Perception of Supervisory Styles.

Supervision is a dynamic and challenging leadership process that remains an essential element within the field of speech-language pathology. This study examines a facet of the supervisory relationship and investigates whether supervision styles are similarly perceived by the supervisor and supervisee and if a mismatch in perceptions relates to satisfaction between supervisor-supervisee dyads. Data were collected through completion of a demographic questionnaire as well as the Supervisory Style Inventory, which categorizes supervisory style as being attractive, interpersonally sensitive, task-oriented, or mixed. Findings demonstrate notable variance in the self-reported supervisor style and the style supervisees perceived as being demonstrated with over half (66%) of supervisor-supervisee dyads reporting a perceived mismatch in style. There was not a significant difference in the level of supervisee satisfaction for supervisor dyads reporting a match in style compared with mismatch. Satisfaction was correlated with all three reported style characteristics; however, interpersonal and task-oriented supervisory style characteristics were more strongly correlated with supervisee satisfaction. Having a mixed style was the only style that was significantly correlated with supervisees reporting having their needs met. Discussions include practical implications, limitations of the study, as well as recommendations for future research.

Combined in-person and tele-delivered mobile school clinic: A novel approach for improving access to healthcare during school hours.

AIMS: We report a novel pilot project that allows access to healthcare for children and staff at school via a mobile clinic or telemedicine portal connected to the mobile clinic. The objectives of this pilot project were (a) to perform physicals for children not attached to a primary care physician; (b) to provide medical consultations and treatment for acute illnesses of students and staff, and (c) to lower absenteeism rates among students and staff. METHODS: In 2013, Ronald McDonald House Charities, a non-profit organization, partnered with Children's Hospital of Erlanger to provide a mobile clinic trademarked Ronald McDonald Care Mobile utilising a large, box-style truck equipped with examination rooms and a telemedicine portal. Initially, starting with three elementary schools in Bradley County, Tennessee, USA, the programme rapidly expanded to include schools in five other participating Tennessee counties. Only three schools in Bradley County have the option of in-person visits. All other schools access care via telemedicine portals. Funding is provided through multiple grants and community partners. If a student does have insurance, the insurance carrier is billed for the visit, but students without insurance are treated free of charge. Prior to the 2018-2019 school year, only limited data were collected. RESULTS: Our first goal was to perform physicals for children not attached to a primary care physician. During the 2018-2019 school year, 28 patients presented for a well-child check. However, 16 of these (57%) did not have a primary care physician. Of note, 19% of students presenting for any complaint did not have a primary care physician on file (172 students). All well-child checks were performed in-person on the Care Mobile. Our second goal was to provide medical consultations and treatment for acute illnesses. A total of 1446 persons were seen for sick visits. Of these, 424 were telemedicine visits (352 students and 72 staff), while 1022 were in-person visits. The five most common diagnoses that the nurse practitioner managed during the 2018-2019 school year included acute pharyngitis, acute upper respiratory infection, streptococcal pharyngitis, fever and acute maxillary sinusitis. Finally, our third goal was to lower absenteeism rates. There were 1446 sick person visits (1253 students and 193 staff). Twenty-two per cent of the students (276 persons) returned to class while 74% (142 persons) of staff returned to work. CONCLUSION: The mobile/telemedicine health clinic is a novel innovation to increase access to acute care and reduce school absenteeism among both students and staff, potentially saving schools hundreds to thousands of dollars.

Comparison of five video-assisted intubation devices by novice and expert laryngoscopists for use in the aeromedical evacuation environment.

