The Differences in Antibiotic Decision-making Between Acute Surgical and Acute Medical Teams: An Ethnographic Study of Culture and Team Dynamics

Background Cultural and social determinants influence antibiotic decision-making in hospitals. We investigated and compared cultural determinants of antibiotic decision-making in acute medical and surgical specialties. Methods An ethnographic observational study of antibiotic decision-making in acute medical and surgical teams at a London teaching hospital was conducted (August 2015–May 2017). Data collection included 500 hours of direct observations, and face-to-face interviews with 23 key informants. A grounded theory approach, aided by Nvivo 11 software, analyzed the emerging themes. An iterative and recursive process of analysis ensured saturation of the themes. The multiple modes of enquiry enabled cross-validation and triangulation of the findings. Results In medicine, accepted norms of the decision-making process are characterized as collectivist (input from pharmacists, infectious disease, and medical microbiology teams), rationalized, and policy-informed, with emphasis on de-escalation of therapy. The gaps in antibiotic decision-making in acute medicine occur chiefly in the transition between the emergency department and inpatient teams, where ownership of the antibiotic prescription is lost. In surgery, team priorities are split between 3 settings: operating room, outpatient clinic, and ward. Senior surgeons are often absent from the ward, leaving junior staff to make complex medical decisions. This results in defensive antibiotic decision-making, leading to prolonged and inappropriate antibiotic use. Conclusions In medicine, the legacy of infection diagnosis made in the emergency department determines antibiotic decision-making. In surgery, antibiotic decision-making is perceived as a nonsurgical intervention that can be delegated to junior staff or other specialties. Different, bespoke approaches to optimize antibiotic prescribing are therefore needed to address these specific challenges

Developing high-fidelity health care simulation scenarios : a guide for educators and professionals

“The final, definitive version of this article has been published in the Journal, Simulation & Gaming, 42 (1), 2011, copyright SAGE Publications Ltd on SAGE Journals Online: http://online.sagepub.com/ "The development of appropriate scenarios is critical in high-fidelity simulation training. They need to be developed to address specific learning objectives, while not preventing other learning points from emerging. Buying a patient simulator, finding a volunteertoact as the patient, or even obtaining ready-made scenarios from another simulation center are rarely insurmountable challenges. The issue often lies in how to use or adapt these for your own purpose: with your team, facilities, and resources but primarily for your learners. Published information is limited in the area of scenario preparation for health care education and continuing medical education or continuing professional development. This article is a guide for clinical tutors, standardized patient trainers, and patient simulator operators on how to script scenarios and proposes a new detailed and reusable template for writing scenarios. It contains practical sections such as how to decide on the learning objectives to be addressed, how to script and organize your scenarios, and how to pitch the suitable level of details to make the scenarios appropriately realistic.Peer reviewe

Initiatives for the quality of medical simulation in the training of nurses

Introduction. In the training of nurses, simulation is used more and more often as an educational tool. For that purpose, various means and tools of simulation are employed, starting with simple trainers, which have been in use for quite a long time, through complex in structure and more and more physiologically and informatically advanced high-fidelity simulators placed in a realistic virtual environment to trained people (so called standardised patients). The addressee of the educational actions, assuming an active role, is a student, but it is the teacher with a special training in conducting this type of courses that is the coordinator of such actions. Purpose. Presentation of selected initiatives for the quality of medical simulation in training nurses. Method. Unsystematic review of literature, based on the thematic selection of articles, with a preference for the studies constituting a systematic review of works published in the last 14 years. Results.All the organizations mentioned below support and shape globally the development of medical simulation in the training of nurses. It is worth getting familiar with their mission and standards as they can help to develop medical simulation and educate the students of nursing at the best possible level so as to master not only the basic skills, but also those related to the communication within a team or decision making. Summary. Simulation has existed for centuries, but only recently has it started to have a big impact on healthcare. A need exists for the change in the training of nurses to facilitate the transfer of theoretical knowledge for the student into the clinical context and develop the necessary personal competences, which can be provided for by high-fidelity simulation

Designing a serious game for community-based disease prevention in the Amazon

Many developing regions around the world rely on community-based healthcare strategies and practices to deal with prevention and control of often neglected diseases, by educating the local population and healthcare professionals, on the mechanisms by which such diseases spread and how they can be controlled. In this paper we describe a multiplayer serious game designed to raise awareness, and foster adoption of preventive measures among local citizens and community-health professionals about Leishmaniosis. We also discuss how the underlying concept for this game and its mechanics have been iteratively designed and developed in collaboration with a group of people with relevant medical and research expertise as well as practical knowledge resulting from working with our target population

Mapping factors influencing EAI adoption in the local government authorities on different phases of the adoption lifecycle

Several private and public organisations have adopted Enterprise Application Integration (EAI), however, its application in the Local Government Authorities (LGAs) is limited. Although, there exist few EAI adoption models, these models mainly focus on a number of different factors (e.g. benefits, barriers, cost) influencing the decision making process for EAI adoption. Moreover, these models do not illustrate which factor(s) influence the decision making process for EAI adoption on the adoption lifecycle phases. Literature indicates that the adoption process involves a sequence of phases an organisation passes through before taking the decision for adoption. This exemplifies that LGAs may also have to pass through several adoption phases before taking the decision to adopt EAI. However, due to the: (a) multiplicity of diverse EAI adoption factors and (b) not able to recognise which factor(s) influence EAI on adoption lifecycle phases, it may not be easy for LGAs to take decisions to adopt EAI by merely focusing on different factors. This may impede the decision making process for EAI adoption in LGAs. Notwithstanding, the implications of EAI have yet to be assessed, leaving scope for timeliness and novel research. Therefore, it is of high importance to investigate this area within LGAs and result in research that contributes towards successful EAI adoption. This paper makes a step forward as it: (a) investigates and proposes four adoption lifecycle phases, (b) validates the adoption lifecycle phases and (c) mapping the factors influencing EAI adoption on the adoption lifecycle phases, through a case study. Hence, it significantly contributes to the body of knowledge and practice. In doing so, providing sufficient support to the decision makers for speeding up the decision making process for EAI adoption in LGAs