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United States Guild Certified Feldenkrais Teachers®: a survey of characteristics and practice patterns.

ABSTRACT: BACKGROUND: Feldenkrais Method® teachers help students improve function and quality of life through verbally and manually guided lessons. The reasons people seek Feldenkrais® lessons are poorly understood. Similarly, little is known about practice characteristics and patterns. To address these knowledge gaps, we conducted an extensive survey of United States Guild Certified Feldenkrais Teachers®. METHODS: We invited all Feldenkrais Teachers to participate in this survey delivered in web-based or print formats. We obtained overall and question-specific response rates, descriptive statistics, chi-square tests of response bias, and performed qualitative thematic review of comments. RESULTS: Overall response rate was 30.5% (392/1287). Ninety percent of responders had college degrees in diverse fields; 12.5% had credentials outside health care, 36.9% held conventional health care licenses, and 23.1% had complementary and alternative medicine credentials. Mean age was 55.7 years; most teachers were women (83%). California (n = 100) and New York (n = 34) had the most teachers. Forty-five percent of teachers earned ≤ 20% of their gross income from their practices, while 26% earned > 80%. Most saw < 10 students/week for individual lessons and < 10 students/week for group lessons. Students were mostly women (71.1%) and 45-64 years old. The primary reason students sought Feldenkrais lessons was pain. A quarter of students self-referred, a fifth were referred by conventional health care providers, and two-thirds paid for services directly. Themes from comments included: beliefs that Feldenkrais training had important personal and professional benefits for teachers; recognition of the challenges of operating small businesses and succinctly describing the Feldenkrais Method; the variety of practice approaches; and a deep commitment to the Feldenkrais Method. CONCLUSIONS: Most Feldenkrais Teachers were well educated, often held additional credentials, were located in the West, were women, were older than 50 years, and had part-time practices. Most students were women, were adults, came from various referral sources, and paid directly for services. Teachers and students utilized the Feldenkrais Method in diverse settings and applications. These findings may foster practice development by Feldenkrais Teachers, improve communication between health care consumers and providers and assist decision-making, and stimulate more research concerning the Feldenkrais Method.

SUBMITTER: Buchanan PA

PROVIDER: S-EPMC4086994 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background:Stereotactic radiosurgery (SRS) has emerged as an important modality for the treatment of intracranial metastases. There are currently few established guidelines delineating indications for SRS use and fewer still regarding plan evaluation in the treatment of multiple brain metastases. Methods:An 18 question electronic survey was distributed to radiation oncologists at National Cancer Institute (NCI) designated cancer centers in the USA (60). Centers without radiation oncologists were excluded. Physicians who indicated that they do not prescribe SRS were excluded from the remaining survey questions. Sign test and Chi-square test were used to determine if responses differed significantly from random distribution. Results:One hundred sixteen of the 697 radiation oncologists surveyed completed the questionnaire, representing 51 institutions. Sixty-two percent reported treating patients with brain metastases using SRS. Radiation oncologists prescribing SRS most commonly treat CNS (66.2%) and lung (49.3%) malignancies. SRS was used more frequently for < 10 brain metastases (73.7%; p < 0.0001) and whole brain radiation therapy (WBRT) for > 10 brain metastases (82.5%; p < 0.0001). The maximum number of lesions physicians were willing to treat with SRS without WBRT was 1-4 (40.4%) and 5-10 (42.4%) (p < 0.0001 compared to 11-15, 16-20 and no limit). The most important criteria for choosing SRS or WBRT were number of lesions (p < 0.0001) and performance status (p = 0.016). The most common margin for SRS was 0 mm (49.1%; p = 0.0021). The most common dose constraints other than critical structure was conformity index (84.2%) and brain V12 (61.4%). The LINAC was the most common treatment modality (54.4%) and mono-isocenter technique for multiple brain metastases was commonly used (43.9%; p = 0.23). Most departments do not have a policy for brain metastases treatment (64.9%; p = 0.024). Conclusions:This is one of the first national surveys assessing the use of SRS for brain metastases in clinical practice. These data highlight some clinical considerations for physicians treating brain metastases with SRS.

