The Effects of Stress Mindset, Manipulated Through Serious Game Intervention, on Performance and Situation Awareness of Elite Female Football Players in the Context of a Match:An Experimental Study

Background: Performance levels in football are ever more important and no longer are just physical, technical, and tactical skills, the ones that make an athlete stand out. Cognitive variables, such as stress-coping, become more important and seem to be explaining differences in performance, for example, through reaching an optimal level of arousal. In addition, it is suggested that stress-coping skills also affect situation awareness (SA), important for decision-making in the complex and dynamic situations in football. Objective: This study was conducted to examine how stress-coping skills, such as stress mindset, affect performance and SA in the context of a football match. Methods: Twenty elite female football players participated in the study. The final sample size consisted of 15 players for the Stress Mindset Measure (SMM) analysis and 8 players for the multilevel model analyses. Two types of intervention were used to manipulate stress mindset and control over heart rate variability (HRV); a serious game called "Stressjam,"and a reflection tool called "Brainjam."Questionnaires for stress mindset and SA and video analysis for performance were used. A total of three matches were assessed. Results: The "Stressjam"intervention resulted in significant differences in stress mindset throughout the intervention [F(1,5) = 7.357, P = 0.008]. Subsequently, multilevel analysis showed a positive, strong, and significant correlation between stress mindset, manipulated through "Stressjam"and SA [r(14) = 0.69, P = 0.014]. A correlation of practical interest, given the confidence intervals, was found between stress mindset, manipulated through "Stressjam,"and performance. Conclusion: Cognitive variables, such as stress-coping, correlate significantly with SA in football. A correlation of practical interest was found between stress-coping and performance. Further research is needed to study the relationship between stress-coping and performance in football.</p

Qualitative development and content validation of the "SPART" model:a focused ethnography study of observable diagnostic and therapeutic activities in the emergency medical services care process

Abstract Background Clinical reasoning is a crucial task within the Emergency Medical Services (EMS) care process. Both contextual and cognitive factors make the task susceptible to errors. Understanding the EMS care process’ structure could help identify and address issues that interfere with clinical reasoning. The EMS care process is complex and only basically described. In this research, we aimed to define the different phases of the process and develop an overarching model that can help detect and correct potential error sources, improve clinical reasoning and optimize patient care. Methods We conducted a focused ethnography study utilizing non-participant video observations of real-life EMS deployments combined with thematic analysis of peer interviews. After an initial qualitative analysis of 7 video observations, we formulated a tentative conceptual model of the EMS care process. To test and refine this model, we carried out a qualitative, thematic analysis of 28 video-recorded cases. We validated the resulting model by evaluating its recognizability with a peer content analysis utilizing semi-structured interviews. Results Based on real-life observations, we were able to define and validate a model covering the distinct phases of an EMS deployment. We have introduced the acronym “SPART” to describe ten different phases: Start, Situation, Prologue, Presentation, Anamnesis, Assessment, Reasoning, Resolution, Treatment, and Transfer. Conclusions The “SPART” model describes the EMS care process and helps to understand it. We expect it to facilitate identifying and addressing factors that influence both the care process and the clinical reasoning task embedded in this process

Circadian variation of plasminogen-activator-inhibitor-1 levels in children with meningococcal sepsis

Objective To study whether the circadian variation of plasminogen-activator-inhibitor-1 (PAI-1) levels, with high morning levels, is associated with poor outcome of children with meningococcal sepsis presenting in the morning hours. Design Retrospective analysis of prospectively collected clinical and laboratory data. Setting Single center study at Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands. Subjects 184 patients aged 3 weeks to 18 years with meningococcal sepsis. In 36 of these children, PAI-1 levels at admission to the PICU were measured in plasma by ELISA. Interventions None. Measurements and main results Circadian variation was studied by dividing one day in blocks of 6 hours. Patients admitted between 6:00 am and 12:00 am had increased illness severity scores and higher PAI-1 levels (n = 9, median 6912 ng/mL, IQR 5808-15600) compared to patients admitted at night (P = 0.019, n = 9, median 3546 ng/mL, IQR 1668-6118) or in the afternoon (P = 0.007, n = 7, median 4224 ng/mL, IQR 1804-5790). In 184 patients, analysis of circadian variation in relation to outcome showed more deaths, amputations and need for skin grafts in patients admitted to the PICU between 6:00 am and 12:00 am than patients admitted during the rest of the day (P = 0.009). Conclusions Circadian variation of PAI-1 levels is present in children with meningococcal sepsis and is associated with illness severity, with a peak level in the morning. Whether circadian variation is an independent risk factor for morbidity and mortality in meningococcal sepsis needs to be explored in future studies

Explicit teaching in the operating room:Adding the why to the what

CONTEXT: Residents need their supervisors in the operating room to inform them on how to use their expertise in present and future occasions. A few studies hint at such explicit teaching behaviour, however without explaining its underlying mechanisms. Understanding and improving explicit teaching becomes more salient nowadays, as access of residents to relevant procedures is decreasing, while end-terms of training programs remain unchanged: high quality patient care. OBJECTIVES: A structured analysis of 1. The practices supervisors use for explicit teaching and 2. How supervisors introduce explicit teaching in real time during surgical procedures. METHODS: An observational qualitative collection study in which all actions of nine supervisor-resident dyads during a total hip replacement procedure were videotaped. Interactions in which supervisors explicitly or implicitly inform residents how to use their expertise now and in future occasions were included for further analysis, using the iterative inductive process of conversation analysis. RESULTS: 1. Supervisors used a basic template of if/then rules for explicit teaching, which they regularly customized by adding metaphors, motivations, and information about preference, prevalence and consequence. 2. If/then rules are introduced by supervisors to solve a (potential) problem in outcome for the present patient in reaction to local circumstances, e.g. what residents said, did or were about to do. CONCLUSIONS: If/then rules add the why to the what. Supervisors upgrade residents' insights in surgical procedures (professional vision) and teach the degree of individual freedom and variation of their expert standards for future occasions. These insights can be beneficial in improving supervisors' teaching skills

Machine learning in anesthesiology:Detecting adverse events in clinical practice

The credibility of threshold-based alarms in anesthesia monitors is low and most of the warnings they produce are not informative. This study aims to show that Machine Learning techniques have a potential to generate meaningful alarms during general anesthesia without putting constraints on the type of procedure. Two distinct approaches were tested - Complication Detection and Anomaly Detection. The former is a generic supervised learning problem and for this a simple feed-forward Neural Network performed best. For the latter, we used an Encoder-Decoder Long Short-Term Memory architecture that does not require a large manually-labeled dataset. We show this approach to be more flexible and in the spirit of Explainable Artificial Intelligence, offering greater potential for future improvement

Quality of life and behavioral functioning in Dutch pediatric patients with hereditary spherocytosis

The objective of this study was to evaluate health-related quality of life (HRQoL) and behavioral functioning in pediatric patients with hereditary spherocytosis (HS). A cross-sectional study was conducted in 132 Dutch children and adolescents with HS and aged 8-18 years of whom 48 underwent splenectomy prior to the study. HRQoL was assessed using the KIDSCREEN-27, and behavioral functioning was evaluated using the strength and difficulties questionnaire (SDQ). Scores of pediatric patients with HS were compared to a Dutch norm population. Additionally, the effects of three factors were assessed: fatigue, self-image, and parents' perceived vulnerability (measured with the checklist individual strength, the self-perception profile for children and adolescents, and the child vulnerability scale). Both unsplenectomised and splenectomised pediatric patients reported lower HRQoL on the domain physical well-being (KIDSCREEN-27) compared to Dutch peers. For behavioral functioning, parents of both groups reported more emotional problems (SDQ) compared to the norm population. Pediatric patients with lower scores on physical well-being experienced more fatigue. The patients' perceived social acceptance and parents' perceived vulnerability appeared as determinants of emotional problems. Conclusion: Pediatric patients in the current study generally report few complaints, and the results suggest that these patients overall have a strong ability to cope with HS. Despite these few complaints, fatigue and parents' perceived vulnerability seem to be important determinants for lower HRQoL and more emotional problems. Therefore, screening on these factors could serve as an addition to the treatment of HS, to help pediatric patients who are at risk for lower HRQoL or more emotional problems

Ethical aspects of hemophilia gene therapy:a qualitative interview study with stakeholders

Background: There are great expectations for the potential role of gene therapy in the treatment of hemophilia. At the same time, developments in the field of hemophilia gene therapy have always raised ethical issues. It remains unknown how these ethical issues are perceived by stakeholders, particularly regarding the most recent developments in the field. Objectives: To obtain insight into stakeholders’ morally reasoned opinions on gene therapy for hemophilia. Methods: We conducted qualitative research with Dutch people with hemophilia (n = 13), parents of children with hemophilia (n = 5), physicians (n = 4), nurses (n = 3), a regulator (n = 1), and a representative from a pharmaceutical company (n = 1). We conducted semistructured interviews based on a topic list and reported the results according to the Consolidated Criteria for Reporting Qualitative Research guidelines. Results: We identified 3 main themes. The theme freedom and independence describes the hope people with hemophilia have of increasing their freedom through gene therapy, as well as concerns that gene therapy increases their dependence on their treatment center. The theme trust and altruism describes how people with hemophilia have a high level of trust in their physician and treatment center as well as in scientific research. As a result of this trust, they are willing to participate in research to help other people with hemophilia. The theme incremental benefits describes doubts respondents have about the added value of gene therapy compared to standard treatment. Conclusion: Stakeholders embrace the theoretical potential of gene therapy, while several people with hemophilia question the added value of the current gene transfer products for themselves.</p

Self-infusion of prophylaxis: Evaluating the quality of its performance and time needed

Prophylactic replacement therapy is the cornerstone of treatment in severe haemophilia. Regular infusions with clotting factor concentrate have been proven effective to prevent bleeding, subsequent (joint) damage, and positively affect the impact of haemophilia on daily life [1]. Patients or parents of younger patients learn to infuse clotting factor concentrate in a peripheral vein (i.v.) or a central venous access device (CVAD) [2]