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PubMed2004

A multi-aspect comparison study of supervised word sense disambiguation.

OBJECTIVE: The aim of this study was to investigate relations among different aspects in supervised word sense disambiguation (WSD; supervised machine learning for disambiguating the sense of a term in a context) and compare supervised WSD in the biomedical domain with that in the general English domain. METHODS: The study involves three data sets (a biomedical abbreviation data set, a general biomedical term data set, and a general English data set). The authors implemented three machine-learning algorithms, including (1) naïve Bayes (NBL) and decision lists (TDLL), (2) their adaptation of decision lists (ODLL), and (3) their mixed supervised learning (MSL). There were six feature representations (various combinations of collocations, bag of words, oriented bag of words, etc.) and five window sizes (2, 4, 6, 8, and 10). RESULTS: Supervised WSD is suitable only when there are enough sense-tagged instances with at least a few dozens of instances for each sense. Collocations combined with neighboring words are appropriate selections for the context. For terms with unrelated biomedical senses, a large window size such as the whole paragraph should be used, while for general English words a moderate window size between 4 and 10 should be used. The performance of the authors' implementation of decision list classifiers for abbreviations was better than that of traditional decision list classifiers. However, the opposite held for the other two sets. Also, the authors' mixed supervised learning was stable and generally better than others for all sets. CONCLUSION: From this study, it was found that different aspects of supervised WSD depend on each other. The experiment method presented in the study can be used to select the best supervised WSD classifier for each ambiguous term.

Abbreviations as Topic↗
PubMedDate not supplied

The dynamics and processes of 'ending' in clinical supervision.

While there is a growing number of papers in academic and professional nursing journals that focus on clinical supervision, there remain unanswered questions and unresolved issues. One such issue where there is a distinct paucity of theoretical or empirical work is that of 'ending' within clinical supervision. Accordingly, this article examines key issues and dynamics of ending within clinical supervision. These key issues are summarized as: ending when the supervisor is reluctant to let go; parallel processes in ending in clinical supervision and ending in clinical relationships; the different ending dynamics of different approaches to clinical supervision; endings in group supervision; ending as a form of bereavement; healthy endings in clinical supervision; and endings as a opportunity for growth and celebration. The authors posit that an understanding of these processes can help facilitate a 'healthy' ending in clinical supervision. Furthermore, there may be particular merit in considering dynamics that, when present, create the best chance of all parties experiencing a health ending, namely: the ending is negotiated; the ending is gradual rather than sudden and all parties work towards the ending; the supervisee retains (wherever possible) a degree of control over the timing of the ending; and both supervisor and supervisee achieve a sense of closure.

Adaptation, Psychological↗
PubMed2005

Supervised exercise training improves aerobic capacity and muscle strength in older women with heart failure.

BACKGROUND: The effect that supervised or unsupervised exercise training has on aerobic capacity (peak oxygen consumption [VO2peak]), muscle strength and quality of life in older women with heart failure remains unknown. OBJECTIVE: To examine the effect of six months (three months supervised followed by three months unsupervised) of aerobic training (AT) or combined aerobic and strength training (CAST) on VO2peak, muscle strength and quality of life in older women with heart failure. METHODS: Twenty older women (mean age +/- SD, 72+/-8 years) with clinically stable heart failure were randomly assigned to AT (n=10) or CAST (n=10). Supervised AT was performed two days per week at 60% to 70% heart rate reserve, whereas unsupervised training was performed two days per week at a rate of perceived exertion of 12 to 14 on the Borg scale. The CAST group also performed one to two sets of low-to-moderate intensity strength training two days per week. RESULTS: Supervised AT or CAST resulted in an increase in VO2peak (12%; P<0.05) and leg press strength (13%; P<0.05) that returned to baseline after unsupervised training. Vertical row strength was greater (+23%; P<0.05) after supervised CAST and remained unchanged after supervised or unsupervised AT. Supervised or unsupervised exercise training was not associated with a significant change in quality of life. CONCLUSIONS: Supervised AT or CAST are effective modes of exercise to improve VO2peak and muscle strength in older women with heart failure. However, the improvements in VO2peak and muscle strength are not maintained with unsupervised exercise training.