Project description:BACKGROUND AND OBJECTIVES:Practicing clinical nephrologists are performing fewer diagnostic kidney biopsies. Requiring biopsy procedural competence for graduating nephrology fellows is controversial. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:An anonymous, on-line survey of all Walter Reed training program graduates (n=82; 1985-2017) and all United States nephrology program directors (n=149; August to October of 2017), regarding kidney biopsy practice and training, was undertaken. RESULTS:Walter Reed graduates' response and completion rates were 71% and 98%, respectively. The majority felt adequately trained in native kidney biopsy (83%), transplant biopsy (82%), and tissue interpretation (78%), with no difference for ≤10 versus >10 practice years. Thirty-five percent continued to perform biopsies (13% did ≥10 native biopsies/year); 93% referred at least some biopsies. The most common barriers to performing biopsy were logistics (81%) and time (74%). Program director response and completion rates were 60% and 77%. Seventy-two percent cited ≥1 barrier to fellow competence. The most common barriers were logistics (45%), time (45%), and likelihood that biopsy would not be performed postgraduation (41%). Fifty-one percent indicated that fellows should not be required to demonstrate minimal procedural competence in biopsy, although 97% agreed that fellows should demonstrate competence in knowing/managing indications, contraindications, and complications. Program directors citing ≥1 barrier or whose fellows did <50 native biopsies/year in total were more likely to think that procedural competence should not be required versus those citing no barriers (P=0.02), or whose fellows performed ≥50 biopsies (P<0.01). CONCLUSIONS:Almost two-thirds of graduate respondents from a single military training program no longer perform biopsy, and 51% of responding nephrology program directors indicated that biopsy procedural competence should not be required. These findings should inform discussion of kidney biopsy curriculum requirements.

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Project description:ImportanceHearing loss is one of the most prevalent chronic conditions in the United States and has been associated with negative physical, social, cognitive, economic, and emotional consequences. Despite the high prevalence of hearing loss, substantial gaps in the utilization of amplification options, including hearing aids and cochlear implants (CI), have been identified.ObjectiveTo investigate the contemporary prevalence, characteristics, and patterns of specialty referral, evaluation, and treatment of hearing difficulty among adults in the United States.Design, setting, and participantsA cross-sectional analysis of responses from a nationwide clustered representative sample of adults who participated in the 2014 National Health Interview Survey and responded to the hearing module questions was carried out.Main outcomes and measuresData regarding demographics as well as self-reported hearing status, functional hearing, laterality, onset, and primary cause of the hearing loss were collected. In addition, specific data regarding hearing-related clinician visits, hearing tests, referrals to hearing specialist, and utilization of hearing aids and CIs were analyzed.ResultsAmong 239.6 million adults, 40.3 million (16.8%) indicated their hearing was less than "excellent/good," ranging from "a little trouble hearing" to "deaf." The mean (SD) age of participants was 47 (0.2) years with 48.2% being men and 51.8% women. Approximately 48.8 million (20.6%) had visited a physician for hearing problems in the preceding 5 years. Of these, 32.6% were referred to an otolaryngologist and 27.3% were referred to an audiologist. Functional hearing was reported as the ability to hear "whispering" or "normal voice" (225.4 million; 95.5%), to "only hear shouting" (8.0 million; 3.4%), and "not appreciating shouting" (2.8 million; 1.1%). Among the last group, 5.3% were recommended to have a CI, of which 22.1% had received one. Of the adults who indicated their hearing from "a little trouble hearing" to being "deaf," 12.9 million (32.2%) had never seen a clinician for hearing problems and 11.1 million (28.0%) had never had their hearing tested.Conclusions and relevanceThere are considerable gaps between self-reported hearing loss and patients receiving medical evaluation and recommended treatments for hearing loss. Improved awareness regarding referrals to otolaryngologists and audiologists as well as auditory rehabilitative options among clinicians may improve hearing loss care.

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United States Guild Certified Feldenkrais Teachers®: a survey of characteristics and practice patterns.

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