Robust Training Programme Research Articles

Training in Cognitive Behavioral Therapy in Psychiatry Residency

In January 2001, Accreditation Council of Graduate Medical Education accredited general psychiatry training programs were charged with the requirement to train residents in cognitive-behavioral therapy (CBT) to a level of competence. Programs were given the responsibility to delineate standards for trainees, to determine measures of competence, and to provide remediation for deficiencies in performance. Effective education in CBT in general and child and adolescent psychiatry residency training can be more successful when educators understand the barriers to implementation of empirically supported therapies (ESTs). Robust training programs in CBT must take into account cultural barriers to psychotherapy training and the educational demands placed on residents in adult and child and adolescent psychiatry. Resources for training and evaluation materials are available to training directors and teachers.

Isometric resistance exercise fails to counteract skeletal muscle atrophy processes during the initial stages of unloading

This study tested the hypothesis that an isometric resistance training paradigm targeting the medial gastrocnemius of adult rodents is effective in preventing muscle atrophy during the early stages of hindlimb unloading by maintaining normal activation of the insulin receptor substrate-1 (IRS-1)/phosphoinositide-3 kinase (PI3K)/Akt signaling pathway. This pathway has been shown to simultaneously create an anabolic response while inhibiting processes upregulating catabolic processes involving expression of key enzymes in the ubiquitination of proteins for degradation. The findings show that during the 5 days of unloading 1) absolute medial gastrocnemius muscle weight reduction occurred by approximately 20%, but muscle weight corrected to body weight was not different from normal weight-bearing controls (P < 0.05); 2) normalized myofibril fraction concentration and content were decreased; and 3) a robust isometric training program, known to induce a hypertrophy response, failed to maintain the myofibril protein content. This response occurred despite fully blunting the increases in the mRNA for of atrogin-1, MURF-1, and myostatin, e.g., sensitive gene markers of an activated catabolic state. Analyses of the IRS-1/PI3K/Akt markers indicated that abundance of IRS-1 and phosphorylation state of Akt and p70S6 kinase were decreased relative to normal control rats, and the resistance training failed to maintain these signaling markers at normal regulatory level. Our findings suggest that to fully prevent muscle atrophy responses affecting the myofibril system during unloading, the volume of mechanical stress must be augmented sufficiently to maintain optimal activity of the IRS-1/PI3K/Akt pathway to provide an effective anabolic stimulus on the muscle.

The Use of Patient Group Directions in the Royal Naval Medical Services

As the first primary care nurse practitioner, the author wished to explore the future use of Patient Group Directions (PGD's) within the Royal Naval Medical Services (RNMS). Extensive investigations carried out within the National Health Service (NHS) have resulted in changes in legislation allowing registered nurses to supply medications using PGD's. The design and implementation of PGD's require a cohesive approach of a doctor or dentist, a pharmacist and the lead health care professional. In order that they are implemented in a safe and effective manner all concerned parties must undertake a robust education and training programme. The RNMS will need to address a number of change management issues in order that registered nurses are supported in continuing professional development and PGD's are adopted as practice.

Transforming the naval district washington into a self‐renewing organization

AbstractIn late 1993, the Naval District Washington (NDW) embarked on a transformational journey that would reshape a rigid hierarchy of semi‐independent departments into a self‐renewing organization. Breaking down organizational barriers, focusing planning efforts centrally, realigning and streamlining its structures, and implementing a robust quality training program were all challenges NDW faced in its efforts to succeed in an ever‐changing, customer‐focused environment. This article describes the background, strategy, and challenges of an organization that is moving proactively into the 21st century while preserving the best of its 200‐year tradition.