Staff Training Requirements Research Articles

Integration of FDG- PET/CT into external beam radiation therapy planning

SummaryThis work addresses the clinical adoption of FDG-PET/CT for image-guided radiation therapy planning (RTP). As such, important technical and methodological aspects of PET/CTbased RTP are reviewed and practical recommendations are given for routine patient management and clinical studies. First, recent developments in PET/CT hardware that are relevant to RTP are reviewed in the context of quality control and system calibration procedures that are mandatory for a reproducible adoption of PET/CT in RTP. Second, recommendations are provided on image acquisition and reconstruction to support the standardization of imaging protocols. A major prerequisite for routine RTP is a complete and secure data transfer to the actual planning system. Third, state-of-the-art tools for image fusion and co-registration are discussed briefly in the context of PET/CT imaging preand post-RTP. This includes a brief review of state-of-the-art image contouring algorithms relevant to PET/CT-guided RTP. Finally, practical aspects of clinical workflow and patient management, such as patient setup and requirements for staff training are emphasized. PET/ CT-guided RTP mandates attention to logistical aspects, patient set-up and acquisition parameters as well as an in-depth appreciation of quality control and protocol standardization. Conclusion: Upon fulfilling the requirements to perform PET/CT for RTP, a new dimension of molecular imaging can be added to traditional morphological imaging. As a consequence, PET/CT imaging will support improved RTP and better patient care. This document serves as a guidance on practical and clinically validated instructions that are deemed useful to the staff involved in PET/CT-guided RTP.

Empfehlung zur Sedierung in der flexiblen Bronchoskopie

Flexible bronchoscopy is a standard examination today and is conducted not only in nearly every hospital but also in privately owned practices. The vast majority of patients want sedation for this examination. Such a procedure is nearly always necessary in complex and interventional procedures, irrespective of the patient's wish. The recommendation at hand to use sedation measures for flexible bronchoscopy is based on the results of numerous clinical studies and also takes account of individual experiences in this area. The structural and procedural requirements and the requirements for staff training are defined and should describe the minimum standard when it comes to conducting a bronchoscopy under sedation. Furthermore the drugs recommended for sedation are discussed and their methods of application shown. Finally the recommendations also include suggestions for patient clarification, monitoring and discharge. They should provide the examiner with concrete operating options and therefore above all increase patient safety.

Assessing user perceptions of staff training requirements in the substance use workforce: A review of the literature

Although the potential range of the workforce that may positively interact with substance users is large, and takes in all who may have to deal with substance use issues in some way, the literature mainly focuses on user views of specialist substance use or health and social care staff. With client-centred care a key policy of modern service delivery, this review assesses the available literature on service user perceptions of staff abilities and comments on possible training needs. Many service users rated a positive attitude towards the user as the key staff attribute that enhanced quality of care. There was also evidence that generally users desired more knowledgeable staff, both professional and ex-user, and that staff working within sub-specialties require advanced training. However, a positive attitude towards the user in interpersonal therapeutic situations was potentially able to overcome a staff member’s knowledge deficiency. Potential methods of instilling positive attitudes within the substance use workforce are discussed, including organizational culture and potential educational requirements.

Extreme Makeover Reference Edition: Restructuring Reference Services at the Robert W. Woodruff Library, Atlanta University Center

The Robert W. Woodruff Library, Atlanta University Center, recently restructured its system for information service delivery by moving from the traditional one-desk model to a dual component model that is delivered from two service points in close proximity. Under the former system, services were solely delivered by reference librarians. The new system offers the same array of information services provided by a combination of librarians and library support staff who have received special training. The observed outcomes have been a higher quality of customer service delivery, an increased use of research consultation services, a more informed and engaged library staff, and increased opportunities for reference librarians to make campus visits. This article outlines the entire process from conception to implementation, including staff training requirements, statistical data, and future implications.

Are alcohol gels better than liquid hand rubs?

