758 research outputs found
The Impact of Task- and Team-Generic Teamwork Skills Training on Team Effectiveness
This study examined the effects of training team members in three task- and teamgeneric teamwork skills: planning and task coordination, collaborative problem solving, and communication. We first examined the degree to which task- and team-generic teamwork skills training impacted team performance on a task unrelated to the content of the training program.We then examined whether the effects of task- and team-generic teamwork skills training on team performance were due to the transfer of skills directly related to planning and task coordination, collaborative problem solving, and communication. Results from 65 four-person project teams indicated that task- and team-generic teamwork skills training led to significantly higher levels of team performance. Results also indicated that the effects of task- and teamgeneric teamwork skills training on team performance were mediated by planning and task coordination and collaborative problem solving behavior. Although communication was positively affected by the task- and team-generic teamwork skills training, it did not mediate the relationship between task- and team-generic teamwork skills training and team performance.Theoretical and practical implications of these results are discussed, as well as possible limitations and directions for future research
Opioid dose and risk of suicide
Chronic pain is associated with increased risk of suicide, and opioids are commonly used to treat moderate to severe pain. However, the association between opioid dose and suicide mortality has not been examined closely. This retrospective data analysis described the risk of suicide associated with differing prescribed opioid doses. Data were from Veterans Affairs health care system treatment records and the National Death Index. Records analyzed were those of Veterans Affairs patients with chronic pain receiving opioids in fiscal years 2004 to 2005 (N = 123,946). Primary predictors were maximum prescribed morphine-equivalent daily opioid dose and opioid fill type. The main outcome measured was suicide death, by any mechanism, and intentional overdose death during 2004 to 2009. Controlling for demographic and clinical characteristics, higher prescribed opioid doses were associated with elevated suicide risk. Compared with those receiving ≤20 milligrams/day (mg/d), hazard ratios were 1.48 (95% confidence intervals [CI], 1.25-1.75) for 20 to <50 mg/d, 1.69 (95% CI, 1.33-2.14) for 50 to <100 mg/d, and 2.15 (95% CI, 1.64-2.81) for 100+ mg/d. The magnitude of association between opioid dose and suicide by intentional overdose was not substantially different from that observed for the overall measure of suicide mortality. Risk of suicide mortality was greater among individuals receiving higher doses of opioids, and treatment providers may want to view high opioid dose as a marker of elevated risk for suicide. Additional research is needed on opioid use, pain treatment, and suicide
Specialty substance use disorder services following brief alcohol intervention: a meta‐analysis of randomized controlled trials
Background and aimsBrief alcohol interventions in medical settings are efficacious in improving self‐reported alcohol consumption among those with low‐severity alcohol problems. Screening, Brief Intervention and Referral to Treatment initiatives presume that brief interventions are efficacious in linking patients to higher levels of care, but pertinent evidence has not been evaluated. We estimated main and subgroup effects of brief alcohol interventions, regardless of their inclusion of a referral‐specific component, in increasing the utilization of alcohol‐related care.MethodsA systematic review of English language papers published in electronic databases to 2013. We included randomized controlled trials (RCTs) of brief alcohol interventions in general health‐care settings with adult and adolescent samples. We excluded studies that lacked alcohol services utilization data. Extractions of study characteristics and outcomes were standardized and conducted independently. The primary outcome was post‐treatment alcohol services utilization assessed by self‐report or administrative data, which we compared across intervention and control groups.ResultsThirteen RCTs met inclusion criteria and nine were meta‐analyzed (n = 993 and n = 937 intervention and control group participants, respectively). In our main analyses the pooled risk ratio (RR) was = 1.08, 95% confidence interval (CI) = 0.92–1.28. Five studies compared referral‐specific interventions with a control condition without such interventions (pooled RR = 1.08, 95% CI = 0.81–1.43). Other subgroup analyses of studies with common characteristics (e.g. age, setting, severity, risk of bias) yielded non‐statistically significant results.ConclusionsThere is a lack of evidence that brief alcohol interventions have any efficacy for increasing the receipt of alcohol‐related services.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/112279/1/add12950.pd
Revisiting our review of Screening, Brief Intervention and Referral to Treatment (SBIRT): meta‐analytical results still point to no efficacy in increasing the use of substance use disorder services
Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152618/1/add13146.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152618/2/add13146_am.pd
Managing the complexity of doing it all : an exploratory study on students' experiences when trained stepwise in conducting consultations
Background: At most medical schools the components required to conduct a consultation, medical knowledge, communication, clinical reasoning and physical examination skills, are trained separately. Afterwards, all the knowledge and skills students acquired must be integrated into complete consultations, an art that lies at the heart of the medical profession. Inevitably, students experience conducting consultations as complex and challenging. Literature emphasizes the importance of three didactic course principles: moving from partial tasks to whole task learning, diminishing supervisors' support and gradually increasing students' responsibility. This study explores students' experiences of an integrated consultation course using these three didactic principles to support them in this difficult task.
