A survey of 151 American Psychological Association-approved predoctoral internship programs shows a ratio of 3 hours of psychotherapy provided by interns to 1 hour of supervision received by the intern. The intern received 4.25 hours of supervision per week, and the supervisory staff provided 3.76 hours of supervision per week. One-to-one supervision remains the predominant supervisory modality. Supervision was considered part of the job, not something to be specifically rewarded. No specific and direct evaluation procedures to assess supervision quality were available. One third of the facilities reported that they provided training in supervision for interns. Programs can be characterized as "open" (accepting other than graduate psychology interns) or "closed" and more intensive (low service supervision) or less intensive in providing supervision. The dimensions of openness and intensity were related to the types and amounts of supervision provided.Presently, about 1,500 doctoral clinical students serve an internship each year (Stedman et al., 1981). Although the internship is central to professional training in psychology, little information is available on the extent and nature of psychotherapy supervision provided to interns. Such information would help administrators and professional staff at internship sites to plan internships. It would also help potential interns in their selection of internship sites.To provide such data on psychotherapy training during internships, we conducted a survey of the American Psychological Association (APA)-accredited predoctoral internship programs. Specific foci were (a) amount of supervision, (b) types of supervision provided, (c) training level and experiences of supervisors, (d) quality control or monitoring of supervision, and (e) training in supervision per se provided by the internship.

Background En bloc resection for treatment of sacral tumors is the approach of choice for patients with resectable tumors who are well enough to undergo surgery, and studies describe patient survival, postoperative complications, and recurrence rates associated with this treatment. However, most of these studies do not provide patient-reported functional outcomes other than binary metrics for bowel and bladder function postresection. Questions/purposes The purpose of this study was to use validated patient-reported outcomes tools to compare quality of life based on level of sacral resection in terms of (1) physical and mental health; (2) pain; (3) mobility; and (4) incontinence and sexual function. Methods Our analysis included 33 patients (19 men, 14 women) who had a mean age of 53 years (range, 22-72 years) with a quality-of-life survey administered at a mean postoperative followup of 41 months (range, 6-123 months). The majority of patient-reported quality-of-life outcome surveys for this study were taken from the National Institute of Health's Patient Reported Outcome Measurement Information System (PROMIS) system. To assess physical and mental health, the PROMIS Global Items Survey with physical and mental subscores, Anxiety, and Depression scores were used. Pain outcomes were assessed using PROMIS Pain Intensity and Pain Interference surveys. Patient-reported lower extremity function was assessed using the PROMIS Mobility Survey. Patientreported quality of life for sexual function was assessed using the PROMIS Sex Interest and Orgasm survey, One-way analysis of variance tests on means or ranks were used to conduct statistical analysis between levels. Results Patients with more caudal resections had higher physical health (95% confidence interval [CI] total sacrectomy 36-42 versus S4 50-64, p \ 0.001), less intense pain (95% CI total sacrectomy 47-60 versus S4 28-37, p \ 0.001), less interference resulting from pain (95% CI total sacrectomy 58-69 versus S4 36-51, p = 0.004), higher mobility (95% CI total sacrectomy 24-46 versus S4 59-59, p = 0.002), and were more functionally able to achieve orgasm (95% CI S1 1-1 versus S4 2.2-5.3, p = 0.043).

Background Surgery with high-dose radiation and highdose radiation alone for sacral chordomas have shown promising local control rates. However, we have noted frequent sacral insufficiency fractures and perceived this rate to be higher than previously reported. Questions/purposes We wished (1) to characterize the incidence of sacral insufficiency fractures in patients with chordomas of the sacrum who received high-dose radiation, and (2) to determine whether patients treated with surgery plus high-dose radiation or high-dose radiation alone are more likely to experience a sacral fracture, and to compare time to fracture in these groups. Methods Sixty-two patients who received high-dose radiation for sacral chordomas with (n = 44) or without surgical resection (n = 18) between 1992 and 2013 were included in this retrospective study. At our institution, sacral chordomas generally are treated by preoperative radiotherapy, followed by en bloc resection, and postoperative radiotherapy. Radiation alone, with an intent to cure, is offered to patients who otherwise are not good surgical candidates or patients who elect radiotherapy based on tumor location and the anticipated morbidity after surgery (such as sexual, bowel, or bladder dysfunction). MRI and CT scans were evaluated for evidence of sacral insufficiency fractures. Complete followup was available at a minimum of 2 years (or until fracture or death) for all 18 patients who underwent radiation alone, whereas 14% (six of 44 patients) in the surgery plus radiation group (9% [three of 33] after high sacrectomy and 27% [three of 11] after low sacrectomy) were lost to followup before 2 years. Results Sacral insufficiency fractures occurred in 29 of the 62 patients (47%). A total of 25 of 33 patients (76%)One author (SJJ) certifies that he has received, an amount less than USD 10,000 from the Anna Foundation (Oegstgeest, The Netherlands), an amount less than USD 10,000 from the De Drie Lichten Foundation (Hilversum, The Netherlands), an amount less than USD 10,000 from the KWF Kankerbestrijding (Amsterdam, The Netherlands), and an amount less than USD10,000 from the Michael van Vloten Foundation (Rotterdam, The Netherlands). One author (JHS) certifies that he or a member of his family has or may receive payments or benefits, an amount less than USD 10,000 from Stryker (Kalamazoo, MI, USA), and an amount less than USD 10,000 from Biom'up (Saint-Priest, Lyon, France). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved or waived approval for the reporting of this investigation and that all investigations were conducted in conformity with ethical principles of research. This work was performed at Massachusetts General Hospital, Boston, MA, USA. with high sacrectomy had fractures develop compared with zero of 11 (0%) after low sacrectomy, and four of the 18 patients (22%) w...

Anterior lumbar interbody fusion via a midline incision and a retroperitoneal approach was associated with 37% overall rate of complication. Patients with a history of abdominal or pelvic surgery are at a higher risk of developing general, instrumentation, and anterior approach-related complications.

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