We read with great interest the study by Traore and coauthors, comparing an alcohol hand gel with a liquid hand hygiene formulation in an intensive care unit [1]. The authors reported better user acceptability for the gel. Compliance for both formulations was significantly better (P = 0.035) when healthcare workers had easy access to hand rubs, but the difference in compliance between the gel and the liquid was not statistically significant. We are concerned that readers may conclude that gels are generally better than and preferable to liquids. The abstract points out that the gel performed significantly better on skin tolerance parameters. Easy access, however, was the only significant predictor for compliance. The article also mentions 'superior acceptance' of the gel, but acceptability scores of 39.1 and 40 (P = 0.44) were presented. Surprisingly, compliance was considerably lower compared with an earlier report from the same institution [2]. The two-phase study design may have biased the results, with the gel coming second and with improvements noted in the second phase. In any ongoing hand hygiene campaign, it is probable that compliance and acceptability will increase with time. Also, the second phase occurred during summer – a season less likely to cause dry, irritant skin. Previous studies found that most liquid hand rubs present significantly better antimicrobial performance than gels [3], and the authors wisely chose a gel that meets the stringent EN 1500 standards. Many gels, however, do not meet these EN 1500 standards. The authors are to be congratulated on publishing this study. We think that the data presented, however, do not allow such strong, general statements to be made in favour of gels. There may also be local preferences. For example, settings with long-standing usage of alcohol for hand hygiene (for example, many parts of Europe) almost exclusively use liquids, with no associated compliance and acceptability problems. Liquids act more rapidly (~15 s) and leave less residual substance on hands. Gels require about 30 seconds to act, and time loss can reduce compliance [4]. The technique of rubbing is also important; some hand surfaces are often missed. Only liquids have been evaluated for staff training requirements and for surface coverage [5]. In conclusion, each institution should evaluate formulations based on local needs, taking antimicrobial activity into account. It may be useful to provide both gel and liquid, as the authors suggested.

Datapoints: use of restraint before and after implementation of the new HCFA rules.

138 T use of physical restraint in psychiatric settings is highly controversial, and the issue is all the more contentious for the lack of systematic data collection and careful evaluation of indications, methods, outcomes, and adverse events. In July 1999 the Health Care Financing Administration (HCFA), now the Centers for Medicare and Medicaid Services, issued rules on restraint and seclusion for general and psychiatric hospitals that participate in Medicare and Medicaid (1). The rules require that a physician or a licensed independent practitioner make a face-to-face assessment of a patient within one hour of the initiation of restraint or seclusion. The “one-hour rule” has provoked tremendous debate as smaller and rural facilities struggle to comply with this “unfunded mandate.” The rules also shorten the interval between mandatory renewal orders, codify requirements for staff training, and create more stringent requirements for documentation. No data on the use of restraints on inpatient psychiatric wards have been published since these rules were put into effect. We report information about restraint episodes on four psychiatric units with a total of 80 beds at the University of Rochester Medical Center during the three months before Use of Restraint Before and After Implementation of the New HCFA Rules

Applicability of CDC guidelines toward the development of an injury surveillance system in the Caribbean

Deaths from injuries worldwide are expected to increase 65% from 5.1 million in 1990 to 8.4 million by 2020.1 This projection is based on increases in population size and age,...

Regulating the Use of Behavioral Procedures in Schools

Researchers conducted a survey of standards developed by state departments of special education (SDSE) for the regulation of behavioral procedures. Specific attention was given to SDSE regulations of aversive behavioral procedures. Each state's standards (i.e., policies and/or guidelines) were analyzed according to 19 questions addressing types of behavioral procedures identified, monitoring of activities for using procedures, prohibited/restricted procedures, staff training requirements, and decision models employed for selecting procedures. Results indicated that most standards identified behavioral procedures. However, considerable variability was found across SDSE regarding which procedures were identified and how they were regulated. Results are compared with a similar survey of SDSE conducted 5 years ago and are discussed in terms of implications for regulation and use of behavioral procedures in schools.

Mealtime difficulties in a home for the aged: not just dysphagia.

A mealtime screening tool was administered to 349 residents of a home for the aged to determine the prevalence of mealtime difficulties including, but not limited to, dysphagia. Mealtime difficulties, as assessed during a single meal observation of each resident, were documented in 87% of these individuals. Though 68% exhibited signs of dysphagia, 46% had poor oral intake, 35% had positioning problems, and 40% exhibited challenging behaviors. An increased prevalence of mealtime difficulties was related to both the presence and degree of cognitive impairment. Oral intake was best among residents with severe cognitive impairment, many of whom received partial to total feeding assistance. In contrast, poor oral intake was associated with mild-moderate cognitive impairment, pointing to a need for more aggressive intervention with this group. The results clearly demonstrate that the prevalence of a wide range of eating-related problems far exceeds accepted estimates of dysphagia alone and support a multidisciplinary approach to mealtime interventions for the institutionalized elderly. Additionally, the magnitude of problems identified has implications for both resource and staff-training requirements in long-term care facilities.

