8 research outputs found
Classification and management of cervical paragangliomas
No full textINTRODUCTIONCervical paragangliomas are slow-growing tumours that eventually cause lower cranial nerve palsies and infiltrate the skull base. Surgical treatment may cause the same deficits and, in some, risks more serious neurological deficits. We describe a classification used to guide investigation, consent and management of cervical paragangliomas based on extensive experience.METHODSThe case notes of patients managed by the senior author at a tertiary referral skull base unit between 1987 and 2010 were reviewed retrospectively. A total of 87 cervical paragangliomas were identified in 70 patients (mean age: 46 years, range: 13–77 years). Of these, 35 patients had 36 vagal paragangliomas, 43 patients had 50 carotid body paragangliomas and 8 had both. One cervical paraganglioma arose from neither the carotid body nor the nodose ganglion. The main outcome measures were death, stroke, gastrostomy and tracheotomy.RESULTSAll tumours were classified pre-operatively based on their relationship to the carotid artery, skull base and lower cranial nerves. Type 1 tumours were excised with a transcervical approach, type 2 with a transcervical-parotid approach and type 3 with a combined transcervical-parotid and infratemporal fossa approach. Type 4 patients underwent careful assessment and genetic counselling before any treatment was undertaken. There were no peri-operative deaths; two patients had strokes, one required a long-term feeding gastrostomy and none required a tracheotomy.CONCLUSIONSThe use of a pre-operative classification system guides management and surgical approach, improves accuracy of consent, facilitates audit and clarifies which patients should be referred to specialised centres.</jats:sec
Hearing and ossicular chain preservation in cholesteatoma surgery
No full textAbstractObjective:To assess the hearing changes associated with sacrificing an intact ossicular chain during cholesteatoma surgery.Methods:We reviewed the operation notes of surgical procedures performed by the senior author between October 2000 and April 2006. Thirty-three cases were identified in which cholesteatoma surgery had been performed in the presence of a mobile, intact ossicular chain. One set of case notes was missing; therefore, 32 cases were included in the analysis. The ossicular chain was preserved in 17 cases (14 males and three females) and sacrificed in 15 (eight males and seven females).Results:At the first post-operative assessment, a median air–bone gap deterioration of 3.3 dB was seen in patients in whom the ossicular chain had been sacrificed, while a median air–bone gap improvement of 3.3 dB was seen in those in whom the chain had been preserved. However, multivariable logistic regression analysis suggested that this difference in hearing outcomes was due to pre-operative hearing status, and that preservation of the ossicular chain did not lead to a better outcome.Conclusions:In cholesteatoma surgery, there is at most a marginal benefit in preserving the ossicular chain. In the current study, the better hearing outcomes associated with preservation of the ossicular chain were accounted for by patients' better pre-operative hearing status. This study did not demonstrate a difference in residual disease rate, but was underpowered to do so.</jats:sec
Becoming a psychologist : students' accounts of their experiences of clinical training
No full textBibliography: leaves 77-82.Interviews were conducted with 14 University of Cape Town Masters' students from three consecutive years to explore their emotional experiences of the professional training in clinical psychology. A qualitative analysis was conducted to identity, in particular, what aspects of their training they found difficult and how they coped with these difficulties. It adopts a psychodynamic approach in examining and understanding the interview material. It was found that trainees struggled mostly with the pervasive feeling of 'not being good enough', feeling unsupported by staff: changes in their interpersonal relationships and challenges facing them in their personal development. Other difficulties identified ranged from trainees' unmet expectations, the heavy workload and the emotional nature of their work. The research highlights the way in which trainees hopes, fears and expectations both conscious and unconscious determines, to a large extent, the way in which the training is experienced and managed. It was identified that trainees coped with these difficulties in various ways. Mostly, however, they coped by talking to classmates and others in the profession, reassessing their expectations as well as distancing themselves emotionally from the painful and difficult experiences encountered during training
What can western management offer Russian social work?
