Shared Decision Making for Clients With Mental Illness: A Randomized Factorial Survey

Objective: The goal of this study was to test the degree to which client clinical characteristics and environmental context and social workers’ practice values and experience influenced support for client’s autonomy and willingness to engage in shared decision making (SDM), and whether willingness to engage in SDM was mediated by support for autonomy. Method: A randomized factorial survey of social workers working with adults with severe mental illness was employed. Eighty-seven social workers responded yielding 435 vignettes. Results: Hypotheses were partially supported. Diagnosis, symptomology, threats of harm, treatment adherence, substance use, and social workers’ values and experience predicted support for autonomy and willingness to engage in SDM. Willingness to engage in SDM was modestly mediated by support for autonomy. Conclusion: Helping social workers avoid bias in decision making is critical to the goal of supporting clients’ autonomy, building their capacity, minimizing disempowerment, and promoting recovery

Improved WIMP-search reach of the CDMS II germanium data

CDMS II data from the five-tower runs at the Soudan Underground Laboratory were reprocessed with an improved charge-pulse fitting algorithm. Two new analysis techniques to reject surface-event backgrounds were applied to the 612 kg days germanium-detector weakly interacting massive particle (WIMP)-search exposure. An extended analysis was also completed by decreasing the 10 keV analysis threshold to ~5  keV, to increase sensitivity near a WIMP mass of 8  GeV/c[superscript 2]. After unblinding, there were zero candidate events above a deposited energy of 10 keV and six events in the lower-threshold analysis. This yielded minimum WIMP-nucleon spin-independent scattering cross-section limits of 1.8 × 10[superscript −44] and 1.18 × 10[superscript −41] at 90% confidence for 60 and 8.6  GeV/c[superscript 2] WIMPs, respectively. This improves the previous CDMS II result by a factor of 2.4 (2.7) for 60 (8.6)  GeV/c[superscript 2] WIMPs.National Science Foundation (U.S.)United States. Dept. of EnergyNatural Sciences and Engineering Research Council of CanadaSpain. Ministerio de Economia y Competitividad (MultiDark

Dark matter effective field theory scattering in direct detection experiments

We examine the consequences of the effective field theory (EFT) of dark matter–nucleon scattering for current and proposed direct detection experiments. Exclusion limits on EFT coupling constants computed using the optimum interval method are presented for SuperCDMS Soudan, CDMS II, and LUX, and the necessity of combining results from multiple experiments in order to determine dark matter parameters is discussed. We demonstrate that spectral differences between the standard dark matter model and a general EFT interaction can produce a bias when calculating exclusion limits and when developing signal models for likelihood and machine learning techniques. We also discuss the implications of the EFT for the next-generation (G2) direct detection experiments and point out regions of complementarity in the EFT parameter space.National Science Foundation (U.S.)United States. Dept. of EnergyNatural Sciences and Engineering Research Council of CanadaSpain. Ministerio de Economia y Competitividad (MultiDark

Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography, From Training Through Independent Practice.

BACKGROUND & AIMS: It is unclear whether participation in competency-based fellowship programs for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) results in high-quality care in independent practice. We measured quality indicator (QI) adherence during the first year of independent practice among physicians who completed endoscopic training with a systematic assessment of competence. METHODS: We performed a prospective multicenter cohort study of invited participants from 62 training programs. In phase 1, 24 advanced endoscopy trainees (AETs), from 20 programs, were assessed using a validated competence assessment tool. We used a comprehensive data collection and reporting system to create learning curves using cumulative sum analysis that were shared with AETs and trainers quarterly. In phase 2, participating AETs entered data into a database pertaining to every EUS and ERCP examination during their first year of independent practice, anchored by key QIs. RESULTS: By the end of training, most AETs had achieved overall technical competence (EUS 91.7%, ERCP 73.9%) and cognitive competence (EUS 91.7%, ERCP 94.1%). In phase 2 of the study, 22 AETs (91.6%) participated and completed a median of 136 EUS examinations per AET and 116 ERCP examinations per AET. Most AETs met the performance thresholds for QIs in EUS (including 94.4% diagnostic rate of adequate samples and 83.8% diagnostic yield of malignancy in pancreatic masses) and ERCP (94.9% overall cannulation rate). CONCLUSIONS: In this prospective multicenter study, we found that although competence cannot be confirmed for all AETs at the end of training, most meet QI thresholds for EUS and ERCP at the end of their first year of independent practice. This finding affirms the effectiveness of training programs. Clinicaltrials.gov ID NCT02509416

Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography, From Training Through Independent Practice.