The HIV Mental Health Spectrum

The growing mental health needs that are related to HIV are immense and diverse. The HIV mental health spectrum is a model that identifies and characterizes populations in need of HIV-related services which can be offered by Community Mental Health Centers. The spectrum describes the specialized service requirements for each of these populations, the challenges in providing these services, and staff training needs. The authors propose this as a useful model for clinicians, researchers, educators, and administrators in planning to meet the needs of this expanding epidemic. HIV/AIDS is likely to become the major mental health issue of the decade. In the time since AIDS was first recognized and reported in the United States (1981), it has become a leading cause of death among men and women under 45 years of age, and children one to five years of age.1 The increasing proportion of cases attributable to heterosexual exposure is reflected in an increased number of AIDS cases among women and adolescents.2 Any epidemic of this proportion will have profound psychological effects on those afflicted and the communities in which they live. Several other characteristics of this illness add to its psychological impact. First, because AIDS originally occurred in the United States disproportionately among the stigmatized populations of gay men, IVDUs, and, later, African-Americans and Hispanics, social ostracism is added to the emotional challenge faced by those with the disease. Second, HIV and associated secondary infections directly attack the CNS producing serious and debilitating neuropsychological symptoms. Third, because there is currently no cure for or vaccine against HIV, the only way to reduce its spread is through behavioral change. Finally, psychoneuroimmunologic research suggests that behavioral factors may influence immune function in HIV-infected individuals and behavioral interventions including stress management, relaxation training, and exercise may provide some benefit.3-5 Taken together, these characteristics make it clear that Community Mental Health Centers (CMHCs) can play a central role in the prevention and treatment of HIV infection and AIDS. Mental health professionals are often unprepared to serve clients with HIV-related needs.6 The comprehensive nature of the mental health services required must be more broadly recognized, and training which allows practitioners to assume a major role in serving AIDS-related cases must be offered.7 Research has already identified significant needs for continuing education of mental health providers to increase knowledge and clinical skills, change attitudes, and reduce the level of discomfort.8 This article proposes a conceptual framework, called the HIV mental health spectrum (see Figure 1), from which program development and training needs may be determined. The spectrum model will help identify necessary services and staff training requirements specific for each level in the model. Mental health workers need to focus on the cognitive, behavioral, and emotional concomitants of the HIV epidemic at all spectrum levels.

Skills shortages and training: a forgotten dimension in new technology

Skills shortages and training problems are forgotten by many companies when they adopt new technology. 52 engineering firms in a ‘traditional’ industry in a single local labour market were interviewed to examine their attitudes to new technology and the skills and training implications of technology adoption. Skills and training issues were often forgotten or misjudged during the new technology appraisal process. It was these same areas which created most problems for many companies after adoption. Misjudgements concerning the level of labour force flexibility and training requirements for staff often created problems after the adoption of new technology. Skills shortages for adopting firms are most acute at the skilled level, this predominantly concerns the ‘local labour market'. Most firms adopted a short term response to skills shortages. Relatively low utilisation of policy initiatives and ‘formal’ avenues of assistance prior to new technology adoption were also identified.

Regulating behavioral procedures for individuals with handicaps: Review of state department standards

We reviewed standards (i.e., mandatory policies or recommended guidelines) from 39 state departments of special education and 41 state departments of developmental disabilities/mental retardation (DD/MR) to determine how they addressed the use of behavioral procedures. Results indicated that many standards described procedures to change behaviors of individuals with handicaps and identified ways to regulate usage. Major findings were that (a) standards from state departments of DD/MR addressed behavioral procedures more frequently than standards from special education departments; (b) many standards addressed procedures to decrease, but not increase, behavior; (c) several standards identified safeguards to clients' rights, such as prior approval requirements and periodic review of behavioral procedures' effects; (d) some standards prohibited and/or restricted the use of specific procedures, such as those judged to be aversive; (e) about one-fifth of special education standards and two-thirds of DD/MR standards described staff training requirements for using some procedures; and (f) relatively few standards used decision models to select behavioral procedures. Implications of these findings for policy makers, service providers, and future research efforts are discussed.