BACKGROUND: The critically ill or injured patient undergoing military medical evacuation may require emergent intubation. Intubation may be life-saving, but it carries risks. The novice or infrequent laryngoscopist has a distinct disadvantage because experience is critical for the rapid and safe establishment of a secured airway. This challenge is compounded by the austere environment of the back of an aircraft under blackout conditions. This study determined which of five different video-assisted intubation devices (VAIDs) was best suited for in-flight use by U.S. Air Force Critical Care Air Transport Teams by comparing time to successful intubation between novice and expert laryngoscopists under three conditions, Normal Airway Lights on (NAL), Difficult Airway Lights on (DAL) and Difficult Airway Blackout (DAB), using manikins on a standard military transport stanchion and the floor with a minimal amount of setup time and extraneous light emission. METHODS: A convenience sample size of 40 participants (24 novices and 16 experts) attempted intubation with each of the 5 different video laryngoscopic devices on high-fidelity airway manikins. Time to tracheal intubation and number of optimization maneuvers used were recorded. Kruskal-Wallis testing determined significant differences between the VAIDs in time to intubation for each particular scenario. Devices with significant differences underwent pair-wise comparison testing using rank-sum analysis to further clarify the difference. Device assembly times, startup times and the amount of light emitted were recorded. Perceived ease of use was surveyed. RESULTS: Novices were fastest with the Pentax AWS in all difficult airway scenarios. Experts recorded the shortest median times consistently using 3 of the 5 devices. The AWS was superior overall in 4 of the 6 scenarios tested. Experts and novices subjectively judged the GlideScope Ranger as easiest to use. The light emitted by all the devices was less than the USAF-issued headlamp. CONCLUSIONS: Novices intubated fastest with the Pentax AWS in all difficult airway scenarios. The GlideScope required the shortest setup time, and participants judged this device as the easiest to use. The GlideScope and AWS exhibited the two fastest total setup times. Both devices are suitable for in-flight use by infrequent and seasoned laryngoscopists.

Expression of positive emotions differs in illness and recovery in anorexia nervosa.

People with Anorexia Nervosa (AN) display reduced facial expression of emotions. This study investigated the expression of positive affect in response to a film, examining Duchenne and non-Duchenne smiles in 20 women who have recovered from AN (REC), 20 with acute AN and 20 healthy controls (HC). The results indicated that the REC group exhibited Duchenne and non-Duchenne smiles with higher duration and intensity than the AN group, comparable to the HC group. The findings warrant longitudinal studies to confirm that reduced expressivity is linked to acute AN, ameliorating after recovery.

Aging in adults with intellectual disabilities.

A cross-sequential design was used to examine changes related to aging in adults with and without Down syndrome (ns = 55 and 75, respectively). Adults received yearly neuropsychological and medical evaluations. Support for precocious aging in adults with Down syndrome was evident only on a test of verbal fluency, with weaker support obtained on a test of fine-motor skills. Cross-sectional age differences for all adults were obtained on tests of memory and community living skills. General intellectual level, gender, and psychiatric status were consistently related to performance, indicating the need to examine such mediating variables in studies on aging.

Facial expression of positive emotions in individuals with eating disorders.

A large body of research has associated Eating Disorders with difficulties in socio-emotional functioning and it has been argued that they may serve to maintain the illness. This study aimed to explore facial expressions of positive emotions in individuals with Anorexia Nervosa (AN) and Bulimia Nervosa (BN) compared to healthy controls (HC), through an examination of the Duchenne smile (DS), which has been associated with feelings of enjoyment, amusement and happiness (Ekman et al., 1990). Sixty participants (AN=20; BN=20; HC=20) were videotaped while watching a humorous film clip. The duration and intensity of DS were subsequently analyzed using the facial action coding system (FACS) (Ekman and Friesen, 2003). Participants with AN displayed DS for shorter durations than BN and HC participants, and their DS had lower intensity. In the clinical groups, lower duration and intensity of DS were associated with lower BMI, and use of psychotropic medication. The study is the first to explore DS in people with eating disorders, providing further evidence of difficulties in the socio-emotional domain in people with AN.

Evaluation of screening tools for dementia in older adults with mental retardation.

We compared groups with and without diagnosed dementia matched on IQ, age, and presence of Down syndrome. The Dementia Scale for Down Syndrome and Dementia Questionnaire for Mentally Retarded Persons were used to assess participants. We developed two performance tasks to determine whether they were useful in separating subjects with and without dementia and also used the Reiss Screen. Both dementia scales and both performance tasks discriminated between groups. The dementia scales were not related to premorbid IQ, age, or gender, whereas performance tasks were related to dementia and IQ but not age or gender. Various Reiss Screen subscales also discriminated between groups. Subscales of the screening instruments and performance tasks were significantly related, indicating congruent validity. Logistic regression was conducted to assess which combination of tests discriminated best between groups.