Age Factors↗
PubMed1993

Judgments regarding appropriate child supervision to prevent injury: the role of environmental risk and child age.

Parents, social service workers, and medical personnel failed to differ in the amount of time they estimated that children of 11 differing ages should be left without adult supervision within 5 different supervision domains. More hazardous circumstances dramatically reduced the amount of time respondents said children should be left unsupervised. Amount of unsupervised time increased with age, with clear developmental cutoffs that varied by level and type of risk. When the moderate center of the distribution was examined, 3 clear areas of consensus emerged. For most domains, constant supervision was recommended for preschool children. For early elementary school children, nearly constant (0-5 min without supervision) or close (0-15 min without supervision) supervision was recommended in safer locations, with constant supervision still recommended in high-risk situations. Only with older children was there an absence of consensus regarding supervision. The implications of these results for future injury prevention research are discussed.

Adult↗
PubMedDate not supplied

A test of alternative supervision strategies for family planning services in Guatemala.

This report presents results of an operations research project that tested the impact and cost-effectiveness of alternative supervision schemes of reproductive health services in Guatemala. The strategies tested were (1) indirect supervision, in which one of the two annual supervised visits to each health unit was replaced by a one-day meeting at the district level with the supervisor; and (2) self-assessment, in which one supervised visit was replaced by a two-day workshop where participants filled out self-assessment checklists identifying quality of care problems and made a plan to solve identified problems during the following months. Health units in the two experimental groups showed greater increases in productivity than units receiving traditional supervision. In both alternative strategies, supervisors were able to reach a larger proportion of health units and service providers than through the traditional supervision system. The supervised cost per unit was also lower in the two experimental groups than in the control group. Few differences were observed between the experimental and control groups in terms of the satisfaction of service providers with their jobs and of clients with services received.

Contraception Behavior↗
PubMed1993

Supervision as a focal point in nurse education: an exploratory study of its effects on the needs of student nurses.

This study reports the results of a 2 year follow up of the effects of experience of supervision on the personal needs of nursing students. Supervision was given during this period on a continual basis as a focal point of nursing education. Students were encouraged to relate critical incidents as starting points for the supervisory process. Students rated the quality of supervision in terms of its perceived effect on their sense of professional identity and on their self-confidence with respect to clinical work. A Swedish version of a standard personality questionnaire, the Edwards Personal Preference Schedule (EPPS), was given at the initiation of supervision and repeated 2 years later on its completion. The results of 48 students are presented. Two hypotheses relating to the global effects of supervision were not confirmed but the hypothesis concerning the effects of supervision to depend on its perceived quality was confirmed. As measured, the effectiveness of supervision was seen in statistically significant correlations between ratings of supervisory quality and changes reflecting an increased need for leadership and a diminished need for subordinance.

Clinical Competence↗
PubMed2005

Improvement of the walking ability in intermittent claudication due to superficial femoral artery occlusion with supervised exercise and pneumatic foot and calf compression: a randomised controlled trial.

OBJECTIVES: To compare the effect of unsupervised exercise, supervised exercise and intermittent pneumatic foot and calf compression (IPC) on the claudication distance, lower limb arterial haemodynamics and quality of life of patients with intermittent claudication. METHODS: Thirty-four eligible patients with stable intermittent claudication were randomised to IPC (n = 13, 3h/d for 6 months), supervised exercise (n = 12, three hourly sessions/week for 6 months) or unsupervised exercise (n = 9). In each patient, initial claudication distance (ICD), absolute claudication distance (ACD), resting ankle brachial pressure index (ABPI), and resting hyperaemic calf arterial inflow were measured before, 6 weeks, 6 months and 1 year after randomisation. Quality of life was assessed with the short form (SF)-36, walking impairment (WIQ) and intermittent claudication questionnaires (ICQ). RESULTS: Compared with unsupervised exercise, both IPC and supervised exercise, increased ICD and ACD, up to 2.83 times. IPC increased arterial inflow (p < 0.05 at 6 weeks) and ABPI. Supervised exercise decreased arterial inflow and increased ABPI (p < 0.05 at 6 months). Unsupervised exercise had no effect on arterial inflow or ABPI. IPC improved significantly the ICQ score and the speed score of the WIQ, while supervised exercise improved the WIQ claudication severity score. At 1 year clinical effectiveness of supervised exercise and IPC was largely preserved. CONCLUSIONS: IPC, by augmenting leg perfusion, achieved improvement in walking distance comparable with supervised exercise. Long-term results in a larger number of patients will provide valuable information on the optimal treatment modality of intermittent claudication.