Methods: Six focus groups were conducted with 20 pre-clerkship and 19 clerkship students in total. Discussions were audiotaped, transcribed and analysed by Nvivo using the constant comparative strategy within a thematic analysis.
Results: Conducting complete consultations motivated students in their learning process as future physician. Initially, students were very much focused on medical problem solving. Completing the whole task of a consultation obligated them to transfer their theoretical medical knowledge into applicable clinical knowledge on the spot. Furthermore, diminishing the support of a supervisor triggered students to reflect on their own actions but contrasted with their increased appreciation of critical feedback. Increasing students' responsibility stimulated their active learning but made some students feel overloaded. These students were anxious to miss patient information or not being able to take the right decisions or to answer patients' questions, which sometimes resulted in evasive coping techniques, such as talking faster to prevent the patient asking questions.
Conclusion: The complex task of conducting complete consultations should be implemented early within medical curricula because students need time to organize their medical knowledge into applicable clinical knowledge. An integrated consultation course should comprise a step-by-step teaching strategy with a variety of supervisors' feedback modi, adapted to students' competence. Finally, students should be guided in formulating achievable standards to prevent them from feeling overloaded in practicing complete consultations with simulated or real patients
Data for improvement and clinical excellence: protocol for an audit with feedback intervention in long-term care
<p>Abstract</p> <p>Background</p> <p>There is considerable evidence about the effectiveness of audit coupled with feedback, although few audit with feedback interventions have been conducted in long-term care (LTC) settings to date. In general, the effects have been found to be modest at best, although in settings where there has been little history of audit and feedback, the effects may be greater, at least initially. The primary purpose of the Data for Improvement and Clinical Excellence (DICE) Long-Term Care project is to assess the effects of an audit with feedback intervention delivered monthly over 13 months in four LTC facilities. The research questions we addressed are:</p> <p indent="1">1. What effects do feedback reports have on processes and outcomes over time?</p> <p indent="1">2. How do different provider groups in LTC and home care respond to feedback reports based on data targeted at improving quality of care?</p> <p>Methods/design</p> <p>The research team conducting this study comprises researchers and decision makers in continuing care in the province of Alberta, Canada. The intervention consists of monthly feedback reports in nine LTC units in four facilities in Edmonton, Alberta. Data for the feedback reports comes from the Resident Assessment Instrument Minimum Data Set (RAI) version 2.0, a standardized instrument mandated for use in LTC facilities throughout Alberta. Feedback reports consist of one page, front and back, presenting both graphic and textual information. Reports are delivered to all staff working in the four LTC facilities. The primary evaluation uses a controlled interrupted time series design both adjusted and unadjusted for covariates. The concurrent process evaluation uses observation and self-report to assess uptake of the feedback reports. Following the project phase described in this protocol, a similar intervention will be conducted in home care settings in Alberta. Depending on project findings, if they are judged useful by decision makers participating in this research team, we plan dissemination and spread of the feedback report approach throughout Alberta.</p
Optimal precision and accuracy in 4Pi-STORM using dynamic spline PSF models
Coherent fluorescence imaging with two objective lenses (4Pi detection) enables single-molecule localization microscopy with sub-10 nm spatial resolution in three dimensions. Despite its outstanding sensitivity, wider application of this technique has been hindered by complex instrumentation and the challenging nature of the data analysis. Here we report the development of a 4Pi-STORM microscope, which obtains optimal resolution and accuracy by modeling the 4Pi point spread function (PSF) dynamically while also using a simpler optical design. Dynamic spline PSF models incorporate fluctuations in the modulation phase of the experimentally determined PSF, capturing the temporal evolution of the optical system. Our method reaches the theoretical limits for precision and minimizes phase-wrapping artifacts by making full use of the information content of the data. 4Pi-STORM achieves a near-isotropic three-dimensional localization precision of 2–3 nm, and we demonstrate its capa-bilities by investigating protein and nucleic acid organization in primary neurons and mammalian mitochondria
Work-Unit Absenteeism: Effects of Satisfaction, Commitment, Labor Market Conditions, and Time
Prior research is limited in explaining absenteeism at the unit level and over time. We developed and tested a model of unit-level absenteeism using five waves of data collected over six years from 115 work units in a large state agency. Unit-level job satisfaction, organizational commitment, and local unemployment were modeled as time-varying predictors of absenteeism. Shared satisfaction and commitment interacted in predicting absenteeism but were not related to the rate of change in absenteeism over time. Unit-level satisfaction and commitment were more strongly related to absenteeism when units were located in areas with plentiful job alternatives
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