Effective teamwork and communication mitigate task saturation in simulated critical care air transport team missions.

BACKGROUND: Critical Care Air Transport Teams (CCATTs) are a critical component of the United States Air Force evacuation paradigm. This study was conducted to assess the incidence of task saturation in simulated CCATT missions and to determine if there are predictable performance domains. METHODS: Sixteen CCATTs were studied over a 6-month period. Performance was scored using a tool assessing eight domains of performance. Teams were also assessed during critical events to determine the presence or absence of task saturation and its impact on patient care. RESULTS: Sixteen simulated missions were reviewed and 45 crisis events identified. Task saturation was present in 22/45 (49%) of crisis events. Scoring demonstrated that task saturation was associated with poor performance in teamwork (odds ratio [OR] = 1.96), communication (OR = 2.08), and mutual performance monitoring (OR = 1.9), but not maintenance of guidelines, task management, procedural skill, and equipment management. We analyzed the effect of task saturation on adverse patient outcomes during crisis events. Adverse outcomes occurred more often when teams were task saturated as compared to non-task-saturated teams (91% vs. 23%; RR 4.1, p < 0.0001). CONCLUSIONS: Task saturation is observed in simulated CCATT missions. Nontechnical skills correlate with task saturation. Task saturation is associated with worsening physiologic derangements in simulated patients.

Screening for depression after stroke: an exploration of professionals' compliance with guidelines.

OBJECTIVE: National guidelines recommend screening for poststroke depression, but compliance is low. This research studied staff compliance in stroke units using the theory of planned behaviour to investigate influences upon screening. DESIGN: The study used a questionnaire based on a semi-structured interview and measuring the theory of planned behaviour components. SETTING: Sixteen stroke units throughout the UK were included. SUBJECTS: Seventy-five health care professionals in stroke services participated. MAIN MEASURES: A postal questionnaire with 7-point rating scales and open-ended questions was used. RESULTS: Response rates were low, but the 75 returns demonstrated poor compliance for screening, despite positive attitudes towards it. Five variables, including three of the theory of planned behaviour components, predicted intention to screen: perceived control over screening, perceived expectations of others (direct and indirect normative beliefs), awareness of guidelines and screening being part of routine assessment. Perceived expectations of others, perceived control and awareness of guidelines also differentiated those intending to screen from 'non-intenders'. Being knowledgeable about screening, having screening in the job role and belief in its clinical value were additional facilitating factors, while time pressure and concerns about screening tests were barriers. Profession and psychology input were not associated with screening. CONCLUSIONS: The theory of planned behaviour provides a framework for understanding screening intentions. Both individual and organizational factors were associated with screening. Compliance may be enhanced by: training to increase knowledge and skills, providing evidence of the utility, increasing awareness of guidelines, support from colleagues and integrating mood assessment into job roles and routine assessment.

Invasive pneumococcal disease in Australia, 2002.

There were 2,271 cases of invasive pneumococcal disease (IPD) notified to the National Notifiable Diseases Surveillance System in Australia in 2002; a rate of 11.5 cases per 100,000 population. The notification rate varied between states and territories and by geographical region with the highest rates in the north of the country. Invasive pneumococcal disease was reported most frequently in children aged less than five years (57.3 per 100,000 population). Enhanced surveillance for IPD in 2002 was carried out in all states and territories, providing additional data on 1,929 (85%) of all notified cases. Rates of IPD in Indigenous Australians were 2.7 times the rate in non-Indigenous Australians. The clinical presentation of IPD was most commonly pneumonia (44%) and bacteraemia (35%). There were 175 deaths attributed to IPD resulting in an overall case fatality rate of 9.2 per cent. Forty-two per cent of all cases had a recognised risk factor for IPD. Seventy-five per cent of all pneumococcal isolates serotyped were serotypes in the seven-valent conjugate vaccine and 93 per cent were serotypes in the 23-valent polysaccharide pneumococcal vaccine. The clinical presentation and rates of risk factors varied between Indigenous and non-Indigenous cases and non-vaccine serotypes occurred more frequently among Indigenous children and adults.