Effect of a two-year national quality improvement program on surgical checklist implementation.

Use of the surgical checklist in Switzerland is still incomplete and unsatisfactory. A national improvement program was developed and conducted in Switzerland to implement and improve the use of the surgical safety checklists. The aims of the implementation program were to implement comprehensive and correct checklist use in participating hospitals in every patient and in every surgical procedure; and to improve safety climate and teamwork as important cultural context variables. 10 hospitals were selected for participation in the implementation program. A questionnaire assessing use, knowledge, and attitudes towards the checklist and the Safety Climate Survey were conducted at two measurement occasions each in October/November 2013 and January/February 2015. Significant increases emerged for frequency of checklist use (F(1,1001)=340.9, p<0.001), satisfaction (F(1,1232)=25.6, p<0.001), and knowledge(F(1,1294)=184.5, p<0.001). While significant differences in norms (F(1,1284)=17.9, p<0.001) and intentions (F(1,1284)=7.8, p<0.01) were observed, this was not the case for attitudes (F(1,1283)=.8, n.s.) and acceptance (F(1,1284)=0.1, n.s.). Significant differences for safety climate and teamwork emerged in the present study (F(1,3555)=11.8, p<0.001 and F(1,3554)=24.6, p<0.001, respectively). However, although statistical significance was reached, effects are very small and practical relevance is thus questionable. The results of the present study suggest that the quality improvement program conducted by the Swiss Patient Safety Foundation in 10 hospitals led to successful checklist implementation. The strongest effects were seen in aspects concerning behaviour and knowledge specifically related to checklist use. Less impact was achieved on general cultural variables safety climate and teamwork. However, as a trend was observable, these variables may simply need more time in order to change substantially

A randomized, double-blind, placebo-and active-controlled, half-head study to evaluate the effects of platelet-rich plasma on alopecia areata

Summary Background Alopecia areata (AA) is a common autoimmune condition, causing inflammation-induced hair loss. This disease has very limited treatment possibilities, and no treatment is either curative or preventive. Platelet-rich plasma (PRP) has emerged as a new treatment modality in dermatology, and preliminary evidence has suggested that it might have a beneficial role in hair growth. Objectives To evaluate the efficacy and safety of PRP for the treatment of AA in a randomized, double-blind, placebo-and active-controlled, half-head, parallelgroup study. Methods Forty-five patients with AA were randomized to receive intralesional injections of PRP, triamcinolone acetonide (TrA) or placebo on one half of their scalp. The other half was not treated. Three treatments were given for each patient, with intervals of 1 month. The endpoints were hair regrowth, hair dystrophy as measured by dermoscopy, burning or itching sensation, and cell proliferation as measured by Ki-67 evaluation. Patients were followed for 1 year. Results PRP was found to increase hair regrowth significantly and to decrease hair dystrophy and burning or itching sensation compared with TrA or placebo. Ki-67 levels, which served as markers for cell proliferation, were significantly higher with PRP. No side-effects were noted during treatment. Conclusions This pilot study, which is the first to investigate the effects of PRP on AA, suggests that PRP may serve as a safe and effective treatment option in AA, and calls for more extensive controlled studies with this method

Multi- and unisensory decoding of words and nonwords result in differential brain responses in dyslexic and nondyslexic adults

The present functional magnetic resonance imaging (fMRI) study was designed, in order to investigate the neural substrates involved in the audiovisual processing of disyllabic German words and pseudowords. Twelve dyslexic and 13 nondyslexic adults performed a lexical decision task while stimuli were presented unimodally (either aurally or visually) or bimodally (audiovisually simultaneously). The behavioral data collected during the experiment evidenced more accurate processing for bimodally than for unimodally presented stimuli irrespective of group. Words were processed faster than pseudowords. Notably, no group differences have been found for either accuracy or for reaction times. With respect to brain responses, nondyslexic compared to dyslexic adults elicited stronger hemodynamic responses in the leftward supramarginal gyrus (SMG), as well as in the right hemispheric superior temporal sulcus (STS). Furthermore, dyslexic compared to nondyslexic adults showed reduced responses to only aurally presented signals and enhanced hemodynamic responses to audiovisual, as well as visual stimulation in the right anterior insula. Our behavioral results evidence that the two groups easily identified the two-syllabic proper nouns that we provided them with. Our fMRI results indicate that dyslexics show less neuronal involvement of heteromodal and extrasylvian regions, namely, the STS, SMG, and insula when decoding phonological information. We posit that dyslexic adults evidence deficient functioning of word processing, which could possibly be attributed to deficits in phoneme to grapheme mapping. This problem may be caused by impaired audiovisual processing in multimodal areas

A systematic review of the effectiveness, compliance, and critical factors for implementation of safety checklists in surgery

