Monitoring the performance of residents during training in off-pump coronary surgery.

OBJECTIVE: Control charts (eg, cumulative sum charts) plot changes in performance with time and can alert a surgeon to suboptimal performance. They were used to compare performance of off-pump coronary artery bypass surgery between a consultant and four resident surgeons and to compare performance of off-pump coronary artery bypass surgery and conventional coronary artery bypass grafting within surgeons. METHODS: Data were analyzed for consecutive patients undergoing coronary artery bypass grafting who were operated on by one consultant or one of four residents. Conversions were analyzed by intention to treat. Perioperative death or one or more of 10 adverse events constituted failure. Predicted risks of failure for individual patients were derived from the study population. Variable life-adjusted displays and risk-adjusted sequential probability ratio test charts were plotted. RESULTS: Data for 1372 patients were analyzed; 769 of the procedures were off-pump coronary artery bypass operations (56.0%). The consultant operated on 382 patients (293 off-pump, 76.7%), and the residents operated on 990 (474 off-pump, 47.9%). Patients operated on by residents tended to be older, more obese, more likely to require an urgent operation, and more likely to need a circumflex artery graft but less likely to have triple-vessel disease. There were 7 conversions (consultant 5, residents 2). The overall failure rate was 8.5% (9.2% for consultant's operations and 8.2% for residents' operations), including 10 deaths (0.7%). Predicted and observed risks of failure were similar for all five surgeons. After 100 off-pump coronary artery bypass operations, performance was the same or better for the residents as for the consultant. For all surgeons, performance was the same or better for off-pump as for conventional coronary artery bypass grafting. CONCLUSIONS: Off-pump coronary artery bypass surgery can be safely taught to cardiothoracic residents. Implementation of continuous performance monitoring for residents is practicable

Female political representation and the gender health gap: a cross-national analysis of 49 European countries

BACKGROUND: Does increased female participation in the social and political life of a country improve health? Social participation may improve health because it ensures that the concerns of all people are heard by key decision-makers. More specifically, when women's social participation increases this may lead to health gains because women are more likely to vote for leaders and lobby for policies that will enhance the health of everyone. This article tries to examine whether female participation is correlated with measures of health inequality. METHODS: We draw on data from the World Health Organization Health Equity Status Report initiative and the Varieties of Democracy project to assess whether health is better and health inequalities are smaller in countries where female political representation is greater. RESULTS: We find consistent evidence that greater female political representation is associated with lower geographical inequalities in infant mortality, smaller inequalities in self-reported health (for both women and men) and fewer disability-adjusted life-years lost for women and men. Finally, we find that greater female political representation is not only correlated with better health for men and women but is also correlated with a smaller gap between men and women because men seem to experience better health in such contexts. CONCLUSIONS: Greater female political representation is associated with better health for everyone and smaller inequalities

On why the Iron K-shell absorption in AGN is not a signature of the local Warm/Hot Intergalactic Medium

We present a comparison between the 2001 XMM-Newton and 2005 Suzaku observations of the quasar, PG1211+143 at z=0.0809. Variability is observed in the 7 keV iron K-shell absorption line (at 7.6 keV in the quasar frame), which is significantly weaker in 2005 than during the 2001 XMM-Newton observation. From a recombination timescale of <4 years, this implies an absorber density n>0.004 particles/cm3, while the absorber column is 5e22<N_H <1 1e24 particles/cm2. Thus the sizescale of the absorber is too compact (pc scale) and the surface brightness of the dense gas too high (by 9-10 orders of magnitude) to arise from local hot gas, such as the local bubble, group or Warm/Hot Intergalactic Medium (WHIM), as suggested by McKernan et al. (2004, 2005). Instead the iron K-shell absorption must be associated with an AGN outflow with mildly relativistic velocities. Finally we show that the the association of the absorption in PG1211+143 with local hot gas is simply a coincidence, the comparison between the recession and iron K absorber outflow velocities in other AGN does not reveal a one to one kinematic correlation.Comment: accepted for publication in MNRAS LETTERS. 5 pages, 4 figure

Case Study: Double J Dairy

The case presents the history and current operations of the Double J Dairy, a large scale (milking about 4,300 cows) dairy farm in the Central Valley of California. The case discusses continuing issues with water, labor and environmental regulations

THE EFFECT OF MUSCLE STRENGTH NORMALIZATION PROCEEDURES ON DECISIONS TO RETURN TO SPORT

The objective of this study was to evaluate different methods of normalizing and reporting muscle strength for making decisions about return to sport following an anterior cruciate ligament injury. 42 participants performed 5 isometric knee extensions on an isokinetic dynamometer. The peak force as well as the rate of torque development were determined and expressed either as the average of 4 trials or the peak value. In addition, the limb symmetry index was determined for each condition and compared. Using the peak method resulted in significantly higher values (

Interprofessional simulated learning: short-term associations between simulation and interprofessional collaboration