BACKGROUND & AIMS: It is unclear whether participation in competency-based fellowship programs for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) results in high-quality care in independent practice. We measured quality indicator (QI) adherence during the first year of independent practice among physicians who completed endoscopic training with a systematic assessment of competence. METHODS: We performed a prospective multicenter cohort study of invited participants from 62 training programs. In phase 1, 24 advanced endoscopy trainees (AETs), from 20 programs, were assessed using a validated competence assessment tool. We used a comprehensive data collection and reporting system to create learning curves using cumulative sum analysis that were shared with AETs and trainers quarterly. In phase 2, participating AETs entered data into a database pertaining to every EUS and ERCP examination during their first year of independent practice, anchored by key QIs. RESULTS: By the end of training, most AETs had achieved overall technical competence (EUS 91.7%, ERCP 73.9%) and cognitive competence (EUS 91.7%, ERCP 94.1%). In phase 2 of the study, 22 AETs (91.6%) participated and completed a median of 136 EUS examinations per AET and 116 ERCP examinations per AET. Most AETs met the performance thresholds for QIs in EUS (including 94.4% diagnostic rate of adequate samples and 83.8% diagnostic yield of malignancy in pancreatic masses) and ERCP (94.9% overall cannulation rate). CONCLUSIONS: In this prospective multicenter study, we found that although competence cannot be confirmed for all AETs at the end of training, most meet QI thresholds for EUS and ERCP at the end of their first year of independent practice. This finding affirms the effectiveness of training programs. Clinicaltrials.gov ID NCT02509416

The willingness to engage: A factorial survey of clinical social workers\u27 adherence to the value of client autonomy in treating the severely mentally ill

Objective. The purpose of this study was to determine the factors that influence social workers\u27 support for client autonomy, and how support for client autonomy impacts the willingness to engage in shared decision making. Shared decision making creates a decisional partnership intended to promote client autonomy while also addressing concerns regarding client safety and decisional capacity. Methods. This study employed a randomized factorial survey of social workers employed working with adults with severe mental illness. The study was designed to test: (1) the degree to which the clinical characteristics such as diagnosis, symptomology, treatment adherence and environmental context such as housing and homeless history of individual clients, and the practice values and experience of social workers influence the social worker\u27s support for a particular client\u27s autonomy and, (2) the degree to which those same factors predict the willingness of a social worker to engage the client in shared decision making. The study also tested whether the willingness to engage in shared decision making was mediated by support for autonomy. In total, 87 social workers responded to the survey yielding 435 vignettes for analysis. Results. The hypotheses were partially supported by the data. Diagnosis, symptomology, threats of harm, treatment adherence, and drug and alcohol use all predicted support for autonomy, and also the willingness to engage in shared decision making. A diagnosis of schizophrenia, psychotic symptoms, or poor treatment adherence predicted reduced support for autonomy by social workers, and a diminished likelihood that social workers would utilize shared decision making. Social worker\u27s values and experience also predicted support for autonomy and willingness to utilize shared decision making. The willingness to engage in shared decision making was mediated by support for autonomy, though the effect was modest. Implications. The results of this study indicate greater need for interventions targeting social work students designed to reduce stigma surrounding severe mental illness, and also the need for ongoing clinical supervision for early career social workers. Helping social workers avoid bias in their decision making is critical to the overall goal of supporting autonomy, building client capacity, minimizing client disempowerment, and promoting recovery oriented services

The willingness to engage: A factorial survey of clinical social workers\u27 adherence to the value of client autonomy in treating the severely mentally ill

Objective. The purpose of this study was to determine the factors that influence social workers\u27 support for client autonomy, and how support for client autonomy impacts the willingness to engage in shared decision making. Shared decision making creates a decisional partnership intended to promote client autonomy while also addressing concerns regarding client safety and decisional capacity. Methods. This study employed a randomized factorial survey of social workers employed working with adults with severe mental illness. The study was designed to test: (1) the degree to which the clinical characteristics such as diagnosis, symptomology, treatment adherence and environmental context such as housing and homeless history of individual clients, and the practice values and experience of social workers influence the social worker\u27s support for a particular client\u27s autonomy and, (2) the degree to which those same factors predict the willingness of a social worker to engage the client in shared decision making. The study also tested whether the willingness to engage in shared decision making was mediated by support for autonomy. In total, 87 social workers responded to the survey yielding 435 vignettes for analysis. Results. The hypotheses were partially supported by the data. Diagnosis, symptomology, threats of harm, treatment adherence, and drug and alcohol use all predicted support for autonomy, and also the willingness to engage in shared decision making. A diagnosis of schizophrenia, psychotic symptoms, or poor treatment adherence predicted reduced support for autonomy by social workers, and a diminished likelihood that social workers would utilize shared decision making. Social worker\u27s values and experience also predicted support for autonomy and willingness to utilize shared decision making. The willingness to engage in shared decision making was mediated by support for autonomy, though the effect was modest. Implications. The results of this study indicate greater need for interventions targeting social work students designed to reduce stigma surrounding severe mental illness, and also the need for ongoing clinical supervision for early career social workers. Helping social workers avoid bias in their decision making is critical to the overall goal of supporting autonomy, building client capacity, minimizing client disempowerment, and promoting recovery oriented services