hundred and fifty studies were gathered using key terms in a search web page, and finally, twelve studies were included with considering a pre-structured inquiry that addressed the desired outcome and then grouped in a table and figure.&#x0D; Results: This systematic review finding revealed that the mean good food handling practice in public food catering establishments in Ethiopia is low. The predicted factors for good food handling practices were included as educational status, experience, training, regular medical checkups, knowledge of the foodborne disease, absence of adequate supervision, lack of clean water, and maintain good hygiene in the workplace played a significant role to keep good food handling practice in Ethiopia.&#x0D; Conclusion: It is suggested that food catering establishments are the main source of food-borne disease. Therefore, massive food catering establishment owners and food inspection authority should give better emphasis with designing necessary strategies to improve food hygiene and safety concerns in the countries.

The current state of lesbian, gay, bisexual, and transgender cultural competency among U.S. dermatology residents.

Background:Lesbian, gay, bisexual, and transgender (LGBT) people interface with dermatology providers for many reasons. Implementing culturally competent LGBT dermatologic care necessitates evaluating provider competency to identify where gaps remain.Objectives:To assess the LGBT cultural competency among U.S. dermatology residents.Methods:A self-reporting, cross-sectional survey was emailed to U.S. dermatology program coordinators (N = 143). LGBT patient exposure, LGBT educational hours, and LGBT cultural competency via the LGBT-Development of Clinical Skills Scale (with the subscales Clinical Preparedness, Attitudinal Awareness, and Basic Knowledge) were measured.Results:Dermatology residents (N = 119) across the United States completed the survey. They reported caring for less than 20 LGBT patients per year and receiving less than 75 minutes of LGBT education per year. They reported significantly higher Attitudinal Awareness than both Clinical Preparedness and Basic Knowledge; they reported significantly higher Basic Knowledge than Clinical Preparedness. They reported significantly less adequate clinical training and supervision, experience, and competence to assess transgender patients compared to lesbian, gay, and bisexual patients. In general, dermatology residents who reported more LGBT patients and LGBT education also reported higher LGBT cultural competency.Limitations:A larger national sample of U.S. dermatology residents is necessary for generalizability.Conclusions:Currently, there is a lack of LGBT education in U.S. dermatology residency curricula, which may delay addressing the health disparities that exist in this patient population. Due to such dearth of standardized LGBT education, dermatology residents likely do not feel adequately knowledgeable or prepared to address LGBT needs. Both LGBT education and LGBT patient experiences may help alleviate these shortcomings and help LGBT patients feel affirmed in their dermatologic care.