<p>Abstract</p> <p>Background</p> <p>Health professions education programs use simulation for teaching and maintaining clinical procedural skills. Simulated learning activities are also becoming useful methods of instruction for interprofessional education. The simulation environment for interprofessional training allows participants to explore collaborative ways of improving communicative aspects of clinical care. Simulation has shown communication improvement within and between health care professions, but the impacts of teamwork simulation on perceptions of others' interprofessional practices and one's own attitudes toward teamwork are largely unknown.</p> <p>Methods</p> <p>A single-arm intervention study tested the association between simulated team practice and measures of interprofessional collaboration, nurse-physician relationships, and attitudes toward health care teams. Participants were 154 post-licensure nurses, allied health professionals, and physicians. Self- and proxy-report survey measurements were taken before simulation training and two and six weeks after.</p> <p>Results</p> <p>Multilevel modeling revealed little change over the study period. Variation in interprofessional collaboration and attitudes was largely attributable to between-person characteristics. A constructed categorical variable indexing 'leadership capacity' found that participants with highest and lowest values were more likely to endorse shared team leadership over physician centrality.</p> <p>Conclusion</p> <p>Results from this study indicate that focusing interprofessional simulation education on shared leadership may provide the most leverage to improve interprofessional care.</p

Approaches to multiplicity in publicly funded pragmatic randomised controlled trials:a survey of clinical trials units and a rapid review of published trials

BACKGROUND: Opinions and practices vary around the issue of performing multiple statistical tests in randomised controlled trials (RCTs). We carried out a study to collate information about opinions and practices using a methodological rapid review and a survey, specifically of publicly funded pragmatic RCTs that are not seeking marketing authorisation. The aim was to identify the circumstances under which researchers would make a statistical adjustment for multiplicity. METHODS: A review was performed extracting information from articles reporting primary analyses of pragmatic RCTs in one of seven high quality medical journals, in January to June (inclusive) 2018. A survey (Survey Monkey) eliciting opinions and practices around multiplicity was distributed to the 47 registered clinical trials units (CTUs) in the UK. RESULTS: One hundred and thirty-eight RCTs were included in the review, and survey responses were received from 27/47 (57%) CTUs. Both the review and survey indicated that adjusting for multiplicity was considered most important for multiple treatment comparisons; adjustment was performed for 11/23 (48%) published trials, and 24/27 (89%) CTU statisticians reported they would consider adjustment. Opinions and practices varied around adjustment for multiplicity arising from multiple primary outcomes and interim analyses. Adjustment was considered less important for multiplicity due to multiple secondary outcomes (adjustment performed for 17/136 [13%] published trials and 3/27 [11%] CTU statisticians would consider adjustment) and subgroup analyses (8/85 [9%] published trials adjusted and 6/27 CTU [22%] statisticians would consider adjustment). CONCLUSIONS: There is variation in opinions about adjustment for multiplicity among both statisticians reporting RCTs and applied statisticians working in CTUs. Further guidance is needed on the circumstances in which adjustment should be considered in relation to primary trial hypotheses, and if there are any situations in which adjustment would be recommended in the context of secondary analyses. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12874-022-01525-9

Preliminary clinical evaluation: The What/Where/How (WWH) approach to scoring.

The SCoR is driving for preliminary clinical evaluation (PCE) however; currently there is no method of quantification to assess quality. FRCR has an approach to quantify comments in the rapid reporting examination (CR2B).The aim of this project was to develop a robust scoring system that enables comprehensive image evaluation regardless of profession. An image test bank was administered using RadBench with equal prevalence of normal /abnormal. A random sample of attempts was selected to pilot the scoring model. Sensitivity, specificity and accuracy were calculated. A scoring system (WWH) was developed based on the WHAT (fracture type), WHERE (location), HOW (displacement/angulation) concept (Harcus & Wright 2014) to evaluate the PCE. The results were compared to those obtained using the FRCR model. Calculated actual mean accuracy, sensitivity and specificity scores were 87%, 80% and 93% respectively. FRCR scores were 88%, 80% and 97%. WWH scores were 65%, 37%, and 93%. The FRCR score appears to mirror the actual decision scores however it does not reflect the fact that the PCE for abnormal cases is often incomplete; 'What' 67%, 'Where' 87%, 'How' 7%. The PCE score should ideally correlate with the actual score in order to provide useful information to the referring clinician. Whilst most comments state the location, less states the type, and very few refer to angulation or displacement. Analysis of the PCE is a useful indicator for targeting professional development. The sam

Supporting group interactions in museum visiting

Ethnographic study in two contrasting museums highlights a widespread but rarely documented challenge for CSCW design. Visitors' engagement with exhibits often ends prematurely due to the need to keep up with or attend to fellow group members. We unpack the mechanics of these kinds of phenomena revealing how the behaviours of summoning, pressurizing, herding, sidelining, and rounding up, lead to the responses of following, skimming and digging in. We show how the problem is especially challenging where young children are involved. As an initial prompt we explore two ways in which CSCW could help address this challenge: enabling a more fluid association between information and exhibits; and helping reconfigure the social nature of visiting