Models of remote professional supervision for psychologists in rural and remote locations: a systematic review

Introduction Psychology workforce shortages in geographically rural or remote contexts have highlighted the need to understand the supervisory experiences of psychologists practising in these locations, and the models of supervision employed to support their practice and improve client safety. Objective To review the models of remote professional supervision and the supervisory experiences of psychologists practising in rural and remote locations. Design Using the Joanna Briggs Institute methodology for mixed‐methods systematic review, 8 health and education databases were searched using keyword and subject heading searches. Findings The initial search identified 413 studies. A full‐text review identified 4 papers that met the inclusion criteria and were subjected to a methodological appraisal by 2 reviewers. Three studies included qualitative data, with 2 using transcribed interviews. Two studies reported quantitative data, with only one study including a statistical analysis of the outcomes. Discussion The results for the efficacy of the current models of remote supervision being used within the allied health and psychology professions are limited, with methodological limitations cautioning generalisability of results. The experiences of psychologists engaged in remote supervision do not appear to have changed over the past decade despite technological advances. Conclusions Quality professional supervision is critical for the sustainability of the psychology workforce in rural and remote locations, reducing professional isolation, and for improved patient outcomes. This review identified a need for improved evidence for remote supervision models for psychologists working in geographically rural and remote locations. Lessons can be learned from other health professions’ models of remote supervision

Vasopressin

Antidiuretic hormone liberated the vertebrates from their aqueous environment, and permitted them to establish themselves on dry land. The combination of sensitive volume and osmoreceptors, a pituitary secretory apparatus which can vary its output from virtually zero to high levels in a short space of time, and receptor cells functioning in the countercurrent system of the renal medulla, has resulted in a water conservation system of great efficiency. The hormone rapidly alters the luminal membrane of receptor cells in the collecting tubule and collecting duct, increasing the permeability of these structures to water.1 The permeability of the collecting duct to urea and sodium is also increased.This review will be centered on the sequence of events that follows the attachment of vasopressin to its receptors in the distal nephron. This has become an area of intense activity since the discovery by Sutherland and his colleagues of the central role of cyclic AMP in the action of hormones [2]. The review will cover in brief much of the ground covered by the extensive review of Handler and OrlofT [3], emphasizing recent additions to the literature. It is regrettable that the important advances in our understanding of the synthesis and release of antidiuretic hormone cannot be included; the reader is referred to recent symposia and reviews in this area [4–6], as well as in the comparative physiology of water regulation [7] and the countercurrent system [8]

Development of Screening Tools for the Interpretation of Chemical Biomonitoring Data

Evaluation of a larger number of chemicals in commerce from the perspective of potential human health risk has become a focus of attention in North America and Europe. Screening-level chemical risk assessment evaluations consider both exposure and hazard. Exposures are increasingly being evaluated through biomonitoring studies in humans. Interpreting human biomonitoring results requires comparison to toxicity guidance values. However, conventional chemical-specific risk assessments result in identification of toxicity-based exposure guidance values such as tolerable daily intakes (TDIs) as applied doses that cannot directly be used to evaluate exposure information provided by biomonitoring data in a health risk context. This paper describes a variety of approaches for development of screening-level exposure guidance values with translation from an external dose to a biomarker concentration framework for interpreting biomonitoring data in a risk context. Applications of tools and concepts including biomonitoring equivalents (BEs), the threshold of toxicologic concern (TTC), and generic toxicokinetic and physiologically based toxicokinetic models are described. These approaches employ varying levels of existing chemical-specific data, chemical class-specific assessments, and generic modeling tools in response to varying levels of available data in order to allow assessment and prioritization of chemical exposures for refined assessment in a risk management context