Aged↗
PubMed2004

Evaluation of an intervention to improve successful completion of the Mini-AQLQ: comparison of postal and supervised completion.

INTRODUCTION: Previous postal administration of Mini Asthma-related Quality of Life Questionnaire (Mini-AQLQ) (validated for self-completion under supervision) resulted in 12.7% completion error rate. AIMS: To administer the Mini-AQLQ by post with instructions, and to compare completion errors with our previous study and usable response rate with supervised self-completion. METHOD: The Mini-AQLQ, with an instruction sheet, was posted to 96 participants from UK general practice, for completion 1 week before supervised self-completion in the surgery. RESULTS: 94/96 (98%) postal questionnaires were returned: the error rate of 10.6% was similar to our previous study (postal versus previous: 10/94 versus 23/181: P=0.62). 86/96 (90%) attended for supervised completion with no completion errors (supervised versus postal: 0/86 versus 10/94: P</=0.01) Overall usable response rates were similar. (supervised versus postal: 86/96 versus 84/96, P=0.65). CONCLUSION: Our instruction sheet did not significantly reduce postal completion errors, however the good postal return rate achieved comparable overall usable response rates to supervised administration.

Journal Article↗
PubMed2005

Transfer of communication skills training from workshop to workplace: the impact of clinical supervision.

OBJECTIVE: Recent studies have recognised that the communication skills learned in the training environment are not always transferred back into the clinical setting. This paper reports a study which investigated the potential of clinical supervision in enhancing the transfer process. METHODS: A randomised controlled trial was conducted involving 61 clinical nurse specialists. All attended a 3-day communication skills training workshop. Twenty-nine were then randomised to 4 weeks of clinical supervision, aimed at facilitating transfer of newly acquired skills into practice. Assessments, using real and simulated patients, were carried out before the course, immediately after the supervision period and 3 months later. Interviews were rated objectively using the Medical Interview Aural Rating Scale (MIARS) to assess nurses' ability to use key skills, respond to patient cues and identify patient concerns. RESULTS: Assessments with simulated patients showed that the training programme was extremely effective in changing competence in all three key areas. However, only those who experienced supervision showed any evidence of transfer. Improvements were found in the supervised groups' use of open questions, negotiation and psychological exploration. Whilst neither group facilitated more disclosure of cues or concerns, those in the experimental group responded more effectively to the cues disclosed, reduced their distancing behaviour and increasing their exploration of cues. CONCLUSIONS: The study has shown that whilst training enhances skills, without intervention, it may have little effect on clinical practice. The potential role of clinical supervision as one way of enhancing the clinical effectiveness of communication skills training programmes has been demonstrated. PRACTISE IMPLICATIONS: This study raises questions about the effectiveness of training programmes which do not incorporate a transfer element, and provides evidence to support the need for clinical supervision for clinical nurse specialist.

Adult↗
PubMed1996

Supervision rating scale: a measure of functional outcome from brain injury.