OBJECTIVE: : A systematic literature review was conducted to assess the effectiveness of, compliance with, and critical factors for the implementation of safety checklists in surgery. BACKGROUND: : With the aim of increasing patient safety, checklists have gained growing attention. Information about effectiveness, compliance, and critical factors for implementation is crucial for whether and which of the available instruments to use. DATA SOURCES: : Medline including Premedline (OvidSP), Embase, and Cochrane Collaboration Library, hand search, a search of reference lists of key articles, and tables of content. STUDY SELECTION: : Electronic databases returned 4997 citations, of which 84 articles were chosen for full-text review. Finally, 22 articles were included in this review. DATA EXTRACTION: : Data relating to care setting, study methods and design, sample population, survey response rate, type of checklist, aim, effectiveness, compliance, attitudes, and critical factors were extracted from the studies. A random effects meta-analysis of effectiveness data was conducted if 2 or more studies reported a specified outcome. RESULTS: : With the use of checklists, the relative risk for mortality is 0.57 [95% confidence interval (CI): 0.42-0.76] and for any complications 0.63 (95% CI: 0.58-0.67). The overall compliance rate ranged from 12% to 100% (mean: 75%) and for the Time Out from 70% to 100% (mean: 91%). CONCLUSIONS: : Checklists are effective and economic tools that decrease mortality and morbidity. Compliance of surgical staff with checklists was good overall. Further research in particular relating to implementation is needed

Climate change and mine reclamation in British Columbia

Since the mid-1900s, mining projects have progressively increased in disturbance area, leading to larger project footprints, and mines with longer lifespans or project durations. Some of the major mines operating in British Columbia began modern mining in the 1960s and are anticipated to be active for as long as eighty years. Local, regional, and global climates have already changed since the inception of such long-term projects, and will continue to change as mines approach closure. Historically, reclamation and closure plans for these mines have been designed with the assumption that abiotic environmental conditions and biological communities are static, but these assumptions are no longer considered valid, and there may be additional risks to mining operations and closure if the influence of a changing climate is not explicitly considered in reclamation planning. With the cumulative area of disturbance caused by major mines in British Columbia over 50,000 hectares, it is necessary to ensure that reclamation approaches, regulations, policies, and objectives consider the implications of climate change, and are directed by quantitative and ecologically relevant metrics of success. The BC Ministry of Energy, Mines and Low Carbon Innovation is in the process of developing reclamation guidance with a focus on the design of end land use and capability objectives based on pre-mining and reference conditions as well as future climatic scenarios, supporting the integration of climate adaptation into reclamation planning. This paper presents information on current tools and approaches available to support reclamation practitioners in designing for a changing climate. In addition, we discuss some of the key challenges—and potential solutions—that climate change introduces to reclamation practice, including, but not limited to, designing and planning prescriptions with shifting climates in mind as well as the inclusion of ecological and climate relevant metrics-of-success within ecosystem capability objectives for closure.Non UBCUnreviewedOthe

Reliability and statistical power analysis of cortical and subcortical FreeSurfer metrics in a large sample of healthy elderly

FreeSurfer is a tool to quantify cortical and subcortical brain anatomy automatically and noninvasively. Previous studies have reported reliability and statistical power analyses in relatively small samples or only selected one aspect of brain anatomy. Here, we investigated reliability and statistical power of cortical thickness, surface area, volume, and the volume of subcortical structures in a large sample (N = 189) of healthy elderly subjects (64 + years). Reliability (intraclass correlation coefficient) of cortical and subcortical parameters is generally high (cortical: ICCs > 0.87, subcortical: ICCs > 0.95). Surface-based smoothing increases reliability of cortical thickness maps, while it decreases reliability of cortical surface area and volume. Nevertheless, statistical power of all measures benefits from smoothing. When aiming to detect a 10% difference between groups, the number of subjects required to test effects with sufficient power over the entire cortex varies between cortical measures (cortical thickness: N = 39, surface area: N = 21, volume: N = 81; 10 mm smoothing, power = 0.8, α = 0.05). For subcortical regions this number is between 16 and 76 subjects, depending on the region. We also demonstrate the advantage of within-subject designs over between-subject designs. Furthermore, we publicly provide a tool that allows researchers to perform a priori power analysis and sensitivity analysis to help evaluate previously published studies and to design future studies with sufficient statistical power

Using the theory of planned behaviour to model antecedents of surgical checklist use: a cross-sectional study.

BACKGROUND Compliance with surgical checklist use remains an obstacle in the context of checklist implementation programs. The theory of planned behaviour was applied to analyse attitudes, perceived behaviour control, and norms as psychological antecedents of individuals' intentions to use the checklist. METHODS A cross-sectional survey study with staff (N = 866) of 10 Swiss hospitals was conducted in German and French. Group mean differences between individuals with and without managerial function were computed. Structural equation modelling and confirmatory factor analysis was applied to investigate the structural relation between attitudes, perceived behaviour control, norms, and intentions. RESULTS Significant mean differences in favour of individuals with managerial function emerged for norms, perceived behavioural control, and intentions, but not for attitudes. Attitudes and perceived behavioural control had a significant direct effect on intentions whereas norms had not. CONCLUSIONS Individuals with managerial function exhibit stronger perceived behavioural control, stronger norms, and stronger intentions. This could be applied in facilitating checklist implementation. The structural model of the theory of planned behaviour remains stable across groups, indicating a valid model to describe antecedents of intentions in the context of surgical checklist implementation