De Veber

How to account for participants' psychological and emotional exhaustion with research has been under-explored in the research ethics literature. Research fatigue, as it is known, has significant impacts on patients' well-being and their ongoing and future participation in studies. From the perspective of researchers and researched communities, research fatigue also creates selection bias and opportunity costs, negatively impacting the collective scientific enterprise. Institutional Review Boards should systematically consider research fatigue during the research approval process and strive to mitigate it.

Pediatrics, Neonatologist, Director of Pediatrics, University Medical Center Groningen, Groningen, NetherlandsCorrespondence: Dr Keith J Barrington, Pediatrics, Universite de Montreal, 3175 chemin Cote-Sainte-Catherine, Montreal, Quebec H3T 1C5.Telephone 514-345-4931 ext 5929, fax 514-345-4822, e-mail keith.barrington@umontreal.caAccepted for publication May 31, 2013

Recently there has been talk about the benefit of advance care planning. This is an issue which resurfaces from time to time, as is evident in recent New England Journal of Medicine articles and editorials (April 2010). It has also resurfaced in Canada in a recent document titled Advance Care Planning in Canada: National Framework for Consultation (Health Canada 2010). This document acknowledges that many of us believe in the value of advance directives, finding "that most of the general public (60-90%) is supportive of advance care planning. However, only 10-20% of the public in the US, Canada and Australia have completed an advance care plan of any kind" (Health Canada 2010: 6). In Muriel R. Gillick's editorial in the New England Journal Medicine, she strongly makes the point that few people complete advance directives and further states that "directives have been a resounding failure" (Gillick 2010: 1239). These statements, although not exhaustive on the subject, show that we have a problem translating the support for advance directives into actual plans.

This article reports on two studies that used three different samples (N = 644) to construct and validate a multidimensional measure of managerial coaching skill. The four dimensions of coaching skill measured were Open Communication, Team Approach, Value People, and Accept Ambiguity. The two studies assessed the context adequacy, dimensionality, reliability, factor structure, and construct validity of the scale. Preliminary reliability and validity evidence of the scale was determined. Consequently, the coaching scale provides future researchers with a valuable tool to measure coaching skill in organizational studies, and it offers human resource development professionals a valid instrument to develop effective managers.

This article compares the social and health characteristics of patients of five kinds of practitioners: family physicians (used as a baseline group); chiropractors; acupuncturist/traditional Chinese medicine doctors; naturopaths; and Reiki practitioners. The data were gathered in a large Canadian city during the period 1994 to 1995. Face-to-face interviews were conducted with 300 patients (60 from each type of treatment group). While the most striking social and health differences occur between patients of family physicians and the patients of alternative practitioners, significant differences are also evident between the different groups of alternative patients. Reiki patients, for example, have a higher level of education and are more likely to be in managerial or professional positions than other alternative patients. The profiles presented here indicate that users of alternative care should not be regarded as a homogeneous population. The findings also show that almost all alternative patients also consult family physicians. The pattern revealed is one of multiple use: patients choose the kind of practitioner they believe can best help their particular problem.