OBJECTIVE: To introduce a new outcome rating scale, the Supervision Rating Scale (SRS), which measures the level of supervision that a patient receives from caregivers. The SRS rates level of supervision on a 13-point ordinal scale that can optionally be grouped into five ranked categories (Independent, Overnight Supervision, Part-Time Supervision, Full-Time Indirect Supervision, and Full-Time Direct Supervision). DESIGN: Descriptive correlational study of the scale's interrater reliability and criterion-related validity. SETTING: Brain injury program of a freestanding rehabilitation hospital. PATIENTS: Referred case series of 114 patients with moderate to severe traumatic brain injury (mean time postinjury = 3.8 years) who resided in the community or a nonhospital facility. INTERVENTION: None. MAIN OUTCOME MEASURES: Functional outcome as measured by the Disability Rating Scale (DRS), Glasgow Outcome Scale (GOS), type of living arrangement and independence in selfcare and instrumental activities of daily living (ADL). RESULTS: SRS ratings showed consistent relationships with type of living arrangement and with independence in self-care and instrumental ADL. SRS ratings were also strongly associated with ratings on the DRS and GOS. Interrater reliability of the SRS was evaluated in a subsample of 19 patients and found to be satisfactory (intraclass correlation = .86, weighted kappa = .64). CONCLUSIONS: The results suggest that the SRS should have sufficient reliability and validity to serve as a measure of functional outcome from brain injury. Because SRS ratings are based on observed behaviors, the SRS may have a smaller subjective component as compared to the DRS and GOS.

Activities of Daily Living↗
PubMed2000

Randomized trial of supervised injectable versus oral methadone maintenance: report of feasibility and 6-month outcome.

AIM: To assess the feasibility of a randomized clinical trial of supervised injectable versus oral methadone maintenance and to assess medium-term treatment outcomes. DESIGN: Randomized clinical trial of supervised injectable versus supervised oral methadone maintenance treatment (MMT). Trial participants were dependent illicit opiate injectors allocated at intake to supervised injectable or oral methadone maintenance treatment. SETTING: Specialist addictions treatment centre in South London. SUBJECTS: Forty dependent illicit opiate injectors seeking methadone maintenance treatment. INTERVENTIONS: Daily supervised injectable and oral methadone maintenance, delivered at the treatment centre. MAIN OUTCOME MEASURES: Frequency of illicit heroin use and frequency of illicit drug injecting during 30 days before intake to treatment and prior to 6-month follow-up. SECONDARY OUTCOME MEASURES: frequency of use of illicit methadone, crack cocaine, benzodiazepines and alcohol, physical and psychological health symptoms and acquisitive crime. RESULTS: Injectable and oral MMT were both generally acceptable to the study participants: there was a high level of agreement to enter the randomized trial, and subsequent retention in treatment was good. The average number of days of illicit heroin use reduced from 22.2 to 7.6 for the injectable MMT group and from 22.4 to 8.7 for the oral MMT group. The average number of days of illicit injecting reduced from 25.7 to 10.8 days for the injectable group and from 20.1 to 11.9 days for the oral group. Patients' physical and psychological health symptoms and involvement in acquisitive crime also reduced in both groups. Treatment satisfaction ratings at follow-up were higher among patients in the injectable MMT group. The ratio for the actual medication costs between injectable and oral MMT was 6.8:1, and for the direct operational costs was 4.7:1. There was some evidence of a differential patient response with greater reductions in heroin use occurring among patients who were daily illicit injectors and had poorer psychological and physical health (at entry) who were allocated to injectable MMT. CONCLUSIONS: Conduct of the trial has demonstrated that it is feasible to implement supervised injectable methadone maintenance treatment in the context of (although separate from) a specialist oral methadone maintenance service. Patients assigned to receive either supervised injectable or oral MMT had broadly equivalent, positive during-treatment outcomes at 6-month follow-up. Future studies should seek to identify patient characteristics which are linked to good outcome in injectable MMT. Practical evidence-based guidance to physicians about determining which patients are more suitable for injectable MMT is urgently needed.

Administration, Oral↗
PubMed1997

Expert views on clinical supervision: a study based on interviews.

