Patient safety culture improvements depend on basic healthcare education:a longitudinal simulation-based intervention study at two Danish hospitals

BACKGROUND: A growing body of evidence supports the existence of an association between patient safety culture (PSC) and patient outcomes. PSC refers to shared perceptions and attitudes towards norms, policies and procedures related to patient safety. Existing literature shows that PSC varies among health professionals depending on their specific profession and specialty. However, these studies did not investigate whether PSC can be improved. This study investigates whether length of education is associated with improvements in PCS following a simulation intervention. METHODS: From April 2017 to November 2018, a cross-sectional intervention study was conducted at two regional hospitals in Denmark. Two groups with altogether 1230 health professionals were invited to participate. One group included nurses, midwives and radiographers; the other group included doctors. A train-the-trainer intervention approach was applied consisting of a 4-day simulation instructor course that emphasised team training, communication and leadership. Fifty-three healthcare professionals were trained as instructors. After the course, instructors performed in situ simulation in their own hospital environment. OUTCOMES: The Safety Attitude Questionnaire (SAQ), which has 6 dimensions and 32 items, was used to collect main outcome variables. All employees from both groups were surveyed before the intervention and again four and nine months after the intervention. RESULTS: Mean baseline scores were higher among doctors than among nurses, midwives and radiographers for all SAQ dimensions. At the second follow-up, four of six dimensions improved significantly (p ≤ 0.05) among nurses, midwives and radiographers, whereas no dimensions improved significantly among doctors. CONCLUSION: Over time, nurses, midwives and radiographers improved more in PSC attitudes than doctors did

A critical evaluation of computational mechanisms of binocular disparity processing

The past decades of research in visual neuroscience have generated a large and disparate body of literature on the computation of binocular disparity in the primary visual cortex. Models have been proposed to describe specific phenomena, yet we lack a theoretical framework which is grounded in neurophysiology and also explains the effectiveness of disparity computation. Here, we examine neural circuits that are thought to play an important role in the computation of binocular disparity. Starting with the binocular energy model (Ohzawa et al. 1990), we consider plausible extensions which include suppressive mechanisms from units tuned to different phase disparities (Tanabe et al. 2011), which is formerly theorized to perform false disparity detection (Read & Cumming 2007) as well as coarse-to-fine (Menz & Freeman 2004a,b) and recurrent processing (Samonds et al. 2013). We rigorously cross-examine the consistency of these circuits with neurophysiology data including ocular dominance and binocular modulation (Ohzawa & Freeman 1990), spike-triggered analysis and temporal dynamics of disparity tuning (Tanabe et al. 2011) and attenuation to anti-correlated stimuli (Cumming & Parker 1997; Tanabe et al. 2011). We further evaluate the ability of the resulting computational models to recover depth, both theoretically and experimentally, using a dataset of natural and synthetic images. Overall, we find that a computational model which combines suppressive mechanisms by units with non-zero phase disparity, contrast normalization as well as lateral interaction between units tuned to specific combinations of phase and position disparities, seems consistent with all of the available V1 neurophysiology data and achieves the highest accuracy in real-world depth computation

Development and validation of a simulation-based assessment tool in colonoscopy

Abstract Background Colonoscopy is difficult to learn. Virtual reality simulation training is helpful, but how and when novices should progress to patient-based training has yet to be established. To date, there is no assessment tool for credentialing novice endoscopists prior to clinical practice. The aim of this study was to develop such an assessment tool based on metrics provided by the simulator. The metrics used for the assessment tool should be able to discriminate between novices, intermediates, and experts and include essential checklist items for patient safety. Methods The validation process was conducted based on the Standards for Educational and Psychological Testing. An expert panel decided upon three essential checklist items for patient safety based on Lawshe’s method: perforation, hazardous tension to the bowel wall, and cecal intubation. A power calculation was performed. In this study, the Simbionix GI Mentor II simulator was used. Metrics with discriminatory ability were identified with variance analysis and combined to form an aggregate score. Based on this score and the essential items, pass/fail standards were set and reliability was tested. Results Twenty-four participants (eight novices, eight intermediates, and eight expert endoscopists) performed two simulated colonoscopies. Four metrics with discriminatory ability were identified. The aggregate score ranged from 4.2 to 51.2 points. Novices had a mean score of 10.00 (SD 5.13), intermediates 24.63 (SD 7.91), and experts 30.72 (SD 11.98). The difference in score between novices and the other two groups was statistically significant (p<0.01). Although expert endoscopists had a higher score, the difference was not statistically significant (p=0.40). Reliability was good (Cronbach’s alpha=0.86). A pass/fail score was defined at 17.1 points with correct completion of three essential checklist items, resulting in three experts and three intermediates failing and one novice passing the assessment. Conclusion We established a valid and reliable assessment tool with a pass/fail standard on the simulator. We suggest using the assessment after simulation-based training before commencing work-based learning