Get PDFThis paper contributes to the debate on the process and the efficacy of Western management 'knowledge' transfer by casting light on the ways in which it has had an impact on the largely neglected area of public service and public administration. The study from which the paper derives took place in 1997 and 1998 in two social services departments in regions south of Moscow, and in the Ministry of Labour and Social Development (formerly Social Protection) in Moscow. The author is a British management academic acting as a consultant to the development of social work management on a recent Tacis project. The paper is an ethnographic, participant observer account of working with Russian social workers, social work managers, and heads of service. In Russia, the institutions for protection of the most vulnerable groups in the population, and the legislative frameworks for such institutions (the ‘social safety net’), are being radically re-drawn, in efforts to forestall the direst social consequences of a rapid shift to the market. Social work as a profession is being shaped and defined within this context, and an infrastructure to manage and resource it is being gradually and painfully developed by its leaders, often in extremis. Social services managers are struggling with a gargantuan task of reconciling the contradiction between vastly expanding public expectations and rapidly dwindling resources. Within this contradiction, Western influences, traditional Russian values and the harsh reality of the present, meet, collide and confront each other. Inherent tensions lead to the psychological phenomenon known as ‘splitting’ - the separating out of negative emotions or feelings judged unhelpful, and their projection onto other groups. Using an ethnographic approach to a small number of recent consultancy episodes, the author contends that only those Western management approaches which can accommodate a diverse range of ideological positions will be helpful, because they will be recognised in terms of current realities and comprehended as consistent with dominant values. No single set of values can yet be said to be dominant. The ensuing result is that a focus on developing practice in social work delivery is seen to be more relevant, and less problematical, than the transfer of new approaches to service management
Developing Employee Counselling
Get PDFThe research focused on the counselling service provided by a major national N-1
organisation. The main aim was identification of managerial mechanisms that might
be instituted to facilitate the development of workplace counsellors.It comprised of
three main studies which utilised both quantitative and qualitative methods.
Over a period of eight months,corresponding quantitative data were collected after
each new counselling session from six hundred and ninety-four clients and forty-six
counsellors.In addition, qualitative data in the form of case notes were obtained from
the counsellors, forty-three of whom also completed Levenson's (1981) Locus of
Control questionnaire.
In the first study,quantitative questionnaire data from both clients and counsellors
were analysed in order to investigate discrepancies between the two groups that might
identify a means of focus for managing the service. Statistical exploration of sociodemographic features that might be implicated as potentially confounding variables in
the assessment of counselling effectiveness and client satisfaction was also
undertaken, and the proposition that non-respondents perceive less benefit from the
service was indirectly explored. A dditionally,the relationship between some of the
Rogerian core qualities and client perceptions of benefit was investigated.
In the second study,qualitative data from counsellor notes were examined in order to
establish the type of notes produced and to consider ways in which counsellors might
be encouraged to focus on counselling process rather than content. As a result an
instrument was developed which provides a tool to facilitate counsellor development
within a professional supervisory re lationship, inside or outside of the organisational
context.
The third study was designed to investigate counsellors' own locus of control and
their perceptions of their clients' primary loci. Objectives of the study included
comparison of the two measures and exploration of relationships between locus of
control and other issues of interest to the research such as client perception of benefit
from counselling, perceived use of Rogerian core variables and results on the process
measure.
The findings of the studies and their implications for counsellor development are fully
discussed and suggestions for future research are provided
Resistência à mudança organizacional: medida de avaliação por meio da Teoria da Resposta ao Ítem
Get PDFTese (doutorado) - Universidade Federal de Santa Catarina, Centro Tecnológico, Programa de Pós-Graduação em Engenharia de Produção, Florianópolis, 2010Nos processos de transformação a resistência ocupa sempre um lugar de destaque. Ela é freqüentemente tida como a vilã dos processos de mudança, sendo considerada a responsável pelos resultados negativos, os atrasos e, mesmo, pelo fracasso desses processos. Contudo, se ela for habilmente tratada poderá auxiliar sobremaneira no alcance dos resultados pretendidos. Para isso é necessário reconhecer a resistência, as suas causas e as suas raízes. Com esta preocupação, esta pesquisa desenvolve um modelo para avaliação da resistência, propondo um indicativo de uma medida de resistência com apoio na Teoria da Resposta ao Item (TRI). A medida, uma vez definida, fornecerá informações valiosas para o planejamento estratégico da mudança. O referencial teórico desenvolvido em resistência à mudança organizacional abrangeu conceitos, causas e formas de resistência. O modelo estudado foi proposto para ser realizado em estágios com oito indicadores que representam as causas da resistência. O primeiro estágio envolveu 810 respondentes. O conjunto de dados coletados apresentou os pressupostos da unidimensionalidade e independência local necessários para o uso do Modelo de Desdobramento Graduado Generalizado (GGUM) da Teoria da Resposta ao Item. Embora o número de respondentes tenha sido grande, ele não foi suficiente para calibrar todos os itens. Dessa forma, esta tese fornece um indicativo para avaliar a resistência à mudança, mas evidencia a necessidade de implementação dos outros estágios para definir a métrica inicial e posteriormente ampliar o conjunto de itens com os demais indicadores, criando um banco de itens para avaliar a resistência à mudança. Como resultado final, esta pesquisa produziu informações para identificar três níveis da escala