Clinical supervision is a didactic process of the purpose of human development and maturity. The aim of this study is to analyse views on clinical supervision held by a number of experts, and to reflect on the effects and value of clinical supervision in relation to public health. Data were collected by interviews and analysed in accordance with the grounded theory construction model. The results showed that clinical supervision is an integration process guiding a person from 'novice to expert' by establishing a relationship of trust between supervisor and supervisee. This study indicates that implementation of systematic clinical supervision may positively affect quality of care, and patients' recovery, create improved feeling of confidence in one's work, and prevent burnout among staff. The negative aspects, as reported, were the possibility of high 'opportunity costs', e.g. the time loss for patient care by those participating in organized systematic supervision. On the other hand, clinical supervision contributes towards more efficient use of resources and hence avoids unnecessary costs. However, neither of these aspects were further elaborated on by the experts but clearly indicate an important field for further research.

Attitude of Health Personnel↗
PubMed2003

Development of a group model of clinical supervision to meet the needs of a community mental health nursing team.

Clinical supervision is an important tool in the development of quality nursing care. It involves a process of reflection upon practice, the aim of which is to improve clinical practices and hence improve patient outcomes. The term 'clinical supervision' is itself problematic in that it implies an hierarchical, rather than a nurse-centred and reflective, process. In addition there are a variety of models of supervision which range from the purely managerial to the clinical. This gives rise to confusion and in some cases suspicion, in clinicians. This paper reports on the development, implementation and evaluation of a group model of clinical supervision developed by a small team of mental health nurses in a community mental health setting. This team recognised the need for a formal clinical supervision model but was unsure as to the model which best suited their practice situation and needs. Through collaboration with a university department of nursing, this group developed its own model of group clinical supervision. This paper reports on the development of the model and its evaluation. The model was developed with a small team of community nurses and hence may not be applicable to other teams and other settings. However, the methods described may be useful as a guide to other nurses who wish to plan, implement and evaluate a model of clinical supervision in their workplace.

Community Mental Health Services↗
PubMed2002

Achieving effective supervision.

Supervision probably does have benefits both for the maintenance and improvement of clinical skills and for job satisfaction, but the data are very thin and almost non-existent in the area of alcohol and other drugs services. Because of the potential complexity of objectives and roles in supervision, a structured agreement appears to be an important part of the effective supervision relationship. Because sessions can degenerate easily into unstructured socialization, agendas and session objectives may also be important. While a working alliance based on mutual respect and trust is an essential base for the supervision relationship, procedures for direct observation of clinical skills, demonstration of new procedures and skills practice with detailed feedback appear critical to supervision's impact on practice. To ensure effective supervision, there needs not only to be a minimum of personnel and resources, but also a compatibility with the values and procedures of management and staff, access to supervision training and consultation and sufficient incentives to ensure it continues.

Alcoholism↗
PubMed2006

Semi-supervised analysis of gene expression profiles for lineage-specific development in the Caenorhabditis elegans embryo.

MOTIVATION: Gene expression profiling is a powerful approach to identify genes that may be involved in a specific biological process on a global scale. For example, gene expression profiling of mutant animals that lack or contain an excess of certain cell types is a common way to identify genes that are important for the development and maintenance of given cell types. However, it is difficult for traditional computational methods, including unsupervised and supervised learning methods, to detect relevant genes from a large collection of expression profiles with high sensitivity and specificity. Unsupervised methods group similar gene expressions together while ignoring important prior biological knowledge. Supervised methods utilize training data from prior biological knowledge to classify gene expression. However, for many biological problems, little prior knowledge is available, which limits the prediction performance of most supervised methods. RESULTS: We present a Bayesian semi-supervised learning method, called BGEN, that improves upon supervised and unsupervised methods by both capturing relevant expression profiles and using prior biological knowledge from literature and experimental validation. Unlike currently available semi-supervised learning methods, this new method trains a kernel classifier based on labeled and unlabeled gene expression examples. The semi-supervised trained classifier can then be used to efficiently classify the remaining genes in the dataset. Moreover, we model the confidence of microarray probes and probabilistically combine multiple probe predictions into gene predictions. We apply BGEN to identify genes involved in the development of a specific cell lineage in the C. elegans embryo, and to further identify the tissues in which these genes are enriched. Compared to K-means clustering and SVM classification, BGEN achieves higher sensitivity and specificity. We confirm certain predictions by biological experiments. AVAILABILITY: The results are available at http://www.csail.mit.edu/~alanqi/projects/BGEN.html.

Algorithms↗
PubMed2005

Understanding unintentional injury-risk in young children I. The nature and scope of caregiver supervision of children at home.

OBJECTIVE: To examine the supervision that young children routinely receive when awake and at home with a parent. METHODS: Mothers were trained to complete continuous recordings about supervision of their young child (2-5 years) when at home on each of 10 randomly selected days within a 3-week period. RESULTS: Children were supervised more often than unsupervised but were completely out of view of supervisors about 20% of their awake time, and supervision was poorer when out of view of supervisors. Older children (4-5 years) were unsupervised (8% of awake time) more often than younger children (2-3 years; 1%), were more often out of view of supervisors than younger children, and received poorer supervision than younger children when out of view of supervisors. Few sex differences were found. CONCLUSIONS: These data provide insights into the nature and scope of supervision that young children routinely experience when at home. Implications of these findings for identifying patterns of supervision that elevate children's risk of injury are discussed.

Attitude↗
PubMed2005

A survey of the provision of educational supervision in occupational medicine in the Armed Forces.

OBJECTIVE: The aim of this study was to assess whether balanced educational supervision was being provided for occupational medicine (OM) specialist registrars (SpRs) in the Armed Forces and to consider the effectiveness of current supervision. METHODS: Anonymized postal questionnaires, using Likert five-point response scales, were sent to Service OM SpRs and their educational supervisors (Ed Sup) to assess the degree of understanding of the purpose, effectiveness and organization of the educational supervision being provided. RESULTS: Completed questionnaires were returned from 35 (92%) specialists and 14 (61%) SpRs. Less than a third of the specialists were involved as Ed Sup and only three (11%) had undergone any formal medical education training. There was an agreement about the purpose and effectiveness of educational supervision between both the groups, though there appeared to be a bias towards providing supportive functions with patient management and educational components scoring less highly. CONCLUSIONS: A high response rate enabled an accurate assessment of OM supervision practices in the Armed Forces to be made. There was agreement over the relative effectiveness, importance and coverage of educational supervision, though this was being provided by a relatively small group of OM specialists, few of whom had undertaken any formal medical education training. The supervision provided also appeared to be biased towards providing supportive functions rather than patient management and educational components of training, which may result in an unbalanced training for the SpRs. Having assessed the relatively close-knit service OM community, there would be value in seeing whether similar patterns prevail in the wider OM community.

Education, Medical, Graduate↗
PubMed1975

Utilization of supervised physician's assistants in emergency room coverage in a small rural community hospital.

A study has been made of an initial 2-year experience in a 90-bed rural community hospital where emergency room primary coverage has been provided by Physician's Assistants under supervision of specialists in the field of general surgery, pediatrics, and internal medicine. Emphasis has been placed on a rigidly supervised program as well as physician supervision and availability on a patient-call basis. This supervision may take the form of immediate availability of the physician to the emergency room, telephone consultation or, in minor illnesses and injuries, continued review of the record of each individual patient seen by the Physician's Assistant. A review of the most recent 2-month ER-OPD experience showed that in a small rural hospital, a majority (62%) of the patients had an illness or injury of a minor, nonserious degree which could be handled primarily by a Physician's Assistant. This has led to emergency room care which has been judged by the patients, the emergency-room nurses, and the supervising physicians to be more efficient and prompt than had been previously provided, yet not reduced in quality. The program described was developed by physicians active in private practice working with the Physician's Assistants and RN's in the ER-OPD. The physicians' time spent in teaching, supervision and development of written policy was great, and, at times, threatened the continuation of the program. A fulltime physician in the hospital could better initiate the program of teaching, supervision, formulating written procedures, and establishing policies with different specialist.

Consumer